March 14, 2025
“White Coats” is an AABB News series that interviews the experts that are transforming the fields of transfusion medicine and biotherapies. Join AABB today to read the rest of this month’s issue.
Marie Paul Nisingizwe, MSc, PhD, is a health services and policy researcher with more than a decade of experience in health systems research, global health and quantitative methods. Her research focuses on global health system inequities and the effect of these inequities on access to health services and outcomes for underprivileged communities. Nisingizwe has previously worked with several international organizations, including the World Bank, USAID, Partners In Health and the Clinton Health Access Initiative (CHAI) across 15 countries.
Nisingizwe’s expertise spans impact and process evaluation of health system-strengthening interventions, particularly in maternal and child health and infectious diseases. She holds a PhD in population and public health from the University of British Columbia and a master’s in applied statistics. A recipient of both the Harvard School of Public Health McGoldrick Fellowship and the World Bank Group Fellowship, she is deeply committed to improving health outcomes for underprivileged communities in low- and middle-income countries (LMICs).
My background is in health systems research, with a strong focus on improving access to care for people in LMICs. I am deeply passionate about using my research and quantitative skills to inform policy and drive meaningful change. One of my key projects examined the impact of drone technology on blood delivery in Rwanda. The findings demonstrated that drones could significantly improve access to blood, particularly in emergency situations and remote areas. They also showed that at 12 months, there was a 67% reduction in blood product expirations at the intervention health facilities.
This evidence influenced the Rwandan government to expand drone-based blood delivery services and inspired other countries with similar health care challenges to explore this technology. This advancement represents a major step toward reducing preventable deaths due to a lack of timely access to blood, especially for underserved communities in remote regions. By leveraging innovative solutions, we can bridge critical gaps in health care delivery and ensure equitable access to life-saving interventions.
My interest in improving access to health care services for underprivileged communities drove me to specialize in health systems research. I grew up in a low-income country where people die daily because of inequities in health care systems. These experiences inspired me to learn and use my knowledge to help address health inequities through research. My current research focuses on global inequities in access to health care and medicines and how novel technologies can be used to improve access to care and medical products, especially for minority and underprivileged communities that live far from health facilities. These interests have played a pivotal role in shaping my career by driving my focus on evidence-based policy and program evaluation.
With a background in population and public health and statistics, I have always been interested in understanding how health systems can be optimized to improve access to care, particularly for vulnerable populations. One of my research papers, recently published in the Lancet Global Health, investigated the effect of drone delivery on blood product delivery time and wastage in rural Africa. This study—the first to assess the effectiveness of drone delivery in African settings—was featured in Wired magazine and received recognition as one of the top 12 groundbreaking studies in 2022 at the School of Population and Public Health at the University of British Columbia. Similarly, my work in evaluating hepatitis C testing and treatment programs highlights global disparities in access to hepatitis C drugs, where developed countries have significantly higher access compared to LMICs, despite the higher disease burden in these regions. This work has given me the opportunity to draw attention to the persistent challenges that hinder progress toward global elimination targets.
These experiences have reinforced my commitment to translating research into actionable policies and system-wide improvements. As a result of my work, I have had an opportunity to contribute to global health initiatives through my work with international organizations such as the World Bank, where my work focused on improving maternal and child nutrition in sub-Saharan Africa. I also contributed to policy development to guide the future of medical work in this region. I have also previously worked with Partners In Health (PIH) and the CHAI, which aim to bring modern medical treatment to vulnerable communities. Integrating impact evaluation methods and knowledge translation, I strive to ensure that health interventions are not only effective but also scalable and sustainable, ultimately contributing to stronger health systems and better health outcomes globally.
Now that we have established that drones have the potential to transform last-mile supply chain issues in LMICs, we are now investigating the impact on health outcomes and once that’s established, we will assess whether this intervention is cost-effective. By using routinely collected administrative data, we can provide rigorous answers to these important questions specifically assessing how improvements in access to blood using drones might have affected health outcomes such as post-partum hemorrhage, referrals and mortality due to lack of blood components, especially in emergency cases. Additionally, while drone technology has addressed some of supply chain challenges, it is important to assess the implications of cost, especially for limited-resource settings.
In remote areas, lack of cold storage leads to high spoilage and wastage of blood products. In some sub-Saharan settings, an estimated 25–40% of temperature-sensitive medical supplies (including blood units) sent from urban centers to rural clinics are wasted due to breaks in the cold chain. Improving infrastructure is a priority, for example, providing solar-powered blood refrigerators and reliable electricity in rural health facilities to keep blood at safe temperatures. Training staff in proper handling and stock rotation is equally important. Additionally, adopting the use of novel technologies such as drones would tremendously improve supply and quality of blood across regions. Overall, investing in the cold chain (from blood centers to transfusing facilities) ensures that blood retains its quality by the time it reaches patients, thereby both improving safety and reducing shortages due to waste.
Optimizing logistics can dramatically improve timely access to blood in remote or underserved regions. Integrated national or regional blood service networks help move blood from where it’s available to where it’s needed most, preventing stockouts. A critical role of regulation is to guarantee equitable access so that a safe blood transfusion is available not just in major cities, but also in rural health facilities. Policy makers can direct investments to underserved areas (e.g., setting up blood banks in every province, or funding transport for blood to remote hospitals).
Rwanda can be used as an example, where the use of drones to deliver blood was made an official part of its blood distribution strategy, ensuring even the most isolated communities are covered. In practice, this means establishing regional blood hubs that supply satellite hospitals and using data to redistribute blood units before they expire. Where services are fragmented (each hospital running its own blood bank in isolation), there is often urban-rural disparity in quality and access. Overall, streamlining the supply chain from donor to patient ensures that blood is collected in a timely manner, stored safely and delivered where needed without delay.
The blood donation systems in resource-limited settings are hindered by several key factors, including low voluntary donor rates, weak regulatory frameworks and financial constraints. Many low-income countries struggle with low voluntary blood donation rates often due to cultural beliefs, misinformation and reliance on family/replacement donors to contribute to frequent shortages. The absence of consistent screening for transfusion-transmissible infections compromises blood safety. Financial constraints also limit investments in critical blood transfusion services, including trained personnel, equipment and testing facilities, making many blood banks under-resourced. Furthermore, the lack of digital inventory systems and data-driven management prevents efficient tracking of donors where needed.
LMICs face significant challenges in maintaining adequate and safe blood supplies compared to high-income countries. A critical issue is the disparity in blood donation rates; high-income countries have a higher rate of donation compared to LMICs. This shortfall is exacerbated by a reliance on family/replacement and paid donors in many LMICs, which can compromise blood safety. These challenges are further compounded by inadequate blood bank infrastructure. Many low-income countries lack adequate refrigeration and storage facilities for blood, leading to spoilage and wastage.
Blood products, particularly platelets and plasma, require strict temperature control and reliable electricity, which can be a challenge in remote areas of LMICs compared to high-income countries. Further, in rural and remote regions, poor road infrastructure and unreliable transportation make timely blood delivery difficult. Emergency deliveries may take hours or even days, reducing the effectiveness of blood transfusions, limited resources and fragmented blood transfusion services. Lastly, many low-income countries allocate limited funds to blood transfusion services compared to high income, leading to shortages in test kits, equipment and human resources. Without sustainable funding, blood programs cannot expand.
One of the most pivotal decisions in my career was to focus on health systems research, leveraging my background in population and public health and statistics to address systemic health care challenges. Driven by personal experiences growing up in a country with health care access challenges, I was determined to apply my knowledge to make a tangible impact on underserved populations. Transitioning from a bachelor’s degree in mathematics to specialized training as a statistician, I recognized the power of data-driven insights in shaping effective health interventions. This journey has been profoundly rewarding, allowing me to contribute to solutions that improve health care delivery and outcomes in resource-limited settings.
In honor of Women’s History Month, I want to recognize two incredible women who have shaped my journey— my mother and my mentor, Bethany Hedt-Gauthier, PhD.
My mother (Agnes Mukamana) exemplifies resilience, discipline and determination. Despite not having access to education due to Rwanda’s history, she instilled in me and my siblings the importance of learning, working tirelessly to ensure we had every opportunity to succeed. After losing my father in 1994, she single-handedly raised five children, demonstrating unwavering strength and sacrifice. Her dedication to our education and well-being has been the foundation of my success, and I am forever grateful.
I also want to recognize Dr. Bethany Hedt-Gauthier, a professor at Harvard Medical School, whose mentorship has profoundly shaped my career. We first met in 2013 when she interviewed me for my first job at Partners In Health, and she has been my guide ever since. As a fellow statistician and educator, she has played a key role in building research and statistical capacity in Rwanda. Dr. Hedt-Gauthier not only mentored me but also provided life-changing opportunities, including introducing me to a fellowship at Harvard that transformed my academic and professional trajectory. She was also a part of my PhD thesis committee, continuing to support my growth. To this day, she remains the person I turn to for career guidance.
To my mother and Dr. Hedt-Gauthier, thank you for your unwavering support, mentorship and dedication to education and empowerment. You are true inspirations!
Playing with my 4-year-old daughter, who is my world.
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