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“Death on Wheels” in sub-Saharan Africa: How to prevent it?

 
Begins:   Sep 03, 2012 
Ends:   Sep 03, 2012 

by Patricio V. Marquez, Lead Health Specialist, World Bank Africa Region

On the eve of the 2010 World Football Cup, former South Africa President Nelson Mandela experienced a tragedy that is all too common across sub-Saharan Africa: his great-granddaughter was killed in a car crash returning home after a concert in Soweto. The car's driver was arrested and charged with drunk driving.  Thousands of African families have experienced the pain of the Mandela family: according to WHO data, close to 250,000 people die each year on African roads, representing one-fifth of the world's road deaths, and about 500,000 sustain non-fatal injuries. Severe underreporting hides the real magnitude of the problem; for example, in Mozambique, estimates done in 2011 by a Harvard University team indicated that road deaths and non-fatal injuries were twice as high as those reported in official statistics.

As the map shows, the sub-Saharan African countries, with an estimated death rate of 32.2 people per 100,000 population, have some of the highest road death rates in the world although they possess only 2% of the world’s registered vehicles.  This rate is double the average rate for Latin America and South-East Asia, and is more than five times that of best road safety performers (Sweden, UK, and Netherlands).  Road traffic injuries are already the fourth leading cause of death in people aged 15–44 years; for young men, they are the second leading cause of premature death after HIV/AIDS.


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Source: Map commissioned by author; data from 2009 WHO Global Status Report on Road Safety


With rapid urbanization, economic growth and higher incomes, and increasing numbers of cars and two wheelers operating in poor road networks, the number of road deaths is predicted to rise in sub-Saharan Africa by at least 80% by 2020 if nothing is done to improve road conditions and traffic safety. Vulnerable road users, such as pedestrians, cyclists, motorcyclists and passengers using unsafe public transport, suffer greatest as they account for more than 50% of road deaths.

The economic cost of road traffic deaths and injuries has been estimated at 1-3 percent of GDP in most countries (WHO/World Bank 2004). This cost reflects the value of medical services used to treat injured people, insurance administration, forgone individual or family earnings, and business costs such as those due to temporary or permanent disability of employees and delayed delivery of goods and services.  Road injuries are also a major burden on already overburdened health systems.

So what is needed to make African roads safer?

Good roads are now seen as a critical investment for enhancing competitiveness and resilience in sub-Saharan Africa since they facilitate the movement of people, goods, and services and access to essential services. With the adoption of the 2011-2020 UN Decade of Action on Road Safety, African governments are also committed to reducing the heavy social toll imposed by road traffic injuries. So, too, are international organizations, despite the fact that in many infrastructure projects funded by multilateral development banks, road safety has often been merely an afterthought.

While economic aspirations and political declarations help, international experience makes it clear that making roads safer presumes the adoption of a “safe system approach” to make a country response effective and sustainable. Indeed, the reality in most of sub-Saharan Africa reflects the need to painstakingly build institutions and capacity to plan, manage and implement road safety initiatives at national scale rather than just adopting parallel or isolated sectoral interventions. A 2009 assessment by WHO covering 41 African countries evidenced this reality:

While the majority (88%) of the countries reported having a road safety agency, in only 10 (24%) has the government endorsed a strategy with targets and earmarked funding.

Most countries not only lack comprehensive road safety laws to address the main risk factors (speed, drunk driving, not wearing seat belts or helmets, using cell phones or texting while driving), but also suffer from sporadic enforcement, where bribes often prevent penalizing drivers who knowingly break traffic rules.

The availability of quality data to accurately assess the problem is limited in most countries, constraining planning, monitoring and impact evaluation efforts.

While 40% of countries reported having a formal emergency medical care system with a national access telephone number, their capacity and quality are poor. In most countries, emergency medical services are usually a marginal element of road safety programs as they are commonly equated with simple transportation arrangements (ambulance service). But to save thousands of lives and prevent long-lasting disabilities, interconnected systems are required  to offer a “continuum of care” from first contact with a victim (communication and transport systems, well-trained paramedics), to medical care provided at different health system levels in accordance to the needs of the injured.

The adoption by governments and international agencies of “shared value” principles (Porter and Kramer 2011), which combine economic and social concerns, could help redress Africa’s road infrastructure deficits that hinder economic growth while addressing the societal harm caused by road traffic injuries and premature deaths. This type of approach is needed to generate collective action by winning political and community support to implement the African Road Safety Action Plan 2011-2020 that was adopted in Addis Ababa last year, forging public and private partnerships to share the cost of enhanced infrastructure and interventions, and building institutional and management capacity to effectively deal with road safety challenges.

Moving forward, all of us will do well to keep in mind the words of Desmond Tutu, the Emeritus Archbishop of Cape Town and 1984 Nobel Peace Prize Laureate, who noted that “From time to time in human history there comes a killer epidemic that is not recognized for what it is and is not acted against until it is almost too late. HIV/AIDS, which is ravaging Sub-Saharan Africa, is one such. Road traffic injuries have the potential to be another."




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