Government support and engagement (eg, ministries of health, defence, transport, including civil aviation authorities) are indispensable to implementation
National, multisectoral stakeholder committees are important to guide and coordinate activities and raise awareness
Value of community engagement and acceptance efforts has been demonstrated
Drone-specific flight regulations have been developed in all countries in reaction to the increased use of drones (with varying current implementation status)
Competitive tendering for drone operator has resulted in identification of most suitable technology
Local human resources, skills and institutional capacity-building efforts contribute to locally owned and operated projects
Favourable operating environments (eg, testing corridor in Malawi) have facilitated testing of new technologies by different users
Feasibility testing resulted in first successful bi-directional flights and dummy cargo transports
Accompanying studies (eg, acceptability, health outcomes, cost-effectiveness analyses) increased the body of evidence and lessons learnt to guide future implementation
Standard operating procedures for drone operations have been developed
Parallel use cases in other sectors, eg, agriculture, conservation, disaster response, have increased interest, advocacy, ease of implementation and acceptance of drone use and created synergies
High international visibility was achieved bringing attention to the use case
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Lengthy and delayed development of drone regulations
Limited in-country technical capacity
Lengthy and costly importation of technology and equipment into country
Need for technology switch mid-projects (technical challenges and unavailability from operating provider)
Limited readiness of technology in real-world settings (eg, GPS interference) leading to need for technology development on site (software and hardware)
Difficulty sourcing funding for activities beyond proof-of-concept or small-scale implementation
Lack of business cases in-country, partly due to lack of implementation beyond proof-of-concept
Scarcity of data on, eg, performance, impact, acceptability, partly due to recent implementation
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Political awareness and desire to work with drones is increasing
Political interests are aligned with drone project objectives
Positive feedback from communities on the potential use of drones for health
African Drone and Data Academy will build local skills and entrepreneurship opportunities
Supportive regulatory environment enables drone use in absence of final regulations
Wealth of lessons learnt by the pioneer implementers of bi-directional drone use encourage project continuation and guide new projects
Drone testing corridor provides opportunities for different types of drones to be tested by different users
Donor interest to fund existing and new projects
Potential for cost-effectiveness compared with conventional transport
Increasing number of use cases reaching more people in need of healthcare
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Occasional unreliability of currently available technology (hardware and software)
Limited technical expertise and capacities in-country leading to dependency on external/international service providers
Competing interests between in-country health stakeholders
Sensitivity and potential dangers of delivery of blood or biological samples
Unsecured funding to continue activities, potentially reversing health gains
Local health sectors reliant on donor funding with limited ability to assume financial responsibility
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