Flights changed the way we travel. Drones may now change the way health care reaches people. A new study by the Indian Council of Medical Research (ICMR) suggests drones could do exactly that for tuberculosis (TB) diagnosis in some of India's remotest regions.
Conducted under its flagship i-DRONE initiative in Telangana's Yadadri-Bhuvanagiri district, the study found that transporting sputum samples by drones instead of requiring patients to travel reduced the median diagnosis time from 15 days to five days. It also cut patients' average out-of-pocket expenditure from around ₹9,451 to just Rs 91, with many participants spending nothing at all.
The findings are significant for India, which bears the world's highest TB burden. According to the WHO Global Tuberculosis Report 2025, TB claimed over 12 lakh lives and affected more than one crore people globally in 2024, with India accounting for the largest share of cases. Yet, delayed diagnosis remains a major challenge, particularly in remote areas where accessing TB diagnostic centres often involves long and expensive travel.
Earlier studies have highlighted this challenge. A 2013 study found that more than half of presumptive TB patients travelled over seven kilometres to reach the nearest diagnostic centre, with longer distances significantly associated with delayed treatment and patients being lost to follow-up.
Similarly, a 2018 qualitative study identified the lack of assured specimen transport as one of the biggest barriers to timely diagnosis of drug-resistant TB. It concluded: "Lack of assured specimen transport and lack of accountability for tracking patient after identification and referral were the key barriers." The researchers recommended strengthening specimen transport systems, particularly in rural areas.
Against this backdrop, the new ICMR study suggests drone-enabled logistics could help bridge one of the biggest gaps in India's TB care pathway by bringing diagnostic services closer to patients.
What did the ICMR study find?
The programme-based study evaluated a drone-assisted transport model for TB sputum samples in Yadadri-Bhuvanagiri district of Telangana. Instead of asking patients to travel to designated TB diagnostic laboratories, sputum samples were collected at nearby Primary Health Centres (PHCs) and Sub-Centres (SCs) before being transported by drones to TB Units (TUs).
The study enrolled 840 participants and compared the conventional transport system with the drone-enabled model.
Researchers found that the median turnaround time for TB diagnosis decreased from 15 days to just five days after drones were introduced. Earlier diagnosis meant patients could receive confirmation of disease much sooner, potentially allowing earlier treatment initiation and reducing delays in clinical decision-making.
The intervention was organised through a hub-and-spoke network connecting 11 Primary Health Centres, 60 sub-centres and four TB Units, enabling patients to submit sputum samples much closer to their homes instead of travelling long distances to district diagnostic facilities.
One of the most striking findings related to the financial burden on patients.
The study reported that the mean out-of-pocket expenditure (OOPE) associated with obtaining a TB diagnosis reduced dramatically from around Rs 9,451 under the conventional system to approximately Rs 91 during the drone-enabled phase. Researchers attributed this reduction primarily to lower travel costs, reduced wage losses and decentralised sputum collection. Importantly, the median out-of-pocket expenditure during the drone phase was zero, indicating that many participants incurred no travel-related expenses at all.
Commenting on the findings, Dr Rajiv Bahl, Secretary, Department of Health Research and Director General, ICMR, said, "Affordable and timely access to diagnosis remains central to India's TB elimination efforts. This study demonstrates how technology can help bridge geographical barriers and reduce the burden on patients, particularly those living in remote areas. The evidence generated through the i-DRONE initiative will help inform future public health innovations while complementing existing health care delivery systems."
Health care workers involved in the programme also reported that drone-assisted transport reduced delays, improved operational efficiency and gradually gained community acceptance after initial familiarisation.
Is drone-enabled TB transport feasible in rural India?
Alongside the operational evaluation, researchers also conducted a qualitative feasibility assessment to understand whether drone-assisted TB sample transport could realistically be integrated into routine healthcare services.
The qualitative study included 28 in-depth interviews and 12 focus group discussions involving 101 purposively selected stakeholders, including frontline health workers and programme officials. Researchers assessed feasibility across five key domains - acceptability, demand, practicality, implementation and integration.
Participants broadly viewed drones as a practical solution for reducing transport delays and improving access to TB diagnostics in rural areas.
According to the researchers, "Participants highlighted that drones improved acceptability, demand, and integration by reducing travel, enabling timely sputum and medicine delivery, and building community trust."
Health care workers felt that drones could particularly benefit people living in villages with poor transport connectivity, elderly individuals without caregivers and economically vulnerable patients who struggle to travel repeatedly for testing.
The study found that stakeholders also recognised the potential to expand drone use beyond tuberculosis. Participants suggested integrating drones for transporting vaccines, medicines, blood samples, dengue test samples and other essential health commodities to maximise utilisation of the technology.
Researchers noted that frontline health workers, especially ASHAs and ANMs, played an important role in improving community acceptance of drone operations.
At the same time, participants highlighted limited public awareness of drone technology, TB-related stigma, adverse weather conditions, payload limitations, navigation issues in difficult terrain, training gaps, and regulatory delays as important barriers requiring attention before large-scale implementation.
The authors noted that concerns around stigma were particularly important because some community members feared that drone visits might inadvertently reveal a person's TB status.
The researchers observed, "Drone-based sputum and medicine transport is operationally feasible and acceptable in rural Indian settings, and participants viewed drones as a promising way to reduce sample transport times and improve access to diagnostics, particularly in hard-to-reach areas."
They added that successful expansion would require community engagement, staff training, streamlined regulatory processes and integration with existing National TB Elimination Programme workflows.
Limitations of the study
The researchers cautioned that the findings should be interpreted within the context of several important limitations.
First, the study was conducted in only one district, meaning experiences and perceptions may differ in other parts of India with different geography, health infrastructure and community contexts.
Second, because the programme was still at the pilot stage, participants' views were based on relatively limited exposure to drone operations. Researchers acknowledged that wider implementation could reveal operational challenges not captured during the pilot.
The authors further noted, "We did not quantitatively evaluate economic feasibility, which remains a key concern for scalability. Future research should incorporate cost assessments to validate the feasibility insights reported here."
Although participants reported lower patient expenses and operational benefits, the study did not comprehensively evaluate long-term programme costs or cost-effectiveness from a health system perspective.
Researchers also emphasised that weather disruptions, payload limitations, continued staff training and regulatory preparedness would need to be addressed before broader implementation.
In conclusion, the authors wrote, "Drone-based sputum transport was seen as acceptable and feasible in rural settings, provided there is successful community engagement, adequate training, and preparedness for risk management."
They added that integrating drone networks into existing TB control programmes and broader healthcare delivery systems could help India and other high-burden countries improve equitable access to diagnostics in remote areas.
Have other countries already adopted drone-based health care?
According to previous research, Médecins Sans Frontières (MSF) demonstrated the healthcare potential of drones as early as 2014, transporting sputum samples for tuberculosis diagnosis in Papua New Guinea.
One of the most widely cited examples is Rwanda, where the government partnered with Zipline in 2016 to establish one of the world's largest medical drone delivery networks.
Initially developed to transport blood products to remote health facilities, the programme later expanded to deliver vaccines, medicines and other essential medical supplies. Zipline drones reportedly travel distances of up to 80 kilometres while carrying payloads of around two kilograms.
Since its launch, the programme has expanded beyond Rwanda to Ghana, Nigeria and the United States.
In Rwanda alone, Zipline has reportedly completed more than 200,000 medical deliveries, covering over two million kilometres. Researchers note that delivery times for emergency blood products, which previously required several hours or even days by road, were reduced to around 30 minutes, substantially improving emergency care in remote regions.
Other countries have also explored drone-assisted healthcare. Papers have documented pilot programmes in Malawi and Guinea for transporting samples related to HIV testing, while Nepal and India's Himalayan regions have evaluated drone operations for healthcare logistics in geographically challenging terrain.
What experts say?
According to Dr Sunil Kumar K, Lead Consultant – Interventional Pulmonology, Aster CMI Hospital, Bengaluru, the findings are significant because early diagnosis remains one of the most effective ways to reduce tuberculosis transmission.
He explained that delayed diagnosis allows infected individuals to continue spreading the disease within their families and communities, particularly in densely populated rural areas. Reducing the turnaround time from 15 days to five days enables treatment to begin sooner, improving recovery while lowering the risk of further transmission.
"The sharp reduction in out-of-pocket expenses also removes a major barrier that often prevents patients from seeking timely care or completing the diagnostic process," he said.
According to Dr Sunil, enabling sputum collection at nearby health centres while using drones to transport samples could improve access to quality diagnostics for underserved populations. If implemented effectively, the model could strengthen India's TB elimination efforts by improving early detection, reducing patient dropouts and increasing treatment adherence.
However, he cautioned that scaling up the intervention nationwide would require addressing several operational challenges.
"Reliable operations during adverse weather, expansion of drone infrastructure, maintenance, trained personnel, integration with existing laboratory networks, regulatory approvals and community acceptance will all be crucial for successful implementation," he said.
Dr Sunil added that the cost-effectiveness of drone-assisted transport would depend on factors such as the number of samples transported, the distance to diagnostic laboratories and the availability of conventional transport. He noted that drones are likely to provide the greatest benefit in remote and hard-to-reach areas where access to diagnostic services is limited.
He also believes the technology could have applications beyond tuberculosis.
"Drone-enabled transport could also be used for vaccines, blood products, emergency medicines and diagnostic samples, particularly in underserved regions. However, large-scale implementation will require robust infrastructure, cold-chain capability, standard operating procedures, trained personnel and compliance with aviation regulations," he said.
He added that integrating drone operations with existing health systems and building community awareness would be essential for wider adoption.
This story is done in collaboration with First Check, which is the health journalism vertical of DataLEADS
