We need resources to achieve results

How big a problem is road safety to Africa? No matter which way you look at it, it is a big problem. If you think about it in terms of public health, which is my primary concern, it is a cause of premature death and disability to a great deal of people. Right now we are finding that it is the leading cause of death amongst young men aged between 15 and 24. So just in terms of how many people die prematurely, how many people are in hospital, how many people are missing work or school, it has got a huge impact. It also incurs huge medical costs in terms of the people that need to be treated.

Olive Kobusingye, WHO's adviser or injury in Africa, warns that good intentions are not enough.

In terms of development generally it also has a very big impact. We have known for a number of decades now that countries are losing revenue to unsafe roads equal to 1%, 2%, 3% of their GDP, so it is not just a public health concern, it’s a development concern.

I think there are a number of reasons why road safety doesn’t get the attention that it deserves. The majority of people that die in road traffic crashes die in their ones and twos - once in a while you have a road crash that kills 30 people. So to the average person they only hear of one person, two people and they don’t think about it in terms of epidemic proportions. But there is also a sense that road traffic crashes are not preventable, people call them accidents, so they want to focus on things that they think they can prevent: infectious diseases, where medicines can be given to patients. So road safety has tended to be relegated to the back seat by governments, and even within the health sector it is not always looked at as a big priority, which is unfortunate as the health sector has a major role to play.

In virtually every country on this continent the health sector provides data about the numbers of people that come to the health facilities, so the health sector is able to articulate the public health tragedy of road traffic crashes. But in addition to that it is also a credible voice for talking about what needs to be done to reduce the crashes - in terms of putting in place safe infrastructure, making sure there is good control on the use of alcohol on the roads, that there is a reduction in speed, consistent use of seat belts and helmets and other interventions that do reduce crashes and minimise injury to those that are involved in crashes. There is also a major issue of improving trauma care, of providing emergency services for those that are involved in crashes. So within the health sector there is a major contribution to be made. But I think that contribution is going to be minimal if it is not brought into the multi-sectoral approach, if health doesn’t link up with transportation, road construction, policing and law enforcement, if it doesn’t involve civil society and the private sector. So I think we need to look at it in that broad context of various sectors bringing into play their various strengths and contributions to make roads safer.

We need to focus on achieving results, on reductions in pedestrian deaths, pedestrian injuries, on reducing the risks for cyclists – for all vulnerable road users. I think there is a danger that we can just stop at words, at putting out reports, declarations and recommendations that are not followed through. One of the challenges is that it requires action by many sectors at different levels. And so it would be easy for various sectors, for governments even, to feel good about having done something when in actual fact all they’ve done is put up a conference or put up recommendations. We need to quickly move to seeing action on implementing those recommendations: in terms of political commitment, budgetary commitment and the actions that would follow, such as safe infrastructure, legislation, enforcement, improving trauma care. We’re looking to the ‘Make Roads Safe’ report and the ‘Make Roads Safe’ campaign to make possible the implementation of the recommendations of the World Report on road traffic injury prevention, which makes important, specific, recommendations that are going to simply remain unimplemented without the necessary resources.

Governments have a big stake in this. They have the mandate to protect everybody and to provide services for all. But I think sometimes there’s a tendency for governments to feel that if the international community is dealing with an issue, if NGOs or the private sector are dealing with an issue, then in a way they are released from that responsibility. Unfortunately with road safety it is not that easy. Governments have the custodianship for policy and they are the custodians for national budgets and action plans. So in this case they have to take responsibility, even if they should and do get a lot of support from the international community. The primary responsibility for putting in the mechanisms for road safety really rests with governments.

Dr Olive Kobusingye is WHO Regional Advisor for violence and injury prevention in the WHO Regional Office for Africa. Dr Kobusingye studied medicine at Makerere University, Kampala, Uganda, and specialised in Surgery. She holds a Master of Science degree from University of London, and an MPH from the University of New York in Albany. Dr Kobusingye worked as an Accident and Emergency Surgeon for six years, lectured in Surgery and Injury Epidemiology at the Faculty of Medicine, Makerere University, and was the Director of the Injury Control Center - Uganda. She was also the founding Secretary General of the Injury Prevention Initiative for Africa. Dr Kobusingye was talking to Richard Stanley.

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