Of Drones For Medical Emergencies And Matters Arising

Earlier this month the Ministry of Health (MoH) hinted of plans to introduce drones for emergency medical response in Ghana’s health sector. This according to the ministry will be the largest and most advanced medical drone delivery network ever anywhere in the world. This news has been received with mixed reactions and as usual has become a veritable political pendulum being swung to and fro depending on one's political leaning or orientation.

The media especially social media has been buzzing with varied opinions on what has become known as the "Drone Deal’. Whilst government and it's assigns are touting and hailing the deal as a novelty that will lead to a significant change in healthcare delivery in the country, the largest opposition party led by its Members of Parliament have condemned it in no uncertain terms describing it as a 'misplaced priority’. It is therefore very imperative that we delve deeper into the drone deal and ascertain what is the issue and what exactly is in it for the good people of this country and judge for ourselves whether the deal is expedient as being touted by government or otherwise.

A drone is simply an aircraft without a human pilot aboard. It is technically known as an Unmanned Aerial Vehicle (UAV). UAVs are a component of an unmanned aircraft system (UAS); which include a UAV, a ground-based controller and a system of communications between the two. The flight of UAVs may operate with various degrees of autonomy: either under remote control by a human operator or autonomously by onboard computers. Compared to manned aircrafts.

UAVs were originally used for missions 'too dull, dirty or dangerous’ for humans. While they originated mostly in military applications their use is gradually expanding to commercial, scientific, recreational, agricultural, and other fields, such as policing, peacekeeping, and surveillance, product deliveries, aerial photography and even smuggling, and drone racing. Civilian UAVs now vastly outnumber military UAVs, with estimates of over a million sold by 2015.

According to the CNN high-tech drones could aid patients faster than an ambulance after an accident and various studies have shown that drones can deliver medication to remote areas faster especially during emergencies. During accidents for instance road accidents, critical minutes pass as victims must wait for an ambulance to arrive yet high tech drones could shorten that waiting period significantly. It is against this background that the Rwandan government successfully piloted the use of drones for medical emergencies in 2016 and has subsequently adopted the use of drones in their health sector and the outcome has been phenomenal.

The Government of Ghana taking a cue from the success story of Rwanda, the rich experiences gotten therein and the gains made so far in the use of drones in the health sector has signed a pact with Zipline, a Silicon valley based robotics firm which is running Rwanda’s drones for medical emergencies services to run a similar program for us here in Ghana. It is this drone deal that has become the subject of discussion and heated arguments and debates in the country.

Those who are expressing misgivings about the deal have done so riding on the crest of very serious challenges bedeviling our health sector. Some of these include dilapidated health infrastructure, inadequate ambulances, poor/bad road network, inadequate health personnel, inadequate medical supplies to our facilities, demotivated health personnel among others. According to them until these basic challenges are fixed the drone technology will continue to remain a misplaced priority. But much as I agree with them I think it is important for us to weigh the options and seek what is best for the country.

It is a truism that there are ongoing efforts by the central government ant the various MMDAs to construct new roads and reshape and make spot improvement on our roads especially in the rural areas to make them fully accessible and motorable. Rome was not built in a day so we can be sure that our rural road network will gradually improve with time, what matters most is commitment on the part of government in this regard and I daresay this has amply been demonstrated. The truth of the matter is that we cannot wait till all our roads are fixed before we start thinking of how to respond to medical emergencies. Assuming we have a utopian country where all our roads are fixed, ambulances are in abundance and health facilities and personnel are everywhere what will be the essence of drone for medical emergencies compared with the stark reality confronting us now as a people?

President Akufo-Addo speaking at this years May Day celebration announced that government intends to employ 32,00 more nurses to augment the number of health workers in the public sector. He opined that this follows the employment of 16,502 health workers in 2017 aside 33,116 teachers recruited by the Ghana Education Service in the same period. As of October 2018, this Government had employed 27,520 health professionals. This is made up of 1485 medical officers, 1103 house officers, 4 specialists, 131 physician assistants,

12,136 nurses,15 medical herbalists, 167 support staff, 8042 rotation nurses, 541 allied health interns, 149 other professionals with health duties and 3702 allied health professionals.

This speaks volumes of government's commitment to increasing the number of health personnel in the country. The Ghana Health Service consistently ensures that all our health facilities have adequate stock of supplies especially for primary health care.

Hon. Hawa Koomson, Minister for Special Development Initiatives has assured that latest by mid 2019 Ghana will take delivery of 275 fully fitted ambulances one per each constituency. This will be a giant leap forward in solving the ambulance conundrum in the health sector. If indeed all these interventions are ongoing in the health sector then I am of the strong opinion that the drone for medical emergencies initiative cannot be described in any way as a misplaced priority.

We live in a country where our compatriots die needlessly in road accidents due to lack of emergency response. You rush accident victims to health facilities and there’s no blood. In the rural areas our women die like chickens especially during labour due to postpartum hemorrhage. Also lack of common serum to cure snake, scorpion and other bites lead people painfully to their early graves. These and many other medical emergencies justify the noble idea of drones for medical emergencies and as such should be embraced by all.

One critical issue that has come to the fore with regards to the drone deal is why the contract was sole sourced. It is very important to state that the project was sole sourced because Zipline happens to be the only supplier of this innovative technology in the whole world. This is consistent with Section 40 (1) of Act 663 which states _inter alia_ single source procurement is appropriate “where there is an urgent need for the goods, works or service".

According to the MoH the drones will operate 24 hours a day from 4 distribution centres across the country. The first distribution centre will be located near Suhum. The sites for the remaining 3 will be finalized by the Ghana Health Service (GHS) subsequently but are expected to cover much of the country. The entire project took about 6 months to implement. A committee was set up, comprising of representatives from the MoH, GHS, National Ambulance Service, Ghana Civil Aviation Authority, National Security etc. All these stakeholders sent a high powered delegation to inquire about how Rwanda had implemented the first Zipline program ever; it was a very successful venture to the extent that Ghana Civil Aviation Authority has approved the project and all security factors have been considered as well.

The Ghana Health Service has tasked Zipline to stock 148 products that range from blood, snake venoms, essential medicines such as tuberculosis & HIV medications etc. When fully implemented, 14 to 16 million people will be covered. In fact, the National Security has also done their checks, and there is no company operating drone medical supply apart from Zipline.

It is noteworthy that Ghana is not procuring drones to deliver medical supplies to health centres as has been put out there by those opposed to the deal. Ghana is only paying for services delivered by Zipline. MoH bears no risk of installation, operation or maintenance of the facilities. MoH will only pay when Zipline succeeds in setting up distribution centers and meets the performance specifications agreed on as in the Service Agreement. The contract is a performance driven contract, which means that Zipline's daily supply per distribution center is what will be paid for. Hence payment will be done based on performance specifications.

One may ask so what exactly is the structure of the MoH contract with Zipline? The contract is a Service Agreement. Zipline is required to meet detailed performance requirements, such as range, payload, and number of flights per day. MoH will not own the facilities or equipment, so it bears no risk for construction cost overruns, maintenance cost, or technology obsolescence. MoH will only pay if Zipline meets its service commitments.

The contract obligates Zipline to build 4 distribution centers at MoH-specified locations across Ghana as already stated. Each distribution center will include at least 20 drones, launch and recover equipment, state-of the-art medical refrigeration equipment, computerized and other management systems. Each centre will be staffed by up to 50 Ghanaian employees. Zipline will operate drone flights from the distribution centres on a 24/7 basis to deliver medical products on request to health facilities within an 80 km service radius, Zipline will guarantee a capacity of 150 flights per dc day. This means that the 4 distribution centres will be able to make up to 600 emergency deliveries per day total (and the flights can usually carry more than 1 product).

The cost of the service in Ghana at full operation is $88,000 per distribution center per month this equates to $352,00 per month for all distribution centers, or $4,224,00 per year for all 4 distribution centers. This price is discounted during Zipline’s ramp-up, to make sure that Ghana only pays for the service as and when Zipline makes it available. There is also an $11,000 per month on time payment discount, which will apply as long as the service fee was timely paid in the previous month. Considering the on-time payment discount and the discounted ramp up, the estimated total 4-year cost of the contract is approximately $12,500.000. Ghana will offset this cost by mainly obtaining corporate social responsibility contributions from private sector contributors.

There comes a point in the life of every country where critical decisions must be taken. We elect leaders to take such critical decisions as and when needed. From the foregoing I believe this drone deal is in the best interest of the good people of this country and must be supported by all well meaning Ghanaians. Never again must our compatriots die needlessly in medical emergencies. We have a way out now, let us commend government for this bold initiative, fully embrace and support the drone deal and ensure it succeeds.

Felix Kwame Quainoo
A public interest writer based in Aboso, Western Region

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