According to the World Health Organization, road traffic injuries claim more than 1.35 million lives each year, injure and disable millions more and have a huge impact on victims, families, communities and governments. Road traffic deaths are particularly frequent among children accounting for around 186,000 deaths globally per year and are the leading cause of death for boys aged 10 and 19 yearsand among the top 5 leading causes for girls (see Figure below). Significant gains have been made over recent decades in terms of reduced child mortality from infectious, nutritional and other diseases but further investment in adolescents is critical with regard to road trauma.
In 2009, the World report on child injury prevention published by the World Health Organization and UNICEF called for an intensified focus on child injuries, particularly on the implementation of evidence-based interventions such as those for road traffic injuries. In addition, the Lancet Commission more recently called for the inclusion of a number of targeted interventions – including a number of road safety measures – in order to improve the health of the world’s adolescents and transform their lives.
The Save LIVES technical package published in 2017 by WHO promotes 22 known good practices, many of which are applicable to children such as:
- Lowering speeds around schools through legislation, enforcement and traffic calming;
- Making walking and cycling safer for children by improving road design;
- Ensuring countries apply UN regulation related to ISOFIX child restraints to improve vehicle safety for child passengers;
- Enforcing all road safety laws but especially those related to helmet wearing, child restraints and seat-belts, drink-driving and speeding;
- Optimizing post-crash facilities for children by ensuring that health personnel are adequately trained to deal with children, equipping emergency vehicles with child-sized equipment and improving paediatric-specific rehabilitation services;
- Supervising young children in the road environment; and
- Collecting and analyzing child-specific information in order to identify high-risk areas which are amenable to improved safety features.
A number of initiatives, focusing on the main causes of death for children and known interventions, have arisen in recent years. These include:
- The Every Women, Every Child global movement, supported by the six big global health agencies, puts into action the Global Strategy for Women’s, Children’s and Adolescent’s Health (2016-2030). Although recognizing that road traffic collisions are THE leading cause of death for adolescents and promoting improved infrastructure as well as helmet and seat-belt wearing, this movement has not yet prioritized the issue.
- The Child Health Initiative is a coalition hosted by the FIA Foundation and is an initiative that combines research, advocacy and evidence-based interventions to promote the child health agenda. Their focus is on safe, accessible, low carbon mobility; clean air and a healthy environment; and a safe and healthy journey to school for children around the world.
- UNICEF-led road safety programme in nine countries focusing on improving the safety of routes to school for child pedestrians, enforcing helmet use for children on motorcycles and strengthening safe school transportation policies.
- Star Rating for Schools is the first evidence-based approach to analysing infrastructural risks around schools developed by the International Road Assessment Programme (iRAP). It utilizes a user-friendly Android-based “app” which analyzes risks and offers low-cost solutions which are easy to implement and will save children’s lives on their commute to and from school.
A new initiative to save childrens’ lives
Addressing the epidemic of children killed and injured on the world’s roads is a priority for the Global Road Safety Partnership (GRSP) – a public-private membership-based global road safety organisation – hosted by the International Federation of Red Cross and Red Crescent Societies, based in Geneva, Switzerland. GRSP recently partnered with the Fondation Botnar – a Swiss-based charitable foundation established in 2003 which focuses on child health and well-being around the world – to implement practical, innovative and evidence-based interventions in medium-sized cities in six countries (India, Mexico, Romania, South Africa, Tunisia and Vietnam) through the Botnar Child Road Safety Challenge (“The Challenge”). This multimillion Swiss Franc project was launched by GRSP in August 2017 and aims to reduce child injuries and deaths in the six countries over 5 years using innovative and evidence-based interventions. The Challenge is timely in seeking to build on the growing global recognition of population shifts to urban areas and the impact of urbanization on public health. The Challenge also sees cities – particularly secondary cities – as great potential agents of change and incubators for innovation. It recognises the importance of multi-sector collaboration and strongly encourages public, private, and civil society sectors to work together to improve child road safety.
The six countries accounted for 359,932 road deaths in 2016 (or just over one quarter of the total 1.35 million global road deaths) with rates ranging from 10.3 per 100,000 (in Romania) to 26.4 per 100,000 (in Vietnam). Children under the age of 15-years account for around 7% of all road traffic deaths in these six countries. Although this sounds like a small proportion, that is more than 25,000 families who suffer the unspeakable pain of losing a child to a largely preventable cause.
The Botnar Child Road Safety Challenge
GRSP launched the Challenge in mid-2017. Interested parties in the six priority countries were invited to submit proposals to receive grant funds to design, implement, and evaluate projects to keep children safer in mid-sized cities (focusing on implementing the good practices from the Save LIVES package). The Challenge received a total of 56 preliminary proposals and each was exposed to a round of community feedback through use of the Innocentive online platform at the donor’s request. This process provided opportunity for interested parties to provide feedback/suggestions with the aim of strengthening proposals. At this stage, GRSP also conducted expert technical reviews and provided detailed feedback to applicants to ensure that proposals were well designed and aligned with international good practice road safety principles. Following the submission of revised proposals, an international judging panel considered 26 proposals to determine which projects to progress to project negotiation stage. Based on this determination, the panel advanced 12 projects to the next stage which involved one-on-one mentoring by a group of road safety experts with each potential grantee. In February 2018, following the presentation of their proposals by each potential grantee, the Fondation Botnar board selected 12 city level projects to fund (see Table below). GRSP supported applicants to further refine their proposals, and project implementation started from April 2018.
Most projects have a focus on improving road safety in and around school zones (see Table below). However, activities being undertaken to achieve this aim vary and include road assessments, infrastructure treatments, speed enforcement, speed limit setting, installation of signage, and school-based road safety education.
Summary of the 12 successful grants
The monitoring and evaluation of such an ambitious, multi-country programme is crucial to demonstrating the potentially enormous returns that such investments in road safety can have. Both GRSP and the Fondation Botnar appreciate the need for monitoring and evaluation and the importance of integrating it into the overall process of The Challenge from its inception. The George Institute for Global Health (TGI) is conducting macro and meso level monitoring for The Challenge in order to assess the impact of interventions undertaken in terms of both outcome (lives saved, crashes averted) and process (behaviour, knowledge, attitude) indicators, as well as outputs.
Evaluation at the macro level is of particular benefit to the overall coordination and running of The Challenge. The information gathered will enable the Fondation Botnar and the GRSP to assess which strategies and programs are effective, identify elements of programs associated with better results, and demonstrate accountability to external stakeholders and make decisions about future funding. Early integration of monitoring and evaluation mechanisms at the individual project level provides grantees with essential information on how projects are progressing, whether they are on track (financially, and in terms of deliverables and milestones), and whether objectives are being met. Appreciating the inherent challenges of assessing the impact of interventions in low- and middle-income countries, TGI developed a monitoring and evaluation framework, based on the Logic Model, to enable a standardised approach to be adopted across all 12 projects. The framework allows individual teams to collect information on processes, outputs and outcomes systematically.
A core element of The Challenge overall is to develop the capacity of country teams on the fundamental aspects of road safety evaluation. TGI are training and mentoring all grantees in monitoring and evaluation methods, including how to conduct baseline assessments, how to conduct and analyse in-depth interviews, focus-group discussions, observation studies, household surveys and knowledge, attitude and practice surveys.
The Botnar Child Road Safety Challenge represents a significant investment in improving child road safety and in developing capacity in six countries. Fondation Botnar and GRSP designed the Challenge to provide innovative opportunities to improve child road safety as well as enhance technical and implementation capacity among grant funds recipients. The Challenge places strong emphasis on implementing evidence-based solutions that are focused on the Safe System approach, and on building working partnerships between civil society, government, and the private sector.
The Challenge aims to produce evidence from good practice interventions that can be scaled up beyond the initial city-level focus to improve the safety of a much larger proportion of society than just the initial 12 project sites.