(Word Count: 799)
One of the oft mentioned ironies about climate change is that its impacts are most likely to affect countries that contributed the least to its cause. Additionally, countries most likely to be affected often have the least infrastructure to mitigate these effects. In the Central African nation of Rwanda, we see how, extreme weather events and lack of quality infrastructure have converged, creating immense pressures on the delivery of public health services. Yet these challenges have also sparked innovations in the operational models of organizations responsible for health delivery.
Rwanda is a small, landlocked nation of 13 million[i] known as the “Land of a Thousand Hills” due to its rugged geography and dispersed population. Surface transportation in the country is thus constrained by challenging landscape and a poor quality of roads[ii]. Climate change is compounding these problems, as rising temperatures have changed weather systems, causing rainfall patterns to shift[iii]. These impacts have manifested themselves in Rwanda as increased incidence of extreme flooding in Western and Southern Rwanda and an elongation of the traditional “rainy season”[iv]. These weather events often make surface roads impassable and damage existing transportation infrastructure, disconnecting parts of the country for days at a time.
To understand how climate change is impeding the delivery of public health, consider the the supply chain and logistics necessary to achieve improvements in maternal health, a Millennium Development Goal toward which the Rwandan Government has devoted many resources. The leading cause of maternal death during childbirth in Rwanda is post-partum hemorrhage[v] (loss of blood pressure due to heavy bleeding). Mothers can be kept in stable condition as the underlying causes are addressed if there is sufficient blood supply, of the correct type, in hospitals reserves. But, when parts of Rwanda become isolated from each other, how is blood supplied to the hospitals?
The supply chain and logistical systems required to provide lifesaving blood supply to childbearing mothers in Rwanda therefore requires the establishment and maintenance of multiple “blood banks” in close proximity to as many hospitals as possible (to prevent any hospital from becoming isolated)[vi]. Unsurprisingly, this distribution strategy suffers from its own shortcomings. Given the limited supply of disease-free blood in the country, how does one insure that each blood bank will have the right blood type for a mother in need? How should inventory of these many blood types be maintained in each bank? In the resource and capacity-constrained Rwanda, these questions have no easy answers.
However, the Rwandan National Center for Blood Transfusion (NCBT) has just recently begun experimenting with a new distribution model to address the stresses placed on existing systems. The Ministry of Health launched a public-private partnership with start-up Zipline, using drones to deliver blood across the country, when required, within 45 minutes[vii]. Healthcare providers throughout the country place requests for certain blood types via text message, at which point technicians load the blood into a drone, which is flown via GPS to the hospitals and then drops its payload (with a parachute) before returning[viii]. Such rapid and long-distance coverage of blood supply has allowed the NCBT to centralize its blood into a single location near the capital. This has allowed the organization to more efficiently manage inventory of blood supply while also increasing the probability of being able to supply the correct blood type, in time, to help save lives.
While these pioneering delivery methods have the potential to mitigate many of the stresses on public health delivery systems, not all health complications are addressed within this model. Blood is but a fraction of the physical capital required for successful health. Not all medical supplies and equipment are small enough to fit into the cargo hold of a drone, or are durable enough to survive a drop from hundreds of feet in the air by parachute. And the most scarce resource in health delivery, human capital (doctors and other medical professionals), requires more traditional transportation methods.
Accordingly, governments and other organizations must seek to make existing transportation infrastructure more resilient in the face of the increasingly extreme weather and flooding, and develop models allowing doctors to provide care beyond their physical presence. Advances in construction technology, telemedicine and other fields must also be brought into these public heath delivery systems to fully overcome the effects of climate change.
[i] CIA World Factbook, Rwanda, https://www.cia.gov/library/publications/the-world-factbook/geos/rw.html
[iii] HBS Note N2-317-032- Climate Change in 2016: Implications for Business, p. 4
[iv] Assessment of Operational Framework Related to Climate Change in Rwanda, Rwanda Environment Management Authority, http://www.rema.gov.rw/rema_doc/Climate%20change/Final_Report_CC_Dpt.pdf
[v] Rwandan Ministry of Health Annual Report, 2014, http://www.moh.gov.rw/fileadmin/templates/MOH-Reports/HEALTH_SECTOR_ANNUAL_REPORT_July_2013-June_2014.pdf
[vii] NYTimes, Drones Marshaled to Drop Lifesaving Supplies Over Rwandan Terrain, http://www.nytimes.com/2016/04/05/technology/drones-marshaled-to-drop-lifesaving-supplies-over-rwandan-terrain.html?_r=0