Health authorities in Madagascar have expanded medical deliveries by drone into the Atsimo-Andrefana and Atsimo-Atsinanana region, south of the country.

With support from Gavi, the Vaccine Alliance, PSI Madagascar – and of course AerialMetric as the drone partner – the Ministry of Public Health opened two drone launch sites to support medical deliveries – one in Sakaraha (Atsimo-Andrefana) and the other in Vangaindrano (Atsimo-Atsinanana), under a project called Level 2 Basic Health Centre (CSB II).

Starting late last year, the drones will be transporting vaccines to twelve districts across three regions.

In Atsimo-Andrefana, the project serves five districts – Sakaraha, Toliara II, Morombe, Betioky, and Ankazoabo Sud – covering 68 Basic Health Centres (CSBs).

In Atsimo-Atsinanana, as well as the Anosy and Ihorombe regions, seven districts benefit from the initiative: Vangaindrano, Farafangana, Midongy Atsimo, Befotaka, Iakora, Vondrozo, and Taolagnaro, with 120 CSBs identified.

In Vangaindrano district alone, 44 CSBs have been approved and are currently receiving drone deliveries.

The heath authorities had to resort to drones as a way to bridge the access problems in these remote communities, which are isolated due to lack of infrastructure, harsh weather conditions, and general insecurity.

Before drones, delivering anything in these areas – be it vaccines, medicines, or even monitoring patients – was a difficult challenge. As a consequence, there were supply shortages, patchy access to healthcare, and children in these areas were more likely to miss out on life-saving immunisation.

The isolated and rugged roads of rural part of Atsimo-Andrefana in southwestern Madagascar are not only a logistical nightmare, but also a dangerous zone where gangs sometimes target healthcare workers on duty.

Marie Totohery Velonarivo, a nurse and head of the Level 2 Basic Health Centre (CSB II) in Bereketa, relives one particularly tough evening at work.

“On my way back from a meeting in Sakaraha, I was attacked on the road,” he says.

To address these challenges, a skyborne solution – already transforming care in other parts of Madagascar – has been extended into this region: since late last year, drones have been delivering vaccines and medical supplies directly to twelve districts across three regions, with key launch sites in Sakaraha (Atsimo-Andrefana) and Vangaindrano (Atsimo-Atsinanana).

Test flights were first carried out in October last year, transporting a payload of 1,030 vaccine doses. Since then, the operation has become routine, with each drone transporting up to 10kg of cargo for distances under 50km, and 5kg for routes between 50 and 100 km.

Avoiding impassable roads and the risk of attacks, these small flying machines ensure safe and rapid deliveries, even during the peak of the rainy season.

“The journey takes only half an hour,” explains Miranto Andrianaly, the project’s marketing and communication supervisor.

Community acceptance of the new delivery solution was not easy; being closed off, the locals viewed drones with suspicion.

At first, the flying vaccine couriers were met with suspicion,” admits the head of CSB II in Bereketa.

“People were hesitant. Some were sceptical, while others questioned whether these flying devices were really carrying vaccines.”

A large-scale mobilisation effort involving political, administrative, religious and traditional authorities turned things around, however.

“We explained to the population the impact of this technology on human health,” says Andrianaly.

 One event sped up the transition: a measles vaccination campaign that coincided with the first drone delivery.

“People saw with their own eyes that the packages delivered actually contained vaccines, medicines, and healthcare supplies – nothing else,” explains Wellydo Rocky Walfred Rakotovelo, the drone logistics supervisor for the Atsimo-Andrefana region.

Now, on delivery days, mothers gather at the CSB with their children, waiting for the arrival of the vaccines.

The drone project is not limited to Sakaraha. Since 2019, medical delivery by drone technology has proven effective in northeastern Maroantsetra before being expanded in 2022 to the Atsinanana and Sava regions.

In 2023, the Melaky region and the city of Maintirano joined the initiative.

Some of the most remote CSBs, located more than 100 km from the launch site, are beyond the drones’ direct range. To reach them, designated relay CSBs serve as drop-off points, where vaccines and medical supplies are delivered before being distributed to more isolated health centres.

And it is not just vaccines that are getting a lift into harder-to-reach areas.

“Drones play a significant role in the fight against malaria, HIV and tuberculosis,” one project official said.

In some areas like Ranomafana-Ifanadiana, they also deliver family planning products.

Despite the project’s success, obstacles remain. Weather conditions are a major factor:

“The wind picks up in the afternoon, and sometimes there’s hail,” said Rakotovelo.

To avoid these difficulties, most flights are scheduled for the morning. And if the 40 weekly flights cannot be completed due to bad weather, they are rescheduled over the weekend.

“The Ministry team is always kept informed of any contingencies,” he added.

New districts are awaiting training – a necessary step before drones can be deployed for healthcare. The goal is to cover all the districts in Atsimo-Andrefana and Atsimo-Atsinanana by the end of the year.

To coordinate these efforts, a health technical working group (GTT Santé) was created, with Gavi as an integral part of the initiative.

What began as a pilot experiment is now transforming how healthcare reaches Madagascar’s most remote populations. The story of Velonarivo and many other frontline health professionals illustrates this revolution: thanks to drones, they can finally focus on their primary mission – providing care – without having to risk dangerous journeys on the road.