Kenya loses close to 5,000 women a year to pregnancy and childbirth. Roughly four in ten of those deaths are attributed to postpartum haemorrhage-bleeding after birth.
One thing that defeats effective management of postpartum heaemorrhage is a link that is missing at the moment it is needed. That missing link is not a skill or a decision. It is a commodity that is somewhere else.
As an obstetrician, and now as the county executive for health in Kisumu, I have come to believe that on-demand aerial delivery belongs in Kenya’s health supply system as infrastructure and not as a pilot or a donor project.
In 2023, after a learning tour in Rwanda with governors from the Lake Region Economic Bloc, my governor directed that we implement this technology. Kisumu County contracted Zipline to strengthen our health supply chain.
The premise is simple: hold products centrally, under proper cold chain, and deliver them within about 15 minutes of an order. That breaks an assumption our system is built around-that every commodity must be forecast, procured and parked at every facility that might one day need it.
In the 2024/25 reporting period, the county’s own records document 3,347 deliveries carrying 37,339 units – vaccines, medical supplies, blood and other critical commodities.
Before this, Kisumu could not reliably meet demand for anti-rabies treatment. Stock was in the wrong places at the wrong times: it expired on shelves that never needed it. So we held it centrally and dispatched on request, including to patients referred from neighbouring counties.
People came to know that if you are bitten by a dog or a snake, you can get to a facility in Kisumu and be taken care of.
The honest business case is that this does not automatically reduce a budget. It recovers money lost to expiry, emergency transport and avoidable referrals, and turns fixed inventory into a demand-led system.
Nor does it solve maternal mortality. Drones do not staff a theatre at 2am or build a transfusion service where none exists. What they do is remove one failure-the commodity that was not where the patient was-from a list of failures that must all be addressed.
The decisive gain is not the cost per delivery. It is that a facility can promise a patient something and keep the promise.
Build it
Kenya has invested in roads, hospitals and airports on the understanding that access is a public good. The last mile deserves the same treatment-planned and procured as infrastructure, not adopted as a technology product.
Four things would move us from county experiments to a national system.
First, aerial delivery should be written into the national health products and technologies supply chain strategy as a recognised distribution modality, with clear service standards.
Second, it should be competitively tendered at national or regional scale, so counties buy a defined service against a published standard and the country gets the benefit of scale, rather than each county negotiating its own arrangement.
Third, delivery should be priced into the commodity itself. We budget for the product and treat getting it to the patient as a separate variable cost-which is why emergency delivery is often the first thing cut when money is tight. Build guaranteed availability into the unit price of what we buy, whether delivered by road or air, and spread the cost across the whole basket.
Our own service in Kisumu is winding down. Which is why ownership matters: we cannot build health systems around things that vanish when a contract ends.
Fourth, Kenya should own the infrastructure and build an industry around it. Hubs, warehouses, launch and charging infrastructure are national infrastructure in much the same way as ports or railway stations. They belong on a public balance sheet, with operators contracted to run the service.
So far, across Africa, the engineering and manufacturing value has largely remained abroad while what comes here is operations. That is the division of value we should be negotiating to share. Assembly here, and eventually component manufacture, would cut the cost of every airframe and spare part, and give Kenyan engineering graduates an industry that does not currently exist.
In Kisumu, the phrase hakuna dawa was heard less often than it was. When people heard the aircraft overhead, they would say, hiyo ni dawa inapelekwa-that is medicine being delivered.
They were not impressed by the technology. They have understood what it means.
A woman bleeding after childbirth does not need to know how a supply chain works. She needs blood, and she needs it now.
Kisumu has shown that this is a solvable part of the problem.
The question is whether we are prepared to solve it everywhere.