(DWB)
Application of Drone Technology to Facilitate Effective HIV Diagnostic and Treatment Services to Children in Rural Malawi
INGO
UNICEF
1Broadway, New NY 10022
USA
Dear Sir,
Drones without Borders (DWB) is an organization which has been created to serve HIV vulnerable children in rural Malawi through a partnership with ZipLine Drones. Our organization seeks to develop and implement an four-months program aimed at ensuring fast and continuous delivery of HIV test kits, results, and antiretroviral drugs to provide immediate medical attention to HIV positive children in rural, cut off, hard to access, often combat zone areas in Malawi. The mortality rate of the infected children has been on the rise due to lack of access of antiretroviral drugs by the infected patients living in the remote areas of the country. With high poverty levels, the infected patients are not able to travel to major hospitals where the drugs have been made available by UNICEF. As such, a better delivery system needs to be put in place to access the patients directly and in the least time possible. With ZipLine Drones having the technology to deliver packages to any destination with no terrain barriers, we wish to step in and alleviate the problem that the citizens in Malawi are facing.
We propose the application of drone technology to facilitate the rapid transport of HIV testing supplies, test samples, and medication, the timely delivery of which has been hampered by the poor state of transport infrastructure in rural Malawi. We seek funding in the amount of $215,000 to support the purchase of 10 drones and their deployment from the United States where they are assembled. The funding will also facilitate the salaries of the workers who will be based in the countries capital. Additionally, the funding will facilitate in importing 10 computers to man the drones into the country. The project duration period is four months. With your assistance, the organization will be able to develop the drone application program, which will assist in transfers between health centers in these cut off rural areas and health centers spread throughout Malawi. There has been immense progress in the application of drones in transport and we see an opportunity for applying this advanced and efficient technology in the healthcare field.
We believe the application of drone technology will be significant in facilitating timely HIV testing for children in rural Malawi and ensure that medical attention is provided within two weeks’ time to children testing HIV+ in rural Malawi. This program will be helpful, not only to the Malawian government by reducing the mortality rate in their children, but also to the many children in rural areas of Malawi who are at risk of death due HIV-related diseases by providing medical supplies in the shortest time possible.
Sincerely,
Executive Director
Drones without Border
1Broadway, New NY 10022
USA
Executive Summary
Drones without Borders (DWB) is a project that incorporates the application of drone technology to help in fast tracking the process of HIV case management for children in rural Malawi. Children in rural Malawi have been dying of HIV-related diseases because there is a lack of appropriate transport infrastructure to facilitate timely delivery of testing and treatment services. Through the proposed project, drones will be used to deliver HIV testing kits, test samples and antiretroviral drugs to and from the handful of urban health centers in Malawi and laboratories to rural health care centers. This will facilitate rapid and cost efficient delivery of the services that have relied on the poor transport network that characterizes rural Malawi.
The proposed project is set to begin in July 2016 and end in October 2017 with pilot projects in selected rural areas. The project will cost approximately $215,000, which will go toward facilitating operating expenses: start-up, salaries, and equipment importation. Drone technology has already been successfully used in such mail programs as FedEx. The application of this technology has shown great potential in providing fast and cost-effective transportation services.
A drone is an unmanned aerial vehicle guided by wireless GPS, cameras, and sensors. Drone technology is capable of delivering goods from point to point without a pilot; in the healthcare field it can be used to shuttle small emergency supply packages from one depot to remote pickup centers. With healthcare centers located in remote areas, poorly constructed and connected road networks may prevent timely delivery of testing kits, test samples, and drugs. Drones will revolutionize air medical delivery services, particularly in reaching small and remote areas where access is limited by bad roads and lack of adequate transport infrastructure in Malawi.
Introduction
Drones without Borders is a non-profit organization located in Malawi. It was created in partnership with UNICEF with the aim of using technology applications to help reduce cases of mother-to-child HIV transmissions in remote, hard to reach locations in Malawi. It was founded in 2016 and seeks to serve rural, remote communities throughout Malawi.
Approximately 10.3% of the population in Malawi is HIV positive (AVERT, 2015). There have been new cases of HIV infection as a result of mother to child transmission. As a result, the Malawian government has recommended that HIV-exposed infants receive early infant diagnosis to determine whether they are infected with HIV. There have been challenges to the implementation of this policy; the process of HIV testing of infants has been slowed by a poor transport infrastructure, including inadequate roads and lack of airport facilities, resulting in the delayed provision of HIV status results regarding infants who have been tested. Consequently, the number of cases of HIV transmission from pregnant mothers to infants has increased by 6.9% in the last 3 years (AVERT, 2015).
DWB has expertise in the field of drone technology and operations as well as highly qualified and experienced administration professionals who ensure the efficiency and accountability of the organization’s programs. We also have a multicultural team comprised of both foreign and local experts who help in scaling the scope of the project to local needs.
Mission
Drones without Borders (DWB) seeks to eradicate HIV related deaths for children in cut off, rural areas in Africa through the use of integrated drone technologies which transfer tests and medicines between local and national health centers. More specifically, through our programs, we:
Work with the government of Malawi to promote an HIV-free children population in Malawi.
Promote children’s health and well-being.
Provide solutions to the dire problem of the spread of HIV to children in regions cut off from normal transport routes.
Population Served
Drones without Borders serves rural/remote communities in Malawi that lack adequate access to immediate medical care and treatment programs. The population of Malawi is estimated at 12.0 million, of which 91% live in rural/remote areas characterized by poor transportation networks (Floyd et al., 2010).
Problem Statement
Malawi has one of the world’s highest HIV infection rates in children; this has not only become a national concern but a global concern as well. There have been many deaths in rural Malawi linked to the lack of timely testing and reports on test results, as well as delayed delivery of needed medical supplies to treat incidences of HIV infection as a result of poor infrastructure, bad roads and inefficient transport systems. The poor transport infrastructure makes it practically impossible to deliver HIV test results and treatment services in a fast and cost-effective manner. In 2014, it was approximated that 10,000 children in remote areas of Malawi died from HIV-related diseases due to lack of immediate medical attention (Government of Malawi, 2015). Drones without Borders addresses this deficit in the transfer and delivery of blood samples, test results and needed medicines to the rural Malawi population by proposing a more efficient and effective transportation mode – drone technology.
Children need immediate medical attention within two weeks of being diagnosed as HIV positive to ensure that their bodies’ immune systems do not succumb to the virus infection and weaken as a result. Additionally, the drugs ensure that the ailment does not progress to the full blown stage rapidly which otherwise results in more deaths. However, there are fewer than 10 laboratories nationwide in Malawi that serve the entire population. The limited number of laboratories puts the rural/remote population of children at risk of being infected with HIV and HIV-related diseases. It usually takes months for the results of blood tests for children to be delivered for diagnosis, because of reliance on motorbike taxis for delivery services. The motorbike taxis are often delayed due to bad weather that affects the roads, and financial problems. This makes it difficult for the children in rural areas to access vital testing and medical treatment services in time to make a difference in the outcome. When children do not take the HIV tests and enroll in treatment programs on time, they are prey to such diseases as Malaria and other infections which may contribute to their early death. This is because the HIV virus weakens the body’s immune system. This causes infected children to be more vulnerable to HIV-related deaths. Pediatric HIV care is being provided in urban health facilities in Malawi, facilities which have access to specialists and diagnostic resources (Fayorsey et al., 2013). This puts the children in rural areas who do not have access to these urban health facilities at a disadvantage.
The streamlining of treatment and diagnostic approaches based on the use of drones simplifies the treatment and diagnostic approaches. First, the patients would not have to travel long distances at their expense to seek for treatment. As such, the drones allow for the decentralization of services for specialized health care systems to primary and community healthcare providers. This would involve moving antiretroviral therapy administration from the national level to the local community healthcare workers. This would result in a marked increase in the number of children who will be able to access HIV diagnosis and treatment services without traveling to major health centers which have laboratories. This will also significantly reduce the expenses incurred when locals seek HIV treatment services. According to a Stylus Publication Report (2010), the decentralization of HIV treatment in Malawi will bring children closer to the point of care and result in more children getting timely. The streamlined approach will thus ensure the delivery of broader HIV-related health services to children. When new born babies are diagnosed with the HIV virus, they are able to start treatment within two weeks after their diagnosis. As such, their chances of survival are significantly increased.
The proposed drone technology has the capacity to transport HIV testing kits to rural community health care centers at a speed of 100km/h. This means that testing kits and samples can be delivered to and from the laboratories and the local health care centers within hours or within a single day. Use of this drone technology will ensure that children have timely access to testing kits and that their blood samples will be transported to the laboratories within the same day for analysis. For HIV-positive children, antiretroviral drugs can be rapidly delivered to the local health care centers for delivery and administration. The current transport infrastructure cannot support a streamlined, efficient and effective delivery system to remote rural communities such as that which can be provided by drone technology. Without the proposed program, which will ensure rapid delivery of HIV diagnostic testing and treatment supplies , countless children in remote areas in Mali infected with HIV will not survive..
Objectives
Drones without Borders aims to serve rural populations in Malawi by revolutionizing the healthcare delivery sector through the use of drone technology. This initiative was developed in response to the global concern and alarm about the rising number of cases of child mortality due to HIV-related diseases where in Africa. Our proposed program is aimed at incorporating the use of Drones to help reduce deaths caused by HIV-related diseases in rural Malawi. The proposed program will be carried out in collaboration with UNICEF, Civil Aviation Authority, and the Malawian government. With all the documentation, labor, equipment and operation plans in place, the program can be operational within a month of startup. Our organization seeks to provide added value to the valuable work done at the grassroots level by UNICEF in serving the healthcare needs of rural, underserved populations in Malawi, by providing in a highly efficient medical supply delivery program. The organization also seeks partnerships with the local Malawian government and Drone America to help tailor the program to suit the local conditions and infrastructure.
Drones without Borders will to use unmanned aerial vehicles to fulfill the following objectives:
Facilitate fast and convenient transfer of HIV test kits, blood samples, and antiretroviral drugs from the urban laboratories to remote healthcare centers
Proposed Activities
Drones without Borders will work with UNICEF, ZipLine Drone Company, and the Malawian Government through the Ministry of Health, as well as the Malawian Civil Aviation Authority in the implementation of the proposed project for four months. Specific activities will include:
Preparatory Phase: 7 Weeks (24th July- 10th September)
Activity 1: Project Committee Formulation- 2 Weeks
Set up a project committee comprising a Director, Head of Operations, and a Chief Project Coordinator to facilitate technical and operational support. The committee will oversee overall project implementation, including set up requirements, scheduling, and monitoring and assessment of project indicators. The project committee will also seek advice from 12 representatives of 6 local communities to whom the services will be offered and who will assist in project implementation. The facilitators appointed by the communities to represent them will undergo project management training, and will work closely with the members of the project committee. The committee will conduct on-site assessment visits and make decisions on course adjustments, if necessary, to ensure smooth program operation.
This 2 week phase will be useful in the establishment of a skilled administrative group that understands the different dimensions of the project and to facilitate the startup of an effective and comprehensive project program.
Activity 2: Operational Certification- 1 Week
Provide necessary information concerning the operations of the drones to the Malawian Civil Aviation Authority for operational and maintenance certification. This activity is designed to confirm the compliance of the drone operations with operational safety requirements.
The project is a compliance-based initiative – i.e. it must be implemented in compliance with civil aviation regulations, and standards, laws, or other directives. Compliance with the major areas of the civil aviation codes is part of the total certification process. In this phase the operational manager and project coordinator will become familiar with the local civil aviation requirements and how they relate to drone operations in Malawi. This phase will ensure that appropriate operational procedures are put in place and that transport service operations will adhere to local laws and regulations.
Activity 3: Training and Familiarization- 3 Weeks
During the training and familiarization phase, emphasis will be put on service and bio-medical technical operations. This is designed to benefit the people operating on the ground and in the control domains to ensure the safety of flights and effectiveness of operations. Technical, medical and administrative personnel will be trained in how to ensure safety in operations and compliance with the local civil aviation standards. This phase also involves the analysis and explanation of the operating and maintenance costs to the community representatives and employees participating in the project. They will also be given a clear explanation of the information concerning other aspects of drone operations that may affect the costs of operations to avoid further unnecessary cost incurrences when the project begins.
It also involves the explanations of the operational aspects of drone flights, including flight endurance, flight paths under consideration, landing area size and locations, maximum take-off load, and reliability of the flights.
Activity 4: Testing- 3 days
Training programs involve DWB, the ZipLine drone company, and the civil aviation authority. The testing phase entails the technical operational personnel and involves launching of drone flights with sample load materials to selected rural areas; inspection of the drone mechanical and software operations, take off centers and potential landing areas obtaining geographical information to help in understanding the terrain in the local areas to identify landing areas. During this phase, specific landing areas will be identified, as well as areas that may require to be changed or improved for drone landing.
Activity 5: Meeting with the Stakeholders- 1 day
The stakeholders in the project involve representatives from the civil aviation authorities, healthcare institutions, national AIDS control, and local communities. A meeting with them will help them familiarize completely with the goals and aims of the project and the possible barriers to the project at different levels of interaction. As such, it will be easier to overcome any progress inhibiting barriers. They will also be encouraged to advocate for the project at different levels of community and organizational interactions.
Activity 6: Formal Project Pre-Operational Review- 1 day
The presentation of operational and technical results by the project engineering supervisor to the project committee and other stakeholders. There will also be a formal presentation of the project by the project manager and project team to the medical representatives from the Malawian government and the local community representatives to consent to the project feasibility. The formal pre-project review will enable the team to identify weaknesses that may arise when the project sets off and focus on areas which need improvement. The benefit of this phase is that it will ensure that procedures are in place to operate the drone delivery system.
Operation Phase: 9 Weeks (10th September- 12th November)
Activity 1: 8 Weeks
Once the operation manager, communities, local government, and other stakeholders such as the aviation authority have ascertained that the project is safe and good to run, the operation phase will begin. The drones will be set out to start the deliveries of test kits and drugs. The drones will make 15 deliveries, 3 days a week, for 8 weeks. The government will also provide a technical team to learn the different ways to maneuver the drones as well as troubleshoot different problem such as startup failure and software failure. The transfers will be run from the dispatch base located in the country’s national hospital to 6 different remote communities. Three project coordinators and 7 drone operators will travel to the local communities to coordinate the recipient of the products in the respective drone landing areas upon delivery. These employees will travel every day there is a test delivery being done for 8 weeks. The recipients will also learn how to offload the drones without damaging them. The software in the computers running the drones will also be monitored in the same 8-week period to ensure that no problems develop after the final handover to the Malawian government.
Activity 2: 1 Week
After the running of the drones, all operation managers and the local people in Malawi who have been trained will meet for a period of one week to make a review of the 8-week operation of the drones and make the necessary reviews from the observations made during the running of the project. As such, the reviews will be addressed according to the people involved. Consultation from Drone America engineering will also be done regarding the observations done in the operation phase and consider their reviews as well.
Project Evaluation Plan
The project committee will conduct regular program assessments and evaluate the program with reference to stated objectives and project indicators. This will facilitate the identification of problem areas and solutions to those problems, and will allow for timely course.
Monthly reports will be produced by the project committee manager which will include information about specific operational and technical aspects recorded by the operational manager and analyzed. This will enable the identification of areas that may require budget adjustments.
Data about technical operation costs will be documented and analyzed for comparison with the operating costs associated with the use of motorbike taxis. The comparison will be used in the assessment of how cost-effective the program is as compared to traditional medical testing and supply delivery strategies.
Community Information
The community served, the beneficiary, is an important stakeholder in the program. The project coordinators will collect information from the communities in the rural areas concerning their views about the effectiveness of the program. The information will be used to identify successes, failures and challenges to effective project implementation. It will also help identify the effects that the technical and operational aspects of the operation of drones have on the local communities.
Budget
The major components of the budget include personnel costs, space and facilities, equipment, project staff travel and consultation, materials, communication and other expenses associated with the implementation of the program. The salaries and wages are calculated for a quarter year; the cost of equipment and facilities are based on costs provided by the manufacturer.
Summary Budget
Personnel Cost: $56,500
Direct Project Costs: $158,500
Total Cost: $215,000
Expected support (if any)
Detailed Budget (24th July- 12th November)
Personnel:
Salaries and Wages
Director (fulltime) $20,000
Project Manager (fulltime) $10,000
Consultation (Drone America) $3,000
Medical Staff (fulltime) $9,000
Project Coordinator (fulltime) $5,000
Operational manager (fulltime) $2,000
Financial Administrator (part-time) $1,000
Accountants (one time audit at end) $1,500
Fringe Benefits $5,000
Direct Project Costs
Space and Facilities:
Control Center Rental: $80,000
Utilities and Maintenance: $35,000
Equipment:
Purchase of Drones: $10,000
Purchase of Computers $5,000
Take off Facilities: $5,000
Transport $7,000
Per Diem $2,500
Materials:
Office Supplies:
Desks $2,000
Stationery $1,000
Chairs $1,000
Protective Gear: $5,000
Communication
Company Website $1,000
Postage $1,000
Telephone $2,000
Other Expenses:
On-site evaluation and assessment\month $1,000
TOTAL $215,000
Sustainability
Conclusion
HIV-related deaths are a major national issue in Malawi; one which has elicited a global reaction. The problem has been worsened by the lack of an effective transportation infrastructure that is hindering access to vital HIV testing and treatment services. This has put many children in rural Malawi at a disadvantaged position. The application of drones in health service delivery is the apex of our proposed program. The project will be undertaken in partnership with other organizations, including the ZipLine Drone Company that specializes in the production and operation of drones, UNICEF, Malawian Civil Aviation Authority and the local communities targeted. This revolutionary project aims to help the disadvantaged children in rural Malawi who cannot access HIV diagnostic and treatment services on time by using drones to facilitate efficient transportation of HIV test kits, test samples, and antiretroviral drugs. The project is expected to cost $215,000 and can be fully operational within approximately one month’s time. Funding this project will be an important step towards saving the children in rural Malawi from HIV-related deaths. The success of the program will be evaluated on the basis of analysis of drone operations, as well as the perspective of the communities served. The project committee will work with the communities to ensure a smooth transition of the project operation responsibilities to the local government health ministry. The committee will assist the community to form an agreement with the local government technical bureaus for major technical operations management that may be required in the future.
References
AVERT. (2015, May 1). HIV and AIDS in Malawi. Retrieved from http://www.avert.org/professionals/hiv-around-world/sub-saharan-africa/malawi
Fayorsey, R. N., Saito, S., Carter, R. J., Gusmao, E., Frederix, K., Koech-Keter, E.,Abrams, E. J. (2013). Decentralization of pediatric HIV care and treatment in five sub-Saharan African countries. JAIDS Journal of Acquired Immune Deficiency Syndromes, 62(5), e124-e130. Retrieved from http://files.icap.columbia.edu/files/uploads/Decentralization_Article.pdf
Floyd, S., Molesworth, A., Dube, A., Banda, E., Jahn, A., Mwafulirwa, C., & French, N. (2010). Population-level reduction in adult mortality after extension of free anti-retroviral therapy provision into rural areas in northern Malawi. PloS ONE, 5(10), e13499. Retrieved from http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0013499
Government of Malawi. (2015). Malawi AIDS Response Progress Report 2015. Government of Malawi. Retrieved from http://www.unaids.org/sites/default/files/country/documents/MWI_narrative_report_2015.pdf
Stylus Pub. LLC, UNAIDS. (2010, July). UNAIDS Outlook Report July 2010: Special Section-State of the AIDS Response. Outlook, 2, 46-54. Retrieved from http://data.unaids.org/pub/Outlook/2010/20100713_outlook_report_web_en.pdf
Appendices
Letter from Christian Health Association of Malawi
Christian Health Association of Malawi (CHAM)
PO Box 30378- Lilongwe.
Area 14, Lilongwe
Executive Director,
Drone without Borders -Technology to Save Children from HIV,
Leiden, the Netherlands
We are pleased with the initiative that seeks to make use of technology to ensure that children in rural Malawi are saved from the tragedy that is HIV-related death. The problem of HIV-related deaths is a product of the country’s limited resources that has affected the effectiveness of the transportation infrastructure. As an organization committed to ensuring that critical areas of Malawi’s health sector are improved, we welcome your idea to make use of drones to save lives.
We welcome your organization to Malawi and promise to support the initiative to the best of our ability.
CHAM Secretariat
