“The Sky is the Limit” In Addressing Impacts of Climate Change on Public Health Provision in Africa

Can public health systems in infrastructure-starved and climate-affected developing countries “leapfrog” current stresses on their operational logistics? Rwanda is experimenting with drone delivery of blood to find out!

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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

[ii] Rwanda State of the Environment and Outlook Report, Chapter 2. http://www.rema.gov.rw/soe/chap2.php

[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

[vi] Rwanda Biomedical Center, National Center for Blood Transfusion Division, http://www.rbc.gov.rw/spip.php?article240

[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

[viii] Zipline, Product, How it Work, http://flyzipline.com/product/



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Student comments on “The Sky is the Limit” In Addressing Impacts of Climate Change on Public Health Provision in Africa

  1. Jared, thanks for the article. Very interesting to read about how a country is developing unique ways to begin addressing climate change related issues. This article reminds me a little of our case on Narayana Hospital System and its method of bringing quality health care to rural residents in Africa and Asia. Both examples show how health services can, in some instances, be brought to tough to reach residents via innovative delivery methods. However, as you mentioned, I wonder how other aspects of medicine will be affected by climate change or how regulations may effect this delivery method. For instance, how can the medical community work to expand availability of machines such as X-rays, given the fact that isolation may become commonplace without an improvement in the transportation infrastructure? I wonder if this is an opportunity for healthcare companies to manufacture smaller, cheaper or more easily transportable necessary medical equipment.

  2. Thanks, Jared. I really enjoyed reading about this novel solution that Zipline has developed. I completely agree with Kerrin’s comment above about the parallels that be drawn with the healthcare delivery methods employed in the Narayana Hospital Scheme. On the topic of the provision of medical equipment, is there are a way in which unused or malfunctioning equipment that is literally gathering dust in hospitals across the world can be repaired and redistributed by a humanitarian agency (or other party) to alleviate the resource strain on local hospitals in places such as Rwanda?

  3. Fascinating reading about Zipline and the work they are doing in Rwanda. Clearly there is a need for this service across Africa and the developing world in general, including specific disaster relief situations (there were even larger issues reaching remote villages after the 2015 earthquake in Nepal as what little infrastructure existed was destroyed by the tremors).

    Having read a little more about Zipline (e.g. great article at http://www.economist.com/news/business/21703399-notion-leapfrogging-poor-infrastructure-africa-needs-come-back-down-earth-look), I understand that one of the constraints to even more services being delivered is the weight that each of these drones can carry in one trip. As the team continues to develop new technology and increase the payload of the drones I think there are even more exciting developments possible in the medical interventions. For example using e-medicine technologies, a doctor in the capital city will be able to understand the need for specialised prosthetics for rural patients, and then, after receiving digital x-rays and other images, could create the perfect prosthetic that can then be delivered efficiently using one of these drones! Very exciting potential!

  4. Interesting attempt to solve a major infrastructure problem by leapfrogging the usual steps in development! I think the drone strategy will be difficult to scale. More importantly, how will drones perform during times of rapid climate change where weather patterns are getting more unpredictable? To me, the climate change variable would suggest that the government should continue to experiment with new delivery mechanisms but at the same time invest in traditional infrastructure that is less disrupted by weather.

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