Rwanda is a country in Africa with many hills. Some roads are difficult to use in the rainy season. Since 2016, drones have carried blood to hospitals there. The drones drop the boxes with small parachutes and fly back.

A study found that the deliveries were much faster than by road. In Japan, new rules in 2022 allowed drones to fly over towns, even out of the pilot's sight. But wind, rain and cost are still problems.

Drone delivery is not just a dream for the future. In Rwanda, a hilly country where roads can be hard to travel in the rainy season, an American company began using airplane-shaped drones to deliver blood to hospitals in 2016. The drones drop packages by parachute without landing.

A 2022 study of 20 health facilities found that emergency deliveries took about 50 minutes on average, about 79 minutes faster than the estimated time by road. Blood wasted because it had expired also fell by about 67% after a year. In Japan, rules changed in December 2022 to allow "Level 4" flights, in which drones fly beyond the pilot's sight over populated areas. However, weather, weight limits and cost still make everyday delivery difficult.

Drone delivery is often imagined as a futuristic convenience, but its most convincing success so far has been in medical logistics. In Rwanda, whose mountainous terrain makes some roads difficult in the rainy season, fixed-wing drones have dropped blood products by parachute to hospitals since 2016. A study published in The Lancet Global Health in 2022 analyzed 12,733 drone deliveries to 20 facilities between 2017 and 2019. Emergency deliveries took about 50 minutes on average, roughly 79 minutes faster than estimated road transport, and blood wastage from expiry fell by about 67% after one year.

Because the study was observational and compared drones with estimated rather than actual road times, other improvements during the same period cannot be fully ruled out, and cost-effectiveness was not assessed. In Japan, a December 2022 revision permitted Level 4 flights beyond visual line of sight over populated areas, provided that certified aircraft and licensed pilots are used, and the first such flight carried mail in 2023. Obstacles remain, however, including wind and rain, limited payloads, safety and privacy concerns in cities, and operating costs. Even the environmental benefits depend on how delivery networks are designed.