Road safety in Africa: a preventable public health crisis

Speeding up progress

Despite the second decade of action towards the UN sustainable development goal 3.6—to halve global deaths and injuries from road traffic incidents from 2020 to 2030—progress is limited. Government and civil society still urgently need to recognise road crashes as a public health crisis, instead of solely a transportation or infrastructure problem, and to demand collaborative global action. The types of actions needed to decrease road deaths have long been known: road safety management through strategy and policy; safer roads and mobility through intentional design; safer road users through awareness, education, and enforcement; safer vehicles; and effective medical response to crashes.4 Investment is needed in research into road safety interventions in low income settings, as it is unclear which evidence translates effectively from high income settings.5

Urbanisation and motorisation across Africa have led to more vehicles and congestion, bringing more people and roads into often dangerous proximity. Vulnerability to crashes is an equity issue: research on road safety in South Africa, for example, showed that the poorest communities are most affected.6

National and local governments must invest in safe road design and improving poor infrastructure that is hazardous for pedestrians and drivers, particularly in informal urban settlements. Investment is also needed in designated infrastructure for vulnerable road users, including lanes for cyclists and safe crossing places for pedestrians, which many countries lack. Pedestrians need dedicated space, which is often lacking in dense urban areas where commercial activities and residential dwellings may border directly onto the roadway. Enforced legislation is also needed to prevent unregulated and dangerous driving and excessive alcohol use among drivers. Governments should prioritise investment in safer roads and improving access to emergency medical care for rural populations, who are particularly vulnerable.

Lack of post-crash care in many African countries leads to avoidably higher death rates.1 Governments should expand post-crash responses: formal emergency medical services, rescue capability for extricating crash victims, and trained emergency care providers in the community and care facilities. Organisations such as WHO, the International Committee of the Red Cross, and the African Federation for Emergency Medicine are making huge strides in training thousands of providers across Africa in basic emergency care.7 Countries are also being supported by WHO and partner organisations to develop formal prehospital systems to provide rapid access to post-crash care.8

Seventeen African countries, including Rwanda, Senegal, and the Democratic Republic of the Congo (DRC), have reduced road deaths over the past decade. Successful projects include increasing public transit systems in Senegal, promoting motorcycle helmet use in Rwanda, and UN funding for systems to ensure safer imported secondhand vehicles in Uganda, DRC, and Congo.1 Kenya has shown promising results from using machine learning to develop a smart traffic control system to optimise traffic flow.9 These results demonstrate that solutions are attainable in low income contexts. Similar projects are needed across the continent.

Over 110 non-governmental organisations (NGOs) in 33 African countries are advocating for policies that promote road safety action and strengthened political and community accountability for safe road use.10 The Global Alliance of NGOs for Road Safety (KP’s employer) supports these local NGOs in advocating for evidence based interventions and developing local, regional, and national awareness campaigns.

A key challenge noted in the WHO report is the lack of morbidity data associated with road crashes. The global health community should collaborate in research, data systems, technological based interventions, and strengthening the post-crash response by supporting scalable emergency care training for all cadres of healthcare providers.

The global health community must act now. This preventable crisis will worsen without immediate intervention. Africa needs a collaborative, multistakeholder response with funding, expertise across government sectors, strong community engagement, and decisive action from political leaders. A long term plan to ramp up road safety, leading to healthier communities, would pay dividends to ensure the continent’s continued economic and social progress.