Medical delivery drones at national scale.

The Luke Commission began two decades ago, when Harry and Echo VanderWal arrived in Eswatini from the United States to do medical work. Harry, a paediatrician, and Echo, a physician assistant, came in 2004, at the height of the HIV pandemic, when Eswatini had the highest HIV prevalence rate of any country in the world. At the time it was common for a Swazi to attend three or four funerals a month.

Roughly 80% of Eswatini’s population lives in rural areas, where healthcare access was, and remains, the hardest problem to solve. TLC started small, running mobile clinics out of two vehicles, treating patients in primary schools and communal meeting places. It did that for eight to ten years. The team grew to 40 or 50 staff. A turning point came when the United States government, struggling with a national male circumcision campaign, partnered with TLC and saw it deliver more procedures in a single outreach than the efforts of providers in the rest of the country combined.

From there the work compounded. Patients who needed more than primary care began arriving at the gate. Temporary inpatient units became permanent ones. Today TLC operates a full-fledged hospital with outpatient, inpatient, and specialty surgical capacity, performing complex surgery in orthopaedics, ophthalmology, and other specialities for patients across the region. During COVID-19 it carried out around 90% of the country’s response and built the national vaccination platform, which the World Health Organization recognised as one of the best-performing systems in the world.

That identity matters to the drone story. Across Africa, faith-based organisations like TLC provide a large share of healthcare, in Eswatini’s case around half, while receiving only a minuscule share of the national health budget. When global aid was cut, TLC treated it as the next problem to solve rather than a reason to retreat, accelerating an already-underway pivot to a diversified funding model. The organisation began offering tiered fee-for-service care, with the same standard of care for every patient, and within roughly twelve months grew earned revenue from covering about 15% of operating costs to about 30%, doubling it in a single quarter. The drone network was conceived in the same spirit: not as a showpiece, but as infrastructure that solves a problem no road network in the country could.

Eswatini is largely mountainous, and the terrain gets harder as you move toward the rural communities that need care most. Road networks thin out, and seasonal rains routinely cut off whole districts as bridges flood and tracks turn to mud. On top of geography, the country faces periodic medication shortages, and TLC is one of the few institutions able to hold reliable stock of specialised supplies such as antivenom. For a snakebite patient, the gap between a road that is washed out and an available aircraft, can be the difference between life and death.

TLC had been watching drone technology for five or six years before it acted, waiting until the technology was capable of real impact rather than a photo opportunity. The decisive advantage turned out to be location. From its centrally located Miracle Campus, TLC can reach most of the country by air in under 45 minutes, a radius that no ground-based service could match. In late 2021 and early 2022 the organisation began approaching drone companies and working with Eswatini’s civil aviation authority on the licensing and operational approvals the programme would need.

When TLC evaluated platforms, the selection criteria came down to two things: simplicity and range. Simplicity meant the operating system and the remote pilot station, the software the team would actually fly on. Range meant the ability to serve a whole country from one base. TLC reached out to companies across Europe, the United States and Asia. What separated the eventual choice then, and still separates it now, was the operating system: a long range drone paired with software built to run a drone network, not just a drone aircraft.

The Nkwe Drone Network launched in June 2024. The reception was immediate. In the first three months of operation, TLC flew more than 1,000 flights to different parts of the country, far faster uptake than the team had expected in communities they assumed would be slow to embrace something new.

Unlike delivery-only systems that parachute payloads, the KITE lands and can pick up as well as drop off, so the network pushes supplies out and brings items back rather than only delivering one way. The cargo ranges from vaccines and routine medication to time-critical supplies such as antivenom.

TLC trained its own Emaswati pilots, licensed in South Africa and endorsed by the Eswatini Civil Aviation Authority, so that the programme does not depend on visiting operators. Local ownership is what makes a medical delivery drones programme sustainable rather than a temporary intervention, and it is what allows TLC to keep expanding the network on its own terms.

The Nkwe network was launched in 2024 with the KITE UAS on the basis that the platform did what it claimed to do, and nothing else the team had evaluated came close on the operating capability of the system. Early 2025, Kite Aero stepped in to continue and support TLC’s operations and in developing the platform. That continuity reflects a deliberate stance on Kite Aero’s side, with its primary focus on enabling organisations like TLC to do their work. An operator whose programme keeps running through a vendor transition, and keeps expanding afterwards, is the clearest proof of that approach.

The conversation TLC is now part of has shifted from local delivery to the future of healthcare across the continent. TLC sees robust operational systems focused on accountability, efficiency, and transparency, as a critical foundation for country-led, sustainable African healthcare. Other African nations have already come to Eswatini to study TLC’s approach, which positions it as a template for other resource-limited contexts rather than as a one-off in a single location.

For the people who built it, the most lasting effect is harder to put on a dashboard. The drones fly to remote clinics that sit close to schools, and the children who watch them arrive see, in real life, something they might otherwise only have seen on a screen.

That is the deeper return on a medical delivery drones programme built to last: not only the antivenom that prevented a death or the medication that reached a patient 100 kilometres away, but a generation of Emaswati who now take for granted that the hardest problems can be solved at home.