The last mile


The last mile

The major problem for remote areas in poor countries is seemingly being resolved. Where people had to walk a full day to reach a doctor or pharmacy, now advanced technology is being used to provide healthcare.

text Menno Bosma photography Niek van Tiem

Two examples

Except for a few stubborn diseases such as dengue and Chagas disease, most common diseases have a cure of medicine available. Unfortunately, the poorest and sickest people live in the most remote areas of the world, where clinics, health care professionals, and pharmacies are sparse. How do you solve this problem of ‘the last mile’? Technology such as drones which deliver medicine and e-health which connects caregivers and care recipients can play a major role. But technology alone is not enough. 

#1 Medical couriers with a propeller

Zipline in Silicon Valley advertises with ‘the fastest commercial delivery drone in the world’. It reaches up to 128 kilometers an hour, has a 160-kilometer action radius, and can carry packages up to 1.75 kilos. The drone was specially developed for the transport of blood and medicine. Zipline’s mission is to bring life0saving medicine to the hardest reachable places on earth. Zipline has made thousands of deliveries already. Through a special system a delivery can commence within minutes of receiving the order. In the last two years, Zipline drones have been making blood, plasma, and blood platelet deliveries to remote clinics. There are plans to expand with emergency deliveries of blood, vaccines, and medicine in Tanzania and the United States. Many Zipline employees are were formerly employed by Boeing or NASA.

#2 A chat app in India

Consulting a specialist, ordering medicines, or requesting a laboratory test, within 30 minutes from the comfort of your own home. All of this is possible through the Indian chat-app DocsApp. This E-health platform in Bengaluru (previously Bangalore), started in 2015 and mostly serves people in mid-sized cities. Over 3000 doctors are associated with DocsApp. Citizens can use the chat-app to get advice on somatic conditions, but also psychological and sexual problems. This is possible in English and Hindi. The doctors, who represent nineteen different specializations, can also be consulted for a second opinion. The starting funds for DocsApp came from, among others, Facebook investors Anand Rajaraman and Venky Harinarayan. DocsApp expects to exceed 10.000 daily consultations by the end of this year.

The problem is getting medicine to where it is needed

The poor often live isolated and have little healthcare

The poor must also cover social distance



Life-line to healthcare

The gap between the have and have-nots can be reduced through providing the ill with proper consultation and medicine. By investing in technology and healthcare professionals. The problems can be solved, as argued in this Dif Report.

An employee receives an order through Whatsapp. He collects the ordered products from the shelves, packs them in shockproof packaging, and places them into the loading area of a drone, together with a mini-parachute. He places the drone on a ramp and launches it. Half an hour later the drone releases the package. Hanging from the parachute, the highly needed medicine lands in the remote outpost. 

This isn’t a future fantasy, but already a standard practice. Blood, medicine, and aid products are being delivered through drones in Rwanda and Kenia, but also in the United States and Canada. What these countries have in common is that many people live in places which cars, planes, and other modes of transportation have a hard time, or are unable, to reach, and are lacking ample medical services. Aid through conventional routes often comes too late.

This isn’t just used for emergency situations such as disasters or emergencies. Three quarters of the world’s poor live in remote areas. They have relatively the most problems with illness, while simultaneously having the least access to healthcare. Easily treatable diseases or non-fatal diseases such as diarrhea therefore claim more casualties than necessary. A life-line to healthcare (blood, medicine, aid), often means the difference between life and death for these people.

A and AAQ

Covering ‘the last mile’, as the problem is being called. At the World Health Organization (WHO), this falls under accessibility. Together with availability, affordability, and quality the WHO sees these as the foundation for good healthcare. Availability is, with the exception of some diseases such as Dengue or Chagas disease, no longer the problem, the remedies are here. The problem lies in getting the cure to the people who need it in time.

Aside from the access to medicine and aid it also involves the access to consultation. Think of a doctor who provides a remote diagnosis, aided by digitally provided data, such as body temperature, blood pressure, and the patients hearth rate. Or a chat-app with which people in remote places can place their concerns with medical professionals. In India DocsApp has already provided a million consults through this system.

Catching up

Both providers and recipients of forms of e-health are positive about it so far. Technology seems to be the salvation for those most in need of healthcare. isn’t it exactly in Africa, the continent with the most healthcare issues, that smartphone usage is most widespread and that they’re ahead of the curve with digital payments and e-health?

Corinne Hinlopen from Wemos, the foundation which fights for public health worldwide, places a footnote. ‘the impact of e-health on public health and who it benefits exactly has never been studied. There are an incredible number of smartphones in African cities and people who can afford and use them. These aren’t necessarily the people who need e-health the most however.’

Besides a geographical distance there is also a social one which needs to be covered. Some people have a harder time accessing healthcare than others. This can be due to poverty, but also social standing (castes), or taboos (e.g. HIV or psychological issues). such groups aren’t always easy to map, not even in the Netherlands. Hinlopen points at low-literate people who are ashamed and therefore hide their handicap. ‘There is more attention for the problem now. General practitioners are being trained to read the signals, for example people who say they keep forgetting their reading glasses.’

Still a need for a human touch

‘Even the Netherlands still has people who lack the access to optimal health, e.g. because they can’t read the information brochure.’ In low- and middle-income countries the focus of healthcare is on accidents and those severely ill, which means those groups have an even smaller chance of being detected. E-health won’t solve this problem on its own says Hinlopen. ‘Because how does someone in Brazil know he can get medicine through a drone? Who prescribes them? Who pays for them? Someone needs to set the delivery in motion, but if you don’t have a smartphone…’

She isn’t opposed to E-health, on the contrary. But it can’t replace the health care professionals, as has been suggested at times. ‘It isn’t either/or, it is and/and. Health care professionals are necessary on site to make contact in the people who need the medical help the most. They need to make sure that these people get access to the e-health services such as drones and the chat-app. Otherwise e-health will only exacerbate the difference between the have and have-nots.’

For this reason the WHO advises to not only invest in technology, but also in professionals. In about half of all countries the number of health care professionals is under the recommended amount (44.5 per 10.000 inhabitants), in which the largest shortcomings are in remote areas. This problem isn’t unsolvable according to the WHO. Make sure that medical training is given in those areas, make internships in those areas mandatory, and give bonuses to professionals who want to work there. This way humans and technology can cover ‘the last mile’, together.

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This post is also available in: Dutch