BMJ  2005;331:710-711 (1 October), doi:10.1136/bmj.331.7519.710

Editorial

Road safety in Africa

Is part of the broader development process

We must now use every day to act on road safety, and implement effective sustainable action to prevent injury and death on the world's roads.

Dr Lee Jong-wook, director-general, World Health Organization

The World Report on Road Traffic Injury Prevention notes that political will and commitment are important for sustainable prevention of road traffic injuries.¹ Development agencies need to place road safety in Africa and elsewhere at the centre of the global agenda along with the institutional, political, economic, and social issues which make roads so dangerous. For example, the World Summit on Sustainable Development held in Johannesburg, South Africa, in September 2002 did not include a single item on road safety—a growing problem in Africa and other low income and middle income countries—on its agenda, declaration, or plan of action.²

Africa's economic and social conditions began to deteriorate in the 1970s and have continued to do so.^{3 4} Between 1990 and 2002, the gross national income per capita grew at an annual average of 0.5% for all Africa and 0.02% for sub-Saharan Africa.⁵ Africa is faced with declining agricultural output, foreign debt burden, unemployment, poorly performing industry, deteriorating healthcare systems, HIV/AIDS, environmental insecurity, and political instability.⁶ This is the context in which the problem of road safety has to be addressed. Several issues require reflection and action. How does the prevailing economic situation in Africa affect the amount of resources devoted to road safety? In what ways does the political setting that has been characterised by instability in many countries affect development of institutions and capacity for road safety and other sectors? Bishai and colleagues show that budgetary expenditure on road safety at all levels of government in Uganda is US $0.09 per capita.⁷ This problem of low and negligible resource allocation to road safety in Africa needs to be addressed: at the moment, funding for road safety activities in Africa is very limited, a mere drop in the ocean.

Road transport can contribute to the socioeconomic development of Africa through facilitating movement of goods and people, opening up isolated areas, and promoting trade.⁸ Intricate movement patterns involve short, medium, and long distances, different modes of transport, and interaction within and between different places in Africa.⁸ The number of motor vehicles, volume of road traffic, and utilisation of the road by different road users in Africa have grown noticeably. The bicycle is increasingly used for passenger and freight transport in urban and rural areas.⁹ These transport characteristics indicate the need to pay adequate attention to safety measures in road transport development, especially safety of urban and rural communities living within the vicinity of roads. Development aid meant for road building takes no account of road safety, and there seems to be neglect of the fact that thousands will die and many more thousands will be injured while using roads in Africa and other parts of the world.

Under-reporting of road traffic injury is a major problem in Africa and virtually all countries of the world.^{1 10} About 200 000 people died on African roads in 2002,¹ and probably many more but we do not have an accurate picture because of the problem of under-reporting. A large proportion of those affected are pedestrians and passengers on public transport.^{1 11 12} Institutional and economic factors that lead to the problem of under-reporting need to be addressed. Governments and development partners need to take practical steps to improve data collection, analysis, and sharing among different agencies.

The lesson we have learnt from our practical experience in supervising implementation of road safety projects in low income and middle income countries, including Africa, is that road safety has a socioeconomic and political context. Real progress can be made if development agencies and governments deal realistically with this context. Road safety is no accident: it is the result of deliberate efforts by many sectors of society, both governmental and non-governmental, that have acknowledged it to be an important and valuable public good and have developed policies and programmes to support and maintain it. Development agencies, governments and non-governmental organizations need to allocate financial and human resources to address the road safety problem; identify and support a lead agency with authority and responsibility to guide national road safety efforts; prepare or revisit national road safety strategies and plans of action; implement specific actions such as enforcement of road safety regulations on speed and alcohol; and improve data collection on road traffic crashes in Africa. The time for action is now.

(khayesim{at}who.int)
Department of Injuries and Violence Prevention, World Health Organization, 20 Avenue Appia, CH-1211 Geneva, Switzerland

Department of Injuries and Violence Prevention, World Health Organization, 20 Avenue Appia, CH-1211 Geneva, Switzerland

---

Competing interests: None declared.

References

1. Peden M, Scurfield R, Sleet D, Mohan D, Hyder AH, Jarawan E, et al. World report on road traffic injury prevention. Geneva: World Health Organization, 2004. www.who.int/world-health-day/2004/infomaterials/world_report/en/ (accessed 22 Sep 2005).
2. United Nations. The road from Johannesburg: what was achieved and the way forward. New York: United Nations, Department of Economic and Social Affairs, 2003.
3. Darkoh MBK. Sub-Saharan Africa in crisis and the need for a new domestic order. In: Yeung Y, ed. Global change and the commonwealth. Hong Kong: Hong Kong Institute of Asia Pacific Studies, Chinese University of Hong Kong, 1996: 45-65.
4. World Bank. Sub-Saharan Africa: from crisis to sustainable growth. Washington, DC: World Bank, 1989.
5. World Bank. African development indicators 2004. Washington, DC: World Bank, 2004.
6. Sachs J. The end of poverty: economic possibilities for our time. New York: Penguin Press: 2005.
7. Bishai D, Hyder AA, Ghaffar A, Morrow RH, Kobusingye O. Rates of public investment for road safety in developing countries: case studies of Uganda and Pakistan. Health Policy Plan 2003;18: 232-5.[Abstract/Free Full Text]
8. Alila P, Khayesi M, Odhiambo W, Pedersen PO. Development of African freight transport—the case of Kenya. Copenhagen: Danish Institute for International Studies, 2005. (Working paper No 2005/6.)
9. Howe J. The headloading and footpath economy—walking in sub-Saharan Africa. World Transport Policy and Practice 2001;7(4): 8-12.
10. Roberts I. Death on the road to international development. BMJ 2005;330: 972.[Free Full Text]
11. Nantulya VM, Muli-Musiime F. Kenya: uncovering the social determinants of road traffic accidents. In: Evans T, Whitehead D, Diderichsen F, Bhuiya A, Wirth M, eds. Challenging inequities: from ethics to action. New York: Oxford University Press, 2001: 211-25.
12. Odero W, Garner P, Zwi A. Road traffic injuries in developing countries: a comprehensive review of epidemiological studies. Trop Med Intl Health 1997:2: 445-60.[CrossRef][ISI][Medline]

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