For years, health workers in Kalangala struggled to transport blood samples from health facilities scattered across the district’s islands to laboratories on the mainland, with the process costing a lot of money and delaying diagnosis for patients who need timely treatment.
At Bukasa Health Centre IV on Bukasa Island in Kyamuswa County, for example, health workers spend more than Shs400,000 transporting samples to Kalangala Health Centre IV on Buggala Island, the district’s main sample collection point, Dr Michael Suuna, the facility’s in-charge, said on October 28.
‘This money is for fuel for the rider and their allowances to transport just one unit of blood. How much more will we need if the blood were coming from Mazinga Health Centre III, which is near the Tanzanian border?’ he asked.
Beyond the financial burden, the transportation arrangement has left health workers waiting for laboratory results for more than a week, delaying decisions on diagnosis and treatment.
‘When we send samples at Kalangala Health Centre IV, we have to wait over a week to get results. This delays us in diagnosing patients in time,’ Dr Suuna explained.
The ministry of Health is now turning to drone technology to address these logistical challenges, with a new sample transportation network expected to reduce reliance on boats and vehicles, hence shorter delivery times and improved access to specialised laboratory services for island communities.
The drone-powered sample transportation network was rolled out on October 27 following route tests conducted on October 20.
The project is expected to connect selected island health facilities directly to the Central Public Health Laboratories in Butabika, Kampala, where samples requiring specialised testing can be analysed.
The ministry has partnered with Samanga Solutions Limited to roll out the beyond-visual-line-of-sight (BVLOS) drone delivery project for laboratory samples, medicines, blood products, vaccines and other essential medical commodities. The operations are managed by Drone Plus.
The cost of delayed diagnosis
At Kalangala Health Centre IV, samples from health facilities across the district are consolidated before being transported by vehicle through Masaka to laboratories in Kampala.
Mr Frank Kisakye, the facility’s in-charge, said the health centre operates a laboratory with limitations, including specialised tests that must be referred to higher-level laboratories.
‘We have a level-three laboratory, so we collect all samples from the 16 health facilities in Kalangala. The car gets them from Kalangala Health Centre IV via Masaka mainland to the laboratories in Kampala,’ he said on October 233.
Mr Kisakye explained that the existing transportation arrangement serves districts across the Greater Masaka region, with vehicles collecting and distributing samples according to established schedules before they reach their destinations in Butabika, Kampala City.
Consequently, samples do not always reach the reference laboratories immediately after collection.
‘When the car collects the samples on Tuesday, they would reach Butabika laboratories on Thursday, hence a long time to get results and depriving patients of timely treatment,’ he said.
Mr Brian Ssemanda, the laboratory in-charge at Kalangala Health Centre IV, said the delays affect samples requiring specialised testing, including those used for monitoring HIV viral loads, hepatitis and tuberculosis, as well as specimens collected from suspected yellow fever cases and for disease surveillance.
Records at Kalangala Health Centre IV indicate that the facility sends between 800 and 1,200 samples monthly to reference laboratories.
‘When there is a delay, it affects patient management and decision-making by the health workers managing that patient. For better diagnosis or patient management, faster sample delivery is key,’ Mr Ssemanda said on October 27.
He added that the current system also places a financial burden on health facilities because riders have to travel by boat to collect specimens from lower-level facilities scattered across the 64 inhabited islands.
‘Moving to lower health facilities to collect samples is costly in terms of fuel costs,’ he said.
Vehicle system
The system, ministry officials said, relies mainly on motor vehicles to transport samples between hubs and reference laboratories. However, it has often faced operational challenges, particularly in hard-to-reach areas where facilities are separated by water or have limited transport connections.
Ms Phiona Namara, the air quality supervisor at the Ministry of Health under the National Health Laboratory and Diagnostic Services, said samples from some facilities would reach the central laboratory only once a week.
‘Oftentimes, samples reached the central lab once a week, yet if there was a problem, none came through,’ she said (when?).
Mr Mark Lwanga, chairperson of Buligo Village on Buggala Island, on October 23 said the technology offers hope to islanders who have long struggled to access timely medical attention.
He said patients from remote islands sometimes travel by boat to Kalangala Health Centre IV, where their samples are collected before being transported by road to Kampala.
‘We have been using boats to transport patients that needed to be checked, sometimes braving the rough lake and rainy season, worsening patients’ conditions,’ Mr Lwanga said.
How the drone system will work
Ms Prossy Mbabazi, who oversees the project at the ministry of Health, said the initiative will reduce diagnostic turnaround time and ease pressure on the existing transportation system.
‘The initiative is expected to ease pressure on the existing sample transportation system, which has been relying on vehicles and water transport to connect health facilities on the islands to collection centres and laboratories on the mainland,’ she said.
The ministry expects the shorter transportation time to enable samples to reach laboratories earlier and, where laboratory schedules permit, be tested on the same day they are collected.
Ms Namara said the network will use an optimised, dynamic schedule to respond to demand.
‘We intended to pick samples from the different islands daily. However, we will use an optimised schedule to visit islands only when there are active samples to collect or deliveries to make,’ she said on October 23 .
Ms Namara added that the drone can make two trips a day whenever samples are available for collection or medical supplies need to be delivered.
The initial routes will serve Koome Island in Mukono District, Jaana, Bukasa and Bubeke islands in Kalangala District.
The programme is expected to expand to Bufumira, Lulamba, Kachanga and Mazinga islands after the initial routes have been completed and assessed. The Ministry also plans to extend the same service to another island district of Buvuma.
‘When we finalise those routes, we shall add on other islands like Bufumira, Lulamba, Kachanga and Mazinga islands in Kalangala District. After exhausting Kalangala District, we shall head to Buvuma Islands,’ Ms Namara said.
She said demonstrations have shown that the drone can fly from Butabika, collect samples from health facilities in Kalangala and return within two hours.
‘With this drone technology, we have already demonstrated that within two hours, a drone can to fly from Butabika, land on Buggala and other islands, pick up the samples, and return so they can be tested on the same day they are collected,’ Ms Namara said.
The Kalangala drone initiative is being introduced into an existing national laboratory transportation system that serves thousands of health facilities.
According to the Ministry of Health, the National Health Laboratory and Diagnostic Services operates a hub-and-spoke transportation model comprising 100 laboratory hubs serving more than 3,000 health facilities across the country.
The ministry plans to purchase two additional medical logistics drones to support service delivery in other districts in eastern and northern Uganda.
Hope for communities
For residents of Kalangala, the project addresses challenges that extend beyond the movement of laboratory samples.
Mr Lwanga said the successful launch of the drone project has raised expectations that the new service will shorten the time required to transport samples and obtain results.
‘We have seen it take like an hour to reach the Kaala Grounds. We believe this has reduced the time it takes to transport the samples and get back results,’ he said.
Patient transportation woes
Kalangala District has only 16 health centres, with only two health center IVs providing improved health services.
A resident of Nkose in Mazinga Sub-county, nearest to the northern border with Tanzania’s Bukoba Islands, has to travel a minimum of 11 nautical miles on the lake to reach the nearest Kachungwa Health Centre III, which only handles maternity health services, HIV treatment, and minor illnesses.
If one has a major illness or any complication, it is better to travel to Rakai and Masaka since they appear nearer than Bukasa and Kalangala health centre IVs. Sometimes, patients reach the main health centres, only to be referred to Masaka.
For one to move from one island to the nearest health centre, he or she needs to hire a boat, coxswain, engine, and fuel to reach the nearest health facility.
For instance, to travel from Kitobo, an outlying island, to Bufumira Health Centre III, one needs to buy 20 litres of fuel at a cost of Shs80,000, hire a coxswain at Shs40,000, and a boat and engine at Shs50,000 to go to a health centre and pick up tablets that can be sold at Shs3,000 in a private clinic.
It is against this background that medics in the district are pushing the government to invest more money in the area’s health sector. Most of the health centres in Kalangala face shortages of diagnostic tools, specialists, and essential equipment.