Friday, 28 June 2013

Will road deaths be a development priority?

Writing today for Guardian Global Development, Oxfam policy adviser and development blogger Duncan Green asks why road traffic injuries are still being ignored by the development community. Duncan writes:

Duncan Green: "road safety will
become ever more prominent"
"Road traffic kills as many people as malaria, but getting Nairobi's bus drivers to slow down is much easier than tackling malaria. So if we know what to do, and the remedies are cheap, why isn't road safety much higher up the development agenda?"

..."My theory is that the collective development gaze skips over road deaths and others like tobacco or alcohol because they are too familiar. The world of aid and development prefers the exotic, the "other". But if you think roads, booze and fags are tricky issues for the aid industry to tackle, try obesity – increasingly present among poor communities in poor countries, as a recent visit to South Africa brought home to me, often side by side with malnutrition. Can you imagine an aid organisation launching a fundraising appeal to tackle obesity?"

Of course a programme to tackle obesity would need to include road safety - the perception (and often in a low and middle income country context the reality) of a lack of safety on the streets being a major motivation for those people who can to give up walking and cycling, or to prevent their children from walking to school, and take to their cars, leaving the danger to the poor. This inter-connection of road safety with other health and environmental agendas holds out the best hope for mainstreaming road injury prevention into development policies and programmes. But, as Duncan Green argues, we first need to surmount the indifference of development policy leaders in the West. He may be correct that they seek the exotic, the quintessentially tropical diseases. They have perhaps become inured to road traffic injuries, lulled by the steady march of improvement and reduced casualties in the UK, Australia, Sweden or the US and the way the media in these countries overwhelmingly portrays road safety as something boring and unsexy, even amusing, preserve of the finger-wagging tendency. Despite considering themselves to be in touch with what is happening in the 'developing' world, and despite being endowed with sophisticated analysis of myriad social issues, these experts seem to ignore the evidence of dysfunction and inequality on the very roads they travel through to visit their health, governance or economic development projects. What, after all, is the real difference between the collapse of a poorly built Bangladeshi garment factory and the cumulative effect of a daily death toll exacted by a poorly designed Bangladeshi road?  

Yet coincidentally, this week also saw the publication of a report by the Overseas Development Institute, the UK's leading development think tank, which argues that if the post-2015 goals are to deliver universal access to infrastructure, road safety must be addressed:

“Investment in transport infrastructure and services is likely to have a significant impact on poverty and more generally on economic growth, productivity and employment. Transport's importance goes beyond a question of mobility, by providing connectivity and social benefits. By one estimate, 900 million people have inadequate access to road transport (Roberts et al., 2006), but data on access to transport are limited. The poorest are often neglected by service providers, and in urban areas access is affected by affordability. With road traffic causing 1.3 million deaths a year, the majority in developing countries, road safety is a major concern for future transport sector development. The transport sector is a major source of greenhouse gas emissions and particulate air pollution, especially in urban areas...A sustainable transport goal would contribute to reduction of global greenhouse gases and particulate air pollution. This would help mitigate climate change and have a significant positive impact on health. Road safety measures would also improve overall health status."
Could this be part of a shift in awareness and attitudes towards road traffic injury within the development community? Kevin Watkins, now Director of the ODI, has been an early adopter of road safety amongst development experts, arguing the case for integrating road traffic injury prevention into wider development objectives. The Global Burden of Disease 2010 study, published last year by the Institute for Health Metrics and Evaluation and the Lancet again confirmed that road traffic injury is a leading contributor to death, disability and injury amongst young people in every part of the world. There have been flashes of recognition from UNICEF, which addressed the impact of road traffic injury in two of its recent State of the World's Children reports, and UNICEF's executive director Anthony Lake recently described the impact road crashes have on the young, but these perceptive diagnoses of the problem are yet to be followed up with any organised policy advocacy or programme implementation. There are strong advocates for action on road safety in the World Bank and some of the other development banks, but in none of these organisations has there yet emerged someone in a senior leadership role who is prepared to make road safety a major priority.
So the post-2015 'Sustainable Development Goals' debate provides a real opportunity for road safety advocates to make the case for integration with wider public health, sustainable transport and environmental issues, to build a broad coalition supporting road injury prevention as a way to tackle a problem which is itself a major global killer, but also a symptom of wider inequality and poverty, and a contributor to the growing crisis of non-communicable diseases. And it is an opportunity to challenge those who, through fatalism or ignorance, see road traffic injury as simply a national transport problem, an unpleasant side-effect of mobility,  rather than an international epidemic which we all have a stake in preventing.   

Friday, 21 June 2013

Life-saving lessons for Ugandan first responders

Participants in the ICCU training course for first responders
According to the World Health Organization's Global Status Report on Road Safety, Uganda loses more than 9000 people a year in road crashes. Despite - or contributing to - such a high death toll, Uganda has no formal pre-hospital emergency system. According to Ugandan trauma staff, the emergency services are insufficient and there is limited capacity to manage the injured. Many casualties arrive at health facilities by any means of transport possible such as motorcycle (boda boda), police trucks and private cars. Fewer than 5% of patients arrive by ambulances because few exist and those that do are privately owned and prohibitively expensive for most Ugandans.
Many patients arrive after the “golden hour” – the critical first hour after the injury has occurred, during which medical intervention is vitally important. Currently, pre-hospital care is given on a voluntary basis by police, drivers, community people and bystanders near crash scenes. The majority of trauma victims who die do so during the pre-hospital stage. The WHO has recommended training of lay persons as first responders, especially in settings where formal emergency systems are absent. Pre-hospital care can be improved by training lay persons such as local leaders, community volunteers, teachers, and police officers, in simple but vital life-saving skills, such as clearing the airway, arresting bleeding, immobilizing fractures and so on. The knowledge attained by laypersons in pre-hospital training and coupled with locally available supplies may form a useful first step towards formalizing Emergency Medical Services in Uganda.

With funding from the Road Safety Fund’s small grants programme, the Injury Control Center- Uganda (ICCU) is undertaking first aid training in local communities to strengthen the front-line response to road traffic injuries. Six training sessions are planned under the Road Safety Fund/ICCU First Responder Training Programme. The first session, held in a community living alongside the Masaka Highway, was a three day workshop for 46 participants including community and religious leaders; village health workers; teachers and pupils; and local community forces. Two sessions will be directed to police officers, two further sessions for local communities and one for ‘train the trainers’. The courses include both theory and hands-on practice, accompanied by a handbook prepared by ICCU for the project.

Thursday, 20 June 2013

Our Rio+20 Commitment, one year on

A survey of progress in delivering sustainable transport-related Voluntary Commitments made at Rio+20  has been published by the Partnership for Sustainable Low Carbon Transport (SLoCaT) exactly one year after the summit in Rio de Janeiro. The Commitments include one coordinated by the Road Safety Fund on behalf of the Zenani Mandela Campaign which focused on 'Protecting Children from road traffic injuries and improving their urban environment'. Bringing together 12 organisations and campaigns, including UNEP, Embarq, AIP Foundation and Safe Kids Worldwide, the Voluntary Commitment has resulted in achievements including a new cycle-way for a city in Costa Rica, a pilot of 'star rating for schools' in Mexico City, delivery of a safe schools road injury prevention programme in Tanzania, and advocacy campaigns aimed at improving child safety legislation in Vietnam.
In a preface to the report, Ban Ki-moon, UN Secretary General, said: "In both urban and rural areas, better planning for land-use and transport systems makes a great difference in facilitating access to jobs, goods and services for men and women alike. It also helps improve road safety and reduce traffic accidents and fatalities".
As well as reporting on the Rio+20 commitments, the report, 'Creating Universal Access to Safe, Clean & Affordable Transport' also calls for a Goal on Sustainable Transport to be included in the post-2015 Sustainable Development Goals, arguing that transport affects so many areas of development and environment policy, delivery of services and access to employment that it needs to be properly addressed in the post-2015 framework. In his foreword, Ban Ki-moon also highlights this debate, telling the transport community:
"I welcome your ideas and suggestions as the United Nations seeks to define a transformative post-2015 development agenda. Global consultations are underway among Governments, civil society, the private sector and others, and I encourage you to make your voice heard."

Sunday, 9 June 2013

Decade funding strategies reviewed

'Friends of the Decade' Governments meeting at the Swedish Cabinet Office
The Road Safety Fund has briefed governments on possible fundraising strategies for the Decade of Action at a meeting of the governmental 'Friends of the Decade of Action'.

Hosted by Sweden’s Minister for Infrastructure, Catharina Elmsäter-Svärd, at Sweden’s Government Offices on June 3rd, the meeting brought together officials from countries including Brazil, France, Indonesia, Mexico, Nigeria, Russian Federation, Spain, Thailand and the USA. Agencies present included the UN Regional Commission for Europe, the World Health Organization and the World Bank. The Commission for Global Road Safety, FIA Foundation, FIA and the Global Road Safety Partnership also participated.

The meeting reviewed the progress of the Decade of Action at the two-year point, focusing particularly on the impact on national policy with reports from the countries present. A strategy session included a presentation on the post-2015 Sustainable Development Goals process from David Ward, representing the Commission for Global Road Safety; a discussion on setting targets and indicators for road traffic injury prevention led by Etienne Krug, Director of Injury Prevention at WHO; and a discussion on the potential for innovative financing schemes to support international catalytic efforts for the Decade, with a presentation from Saul Billingsley of the FIA Foundation/Road Safety Fund. The meeting was also briefed by Alexander Alimov, Deputy Director of the Russian Ministry of Foreign Affairs, on a forthcoming UN General Assembly Resolution on global road safety, expected to be agreed by consensus in UN member states in Spring 2014.

Friday, 7 June 2013

How safe are India's roads?

Aftermath of a crash in India. Photo Copyright: iRAP
The answer: not very. But road fatalities and serious injuries on high risk roads could be reduced by up to 50% if safety 'star rating' recommendations are implemented on road infrastructure. This is the message of a new report from the International Road Assessment Programme which highlights the charity's work in India - the frontline of global road traffic deaths and injuries. The report details road assessments in seven Indian states, including Karnataka, where minimum '3 star' safety ratings to protect all road users - vehicle, cyclist and pedestrian - is being implemented on major roads. The report, produced with the support of iRAP's leading funding partners: Bloomberg Philanthropies, the FIA Foundation, the Global Road Safety Facility and the Road Safety Fund; can be downloaded here.

Your Life is Your Wealth

'Your Life is your wealth' - so protect yourself and stay safe - is the message to Uganda's 'boda boda' motorcycle taxi operators in a helmet safety awareness campaign led by the Uganda Helmet Vaccine Initiative. The latest phase of the campaign has included a train-the-trainer workshop from March 14-15 and boda boda workshops in the Rubaga (March 19), Kampala Central (April 10), Lubaga (April 16), Makindye (April 23), and Kawempe (May 28) divisions of Kampala. Radio advertisements promoting boda boda helmet use began airing throughout the capital on May 6. Billboards with the campaign's message are being posted throughout Kampala, and UHVI will also host the remaining five boda boda operator workshops. The campaign is being conducted as part of the Global Helmet Vaccine Initiative (GHVI), promoting helmet wearing in the UN Decade of Action for Road Safety. The work of GHVI is supported by the FIA Foundation, including through a grant via the Road Safety Fund. Monitoring and evaluation has been undertaken by the US Centers for Disease Control and Injury Prevention, and the World Bank Global Road Safety Facility has also contributed by enabling international expert mentoring for Uganda's traffic police.