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On the road in Zambia
World Report
On the road in Zambia More and more people are becoming car owners in Zambia but more are also dying from roadtraffic accidents each year. Collaboration between several different sectors will be needed to address this public-health problem, say experts. Joseph Schatz reports from Lusaka.
www.thelancet.com Vol 372 August 9, 2008
27 deaths for every 100 000 people, compared with the global average of 19 deaths for every 100 000 people. Most of the people killed, WHO says, are pedestrians, people using public transport, and cyclists.
“...although road-traffic accidents are a public-health problem, addressing them will require cooperation far beyond the health community.” In Ghana, for instance, it is estimated that four people die every day in road-traffic accidents—and 40% of the victims are pedestrians, according to the Global Road Safety Partnership—a programme hosted by the International Federation of Red Cross and Red Crescent Societies. The scale of the problem is attributed to an increase in population growth, combined with an increase in the number of vehicles on the road. Efforts to deal with the problem throughout the region have had mixed results. But success stories can be found. For example, in Rwanda, where a concerted government campaign on
road safety has reduced deaths and injuries and won international praise. In Zambia, a country with a long history of road-traffic problems, 1266 people were killed in traffic accidents in 2007—up from 1170 the year before and 892 in 2004. More than 9000 more people were slightly or seriously injured, according to government statistics. And 2008 has started ominously. Part of the problem has to do with infrastructure. Although Zambia’s main highways are fairly well-maintained, they lack street lights—a particular hazard in rural areas, where villagers often walk on main roads late in the evening. Development agencies and non-governmental organisations routinely prohibit their staff from driving after 6pm each evening. Roads off the main “line-of-rail” are in even poorer condition. Beyond infrastructure, many accidents result from speeding, drunk driving, and other poor judgments, such as reversing on main roads. A frequent cause of major accidents, and deaths, is overtaking without a clear view of oncoming traffic.
The printed journal includes an image merely for illustration African Pictures
In Zambia, travellers often begin long bus trips with a group prayer to ask for the safety of the bus and the driver. From a look at recent Zambian headlines, it is not difficult to see why. A bus accident in Zambia’s rural Eastern Province claimed the lives of 27 people in early June. Weeks later, a collision between two trucks in southern Zambia killed eight people and injured 22. A local newspaper referred to the minibuses that dominate Zambia’s roads as “death traps”. Road-traffic fatalities are increasing at rapid pace this year, according to Zambia’s Road Transport Safety Authority (RTSA). In a country where a persistent HIV/AIDS epidemic and other infectious diseases, such as malaria and tuberculosis, claim the most lives and headlines, road-traffic accidents are the third leading cause of death. The epidemic, road safety and health officials say, stems from a toxic mix of poor driver education, faulty vehicles, strained road infrastructure, reckless drivers, and even corruption at police roadblocks. And it comes at a time of economic growth in Zambia, when more and more Zambians have the desire—and the means—to own cars. “Recognition of the problem is still low but it is rising”, says Canisius Banda, spokesman for the Zambian Ministry of Health. “People are very aware that malaria is a problem, that HIV is a problem, that TB is a problem”, but not road-traffic accidents, he told The Lancet. Zambia’s situation is hardly unique among developing countries, especially on the African continent. According to WHO, which launched a worldwide awareness campaign on road traffic safety in 2007, more people die from road crashes, per head, in Africa than in any other region of the world—
A bus on the road following the Zambezi River between Katima Mulilo and Sioma Falls, Zambia
435
World Report
African Pictures
The printed journal includes an image merely for illustration
South Africa’s Transport Minister at the launch of a plan to improve road safety
Some driving schools operate illegally—which is a big problem in a country in which more and more of the population wants to drive. Traffic in the capital city, Lusaka, is increasing along with economic growth, and a strengthening currency—the kwacha—is making it easier for Zambians to buy imported cars. The influx of second-hand cars—mostly imported from Japan through South Africa or Tanzania, sometimes with safety issues—is also cited by some officials as a road-safety problem. However, officials lay a great deal of blame on the drivers of the ubiquitous, and often decrepit, blue-and-white minibuses that serve as daily public transportation for many Zambians, and on larger, long-haul buses. Drivers and their ticket salesmen routinely pack buses well past their capacity. 436
Legal weight limits are often ignored, as are basic safety procedures, says RTSA commissioner Sakubita Sakubita, who adds that many bus drivers have an “I don’t care” attitude. However, law-enforcement officials can be part of the problem. The police checkpoints common on Zambian highways—and on highways throughout the continent—are supposed to help get unfit vehicles and drivers off the road. But police officers at these roadblocks are poorly paid and susceptible to bribes to look the other way. This situation is especially troublesome given the number of cars on Zambian roads that lack working headlights and other basic equipment. In addition to the physical and emotional traumas, the financial costs of road-traffic accidents, from economic losses to public-health costs, such as hospital spending, approach 3% of Zambia’s gross domestic product. The costs of road-traffic accidents in Africa, and other parts of the world, are increasingly drawing attention from international organisations. In March, the UN General Assembly voted to convene a ministerial meeting on road safety. “Road crashes kill an estimated 1·2 million people a year and injure 50 million more, disproportionately affecting the poor”, Anthony Bliss, programme coordinator for the World Bank’s Global Road Safety Facility, said in a recent statement. Whether international meetings will actually spark action at ground level remains to be seen. But there have already been successful interventions within Africa that have targeted road-traffic safety. An intriguing example of this has been found in Rwanda. In the years immediately after the central African country’s genocide in 1994, the World Bank found that Rwanda had one of the highest rates of death from road accidents. As part of the government’s post-genocide
rehabilitation and development efforts, it embarked on a campaign for road safety, funded by the World Bank, which overhauled regulations on road safety for both drivers and police and put in place new penalties. Seatbelt use is now mandatory, and the speed limit has been set at 60 km per hour, lower than in surrounding countries. And WHO has been singing Rwanda’s praises, highlighting the campaign in its 2006 regional health report on Africa, and noting statistics that show that road-traffic deaths have decreased from between 450 and 550 per year before 2001 to between 320 and 370 since 2001. In South Africa, the continent’s most developed country, the long-running “Arrive Alive” campaign has sought since 1997 to decrease road fatalities and injuries. Although the campaign has claimed some successes—such as a decrease in fatality rates in KwaZulu Natal province in the late 1990s, the government acknowledges that the campaign is not enough. In the Zambian capital, Lusaka, efforts have been made to stem pedestrian fatalities. After several students at the University of Zambia were killed trying to cross the busy road just off campus, authorities built a large walkway that stretches over the road, a safety mechanism also used near one of Lusaka’s biggest shopping centres. Indeed, although road-traffic accidents are a public-health problem, addressing them will require cooperation far beyond the health community. The Ministry of Health’s Banda argues that it will require cooperation from several different sectors, including road designers, law enforcement, and even the alcohol industry, to truly address the effect of road-traffic accidents on public health. People need to “recognise road safety as a health issue”, Banda says. “It’s a huge cost to Zambia both in terms of morbidity and mortality.”
Joseph Schatz www.thelancet.com Vol 372 August 9, 2008
On the road in Zambia More and more people are becoming car owners in Zambia but more are also dying from roadtraffic accidents each year. Collaboration between several different sectors will be needed to address this public-health problem, say experts. Joseph Schatz reports from Lusaka.
www.thelancet.com Vol 372 August 9, 2008
27 deaths for every 100 000 people, compared with the global average of 19 deaths for every 100 000 people. Most of the people killed, WHO says, are pedestrians, people using public transport, and cyclists.
“...although road-traffic accidents are a public-health problem, addressing them will require cooperation far beyond the health community.” In Ghana, for instance, it is estimated that four people die every day in road-traffic accidents—and 40% of the victims are pedestrians, according to the Global Road Safety Partnership—a programme hosted by the International Federation of Red Cross and Red Crescent Societies. The scale of the problem is attributed to an increase in population growth, combined with an increase in the number of vehicles on the road. Efforts to deal with the problem throughout the region have had mixed results. But success stories can be found. For example, in Rwanda, where a concerted government campaign on
road safety has reduced deaths and injuries and won international praise. In Zambia, a country with a long history of road-traffic problems, 1266 people were killed in traffic accidents in 2007—up from 1170 the year before and 892 in 2004. More than 9000 more people were slightly or seriously injured, according to government statistics. And 2008 has started ominously. Part of the problem has to do with infrastructure. Although Zambia’s main highways are fairly well-maintained, they lack street lights—a particular hazard in rural areas, where villagers often walk on main roads late in the evening. Development agencies and non-governmental organisations routinely prohibit their staff from driving after 6pm each evening. Roads off the main “line-of-rail” are in even poorer condition. Beyond infrastructure, many accidents result from speeding, drunk driving, and other poor judgments, such as reversing on main roads. A frequent cause of major accidents, and deaths, is overtaking without a clear view of oncoming traffic.
The printed journal includes an image merely for illustration African Pictures
In Zambia, travellers often begin long bus trips with a group prayer to ask for the safety of the bus and the driver. From a look at recent Zambian headlines, it is not difficult to see why. A bus accident in Zambia’s rural Eastern Province claimed the lives of 27 people in early June. Weeks later, a collision between two trucks in southern Zambia killed eight people and injured 22. A local newspaper referred to the minibuses that dominate Zambia’s roads as “death traps”. Road-traffic fatalities are increasing at rapid pace this year, according to Zambia’s Road Transport Safety Authority (RTSA). In a country where a persistent HIV/AIDS epidemic and other infectious diseases, such as malaria and tuberculosis, claim the most lives and headlines, road-traffic accidents are the third leading cause of death. The epidemic, road safety and health officials say, stems from a toxic mix of poor driver education, faulty vehicles, strained road infrastructure, reckless drivers, and even corruption at police roadblocks. And it comes at a time of economic growth in Zambia, when more and more Zambians have the desire—and the means—to own cars. “Recognition of the problem is still low but it is rising”, says Canisius Banda, spokesman for the Zambian Ministry of Health. “People are very aware that malaria is a problem, that HIV is a problem, that TB is a problem”, but not road-traffic accidents, he told The Lancet. Zambia’s situation is hardly unique among developing countries, especially on the African continent. According to WHO, which launched a worldwide awareness campaign on road traffic safety in 2007, more people die from road crashes, per head, in Africa than in any other region of the world—
A bus on the road following the Zambezi River between Katima Mulilo and Sioma Falls, Zambia
435
World Report
African Pictures
The printed journal includes an image merely for illustration
South Africa’s Transport Minister at the launch of a plan to improve road safety
Some driving schools operate illegally—which is a big problem in a country in which more and more of the population wants to drive. Traffic in the capital city, Lusaka, is increasing along with economic growth, and a strengthening currency—the kwacha—is making it easier for Zambians to buy imported cars. The influx of second-hand cars—mostly imported from Japan through South Africa or Tanzania, sometimes with safety issues—is also cited by some officials as a road-safety problem. However, officials lay a great deal of blame on the drivers of the ubiquitous, and often decrepit, blue-and-white minibuses that serve as daily public transportation for many Zambians, and on larger, long-haul buses. Drivers and their ticket salesmen routinely pack buses well past their capacity. 436
Legal weight limits are often ignored, as are basic safety procedures, says RTSA commissioner Sakubita Sakubita, who adds that many bus drivers have an “I don’t care” attitude. However, law-enforcement officials can be part of the problem. The police checkpoints common on Zambian highways—and on highways throughout the continent—are supposed to help get unfit vehicles and drivers off the road. But police officers at these roadblocks are poorly paid and susceptible to bribes to look the other way. This situation is especially troublesome given the number of cars on Zambian roads that lack working headlights and other basic equipment. In addition to the physical and emotional traumas, the financial costs of road-traffic accidents, from economic losses to public-health costs, such as hospital spending, approach 3% of Zambia’s gross domestic product. The costs of road-traffic accidents in Africa, and other parts of the world, are increasingly drawing attention from international organisations. In March, the UN General Assembly voted to convene a ministerial meeting on road safety. “Road crashes kill an estimated 1·2 million people a year and injure 50 million more, disproportionately affecting the poor”, Anthony Bliss, programme coordinator for the World Bank’s Global Road Safety Facility, said in a recent statement. Whether international meetings will actually spark action at ground level remains to be seen. But there have already been successful interventions within Africa that have targeted road-traffic safety. An intriguing example of this has been found in Rwanda. In the years immediately after the central African country’s genocide in 1994, the World Bank found that Rwanda had one of the highest rates of death from road accidents. As part of the government’s post-genocide
rehabilitation and development efforts, it embarked on a campaign for road safety, funded by the World Bank, which overhauled regulations on road safety for both drivers and police and put in place new penalties. Seatbelt use is now mandatory, and the speed limit has been set at 60 km per hour, lower than in surrounding countries. And WHO has been singing Rwanda’s praises, highlighting the campaign in its 2006 regional health report on Africa, and noting statistics that show that road-traffic deaths have decreased from between 450 and 550 per year before 2001 to between 320 and 370 since 2001. In South Africa, the continent’s most developed country, the long-running “Arrive Alive” campaign has sought since 1997 to decrease road fatalities and injuries. Although the campaign has claimed some successes—such as a decrease in fatality rates in KwaZulu Natal province in the late 1990s, the government acknowledges that the campaign is not enough. In the Zambian capital, Lusaka, efforts have been made to stem pedestrian fatalities. After several students at the University of Zambia were killed trying to cross the busy road just off campus, authorities built a large walkway that stretches over the road, a safety mechanism also used near one of Lusaka’s biggest shopping centres. Indeed, although road-traffic accidents are a public-health problem, addressing them will require cooperation far beyond the health community. The Ministry of Health’s Banda argues that it will require cooperation from several different sectors, including road designers, law enforcement, and even the alcohol industry, to truly address the effect of road-traffic accidents on public health. People need to “recognise road safety as a health issue”, Banda says. “It’s a huge cost to Zambia both in terms of morbidity and mortality.”
Joseph Schatz www.thelancet.com Vol 372 August 9, 2008