“For Us, Drones Mean Health”: How Medical Drone Delivery Affects Healthcare Outcomes, Accessibility, and Trust in Remote Regions of Madagascar

Medical drone delivery (MDD), defined as the use of uncrewed aerial vehicles to transport medical products, is an emerging technological innovation responding to persistent health supply chain challenges in rural and low-resource settings. Within sub-Saharan Africa, MDD systems have demonstrated large-scale success in improving key health outcomes, health supply chain efficiency, and reductions in medical product stockouts and wastage. However, the existing evidence base on the effectiveness of this technology is dominated by quantitative, performance-based evaluations, with limited emphasis on the community-driven mechanisms that shape such outcomes. Drawing on original qualitative research, this article presents a qualitative secondary analysis (QSA) of interview data collected as part of a larger case study on MDD in Madagascar. The QSA, guided by socio-technical systems theory, analyzes a subset of 18 interviews with 23 community-level stakeholders to understand how MDD affects healthcare services in remote regions of the country. Participants reported that MDD led to downstream healthcare improvements in vaccination coverage and malaria-related health outcomes. These improvements were enabled through four interconnected socio-technical mechanisms: (1) improved medical product availability through the mitigation of geographic and transportation barriers, (2) stabilization of vaccine and cold chain transportation, (3) building trust and healthcare-seeking behaviours through predictable service delivery, and (4) reduced physical, mental, and financial burdens experienced by healthcare workers. A final, cross-cutting theme emphasized was the criticality of MDD program continuity, with participants noting that operation disruptions or withdrawals risked reversing benefits and breaking communities’ trust in the health system. By centering lived realities, perceptions, and social processes, this article bridges the gap between predominantly quantitative evidence on MDD systems and the experiences of the communities they are intended to serve.