Completed Research

From A to O-Positive: Blood Delivery Via Drones in Rwanda

University of Toronto

Rwanda’s mountainous topography and infrastructure makes medical supply delivery unreliable – with between 25 to 40 per cent of all temperature-sensitive medical supplies wasted due to inconsistent cold-chain infrastructure. Rural clinics face stockouts, and patients in need of specialized supplies are unable to acquire them. Zipline, a US-based health logistics company, addresses this issue by using drones to deliver medical supplies to district hospitals and rural health centres.

The Hard to Reach

Patients of Rwandan rural and remote health facilities.

Key Takeaways

Several lessons were gleaned from this study:

  1. Partnership with the Public Sector: the company relied on a great degree of flexibility on the part of the Rwandan government, to update its air space regulations. Similarly, the collaboration with the Rwandan Biomedical Centre ensured that Zipline is not solely responsible for procuring essential medicine and conducting quality assurance controls.
  2. Regulatory and Technical Hurdles: By operating in small countries, the regulatory and technical hurdles for Zipline’s operations were manageable, allowing it to establish transparency in assuring the safety of everyday operations.
  3. Integration into Supply-Chain: Zipline’s service was well-integrated into the existing medical supply chain in Rwanda. The company filled a substantial gap in Rwanda’s health care logistics as opposed to replacing existing logistics.
  4. Scale is Essential to Keep Cost Low: The costs of purchasing, building, and maintaining infrastructure, and operating drones can be substantial. There is some indication that, if done at scale, the delivery operations could increase medical products’ availability and reduce the average cost per delivery.
  5. Comparing Investment for Long-term Impact: It is important to consider the opportunity cost of side-lining traditional alternatives. Foregoing investments in roads could have an impact on other important social and economic indicators. Nonetheless, the comparison is indicative of the kinds of economic trade-offs involved in assessing the construction and set-up of drone delivery systems.
  6. Understanding Rural Needs: Zipline appears effective in increasing access to medical supplies. To determine impact, we must better understand the needs of patients in rural communities, and the implications for health system development, including the availability of trained medical personnel and technical equipment.


This research was made possible through the Reach Alliance, a partnership between the University of Toronto’s Munk School of Global Affairs & Public Policy and the Mastercard Center for Inclusive Growth. Research was also funded by the Ralph and Roz Halbert Professorship of Innovation at the Munk School of Global Affairs & Public Policy. We express our gratitude and appreciation to those we met and interviewed. We are also grateful to Professor Anita McGahan for her mentorship through this research project, and Reach Project Officers Anushree Warrier and Siddhartha Sengupta for their guidance in the early stages of the project.    

This research was vetted and received approval from the Ethics Review Board at the University of Toronto. This research was conducted virtually during the COVID-19 pandemic in compliance with local public health measures.