Integrating Drones in India’s Healthcare System: Opportunities and Challenges

INTRODUCTION Despite efforts to improve healthcare infrastructure and delivery, achieving universal access to essential health services remains a formidable challenge, especially in hard-to-reach geographical terrain.[1] Unmanned aerial vehicles, commonly known as drones, have the potential to revolutionise the healthcare sector by providing a faster, more reliable and more efficient means of delivering medicines to remote or inaccessible areas.[2-4] Drones have been effectively utilised during the COVID-19 pandemic to transport medical samples, aerial disinfection and vaccinations in certain parts of the world.[5,6] In addition, drones can be used to transport blood from a recognised medical facility to remote towns or areas in a timely manner, thereby cutting down the wastage in healthcare facilities.[7] The evidence supporting the integration of drone technology into the healthcare system is scant in low-income nations, and its application in healthcare is still developing. ADVANTAGES OF USING DRONES IN HEALTHCARE Drones are a highly versatile technology that has revolutionised the healthcare industry and expanded their applications into various healthcare domains broadly categorised into three areas: medical emergency surveillance, laboratory diagnostic tests and pre-hospital emergency care. The primary advantage of using drones for medicine delivery lies in their ability to overcome geographical barriers and reach remote or isolated regions that are challenging for conventional transportation methods.[4] In rural or underserved communities, where healthcare facilities may be limited, drones offer a lifeline by ensuring that essential medicines reach those in need, promoting better health outcomes. The speed of drone deliveries significantly reduces the time it takes for healthcare logistics (blood products, vaccines, laboratory samples and automated external defibrillators) to reach their destination.[7-10] The use of drones in healthcare delivery also contributes to cost-effectiveness. Drone deliveries have been found to be more cost-efficient than traditional ground transportation methods in various scenarios. By reducing costs, healthcare providers can allocate resources more efficiently, potentially lowering the overall cost of healthcare delivery.[11,12] In addition, safety and security are paramount considerations in medicine delivery, and drones offer features that enhance both aspects. Modern drones come equipped with advanced navigation systems, obstacle avoidance technologies and real-time tracking capabilities, ensuring the safe and secure transportation of medicines.[13] Healthcare delivery is being revolutionised by drones, particularly in remote locations. Their compact size enables them to safely and swiftly deliver medication to hard-to-reach areas.[14,15] This innovation may improve access to healthcare worldwide. However, certain administrative conundrums and legal issues need to be resolved to use this technology effectively. It can be operated quickly and safely because it does not need a pilot. Beyond visual line of sight (BVLOS) technology allows drones to go farther distances safely. Drones have been used in emergency conditions such as cardiac arrest situations to improve prehospital care through operator-led cardiopulmonary resuscitation.[16] Drone-based transportation of laboratory specimens for coagulation-based testing, biochemistry and haematology has also been studied and no significant disparities in biochemical composition after drone flights were observed in studies.[12,17] In 2016, To improve blood accessibility during emergencies, Rwanda, a country in Central Africa has partnered with Zipline International Inc. to employ drones to transport blood between medical facilities. A study demonstrated the efficacy of drone-mediated blood transportation, revealing negligible variations within a 24-h timeframe.[18] Another promising avenue for drone technology is the transportation of vaccines, particularly in remote areas, where its utilisation has been observed in diverse geographical contexts, notably during the COVID-19 pandemic.[10,19,20] In addition, forensic science increasingly uses drones to enhance investigative processes and data collection. Being equipped with high-resolution cameras and deployment of various sensors can quickly assess and document virtually any area in question where traditional access is challenging, namely mass casualty incidents, natural disasters, traffic accident sites or a crime scene.[21] Providing an aerial overview it helps to plan and prioritize response, search and rescue operations, locating victims or missing persons and identify potential evidence or points of interest. Reconstructing events and establishing accountability are aided by information gathered from accident scenes, such as skid markings, vehicle positions and injury patterns. Since drones are not appropriate for controlled situations, they have not been used for autopsies. They can, however, deliver medical samples to forensic laboratories, supporting inquiries in far-flung locations. It is not recommended to use drones indoors because of possible downwash effect.[22] INTEGRATION OF DRONE TECHNOLOGY IN INDIA’S HEALTHCARE LANDSCAPE Due to the inherent geographical challenges and limitations in last-mile connectivity, several Indian states such as Meghalaya, Uttarakhand, Arunachal Pradesh and Himachal Pradesh have recently conducted successful field trials using drone technology for the delivery of emergency medical supplies and the transport of diagnostic samples.[5,23,24] India is investigating the application of drones for healthcare delivery, yet it confronts ethical and legal dilemmas. It is imperative to establish frameworks considering privacy, airspace management and regulatory adherence to ensure safe and responsible deployment.[25] Establishing standards for incorporating drones into the healthcare supply chain will require cooperation between governmental bodies, medical institutions and drone makers. Airspace regulation in India is managed by the Directorate General of Civil Aviation. The New Drone Rules-2021 divide the country into three zones: Red, which forbids drone activities without permission from the central government. Yellow, which requires approval near airports, and Green, which allows unrestricted operations up to 400 feet.[25,26] In May 2022, the Indian Council of Medical Research (ICMR) released a guidance document for the use of drones in the healthcare detailing the process to be adopted for use of drones into the public healthcare system in India.[27] Drone integration into India’s logistics and healthcare sectors may provide substantial advantages, but sustainability calls for actual data. Detailed information on the expenses of purchasing, maintaining and operating is essential. To ascertain the benefits of unmanned aerial vehicles for the national healthcare program, long-term multicentric research is required. The governments of several states and India have launched pilot programs in respective provinces for drone-based medical services. In 2020, the World Economic Forum, Apollo Hospitals and the Telangana government launched a trial initiative named ‘Medicines from the Sky’. In isolated locations, drones were utilised to transport vital medical supplies including blood units and vaccinations.[28] Northeast Drone Response and Outreach Program (I-Drone) of ICMR was launched in 4 October 2021. The I-Drone project sought to use drones to improve emergency response and healthcare services in the geographically difficult North East area.[5] CHALLENGES AND WAY FORWARD Drone utilisation in the healthcare system faces several challenges, including autonomous takeoff and landing, as well as the absence of robust obstacle detection systems. Furthermore, live tracking, path adjustments during flight and the effective use of geographic information system tools are critical factors for ensuring seamless drone operations, particularly in BVLOS technology. Indeed, the integration of machine learning models offers further potential, as these models can be continuously refined to enhance both the safety and efficiency of emergency responses.[29,30] CONCLUSION For the delivery of healthcare in rural locations, drones are revolutionary and cutting-edge technology. They are ideal for disaster areas and catastrophes since they can navigate challenging terrain more quickly and affordably utilising BVLOS technology. Pilot projects and trials have been undertaken at various prestigious Institute of National Importance (INIs) and state healthcare facilities to explore the application of drone technology in healthcare. Nevertheless, achieving successful implementation requires a multifaceted approach, along with adequate financial support and indigenous manufacturing capabilities, so that this technology can offer a cost-effective solution. Declaration of generative AI and AI-assisted technologies in the writing process ChatGPT and Grammarly were used for checking and refining the grammar where required. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.