Publications
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Road Users
Drink-Driving: A Road Safety Manual for Decision-Makers and Practitioners (2nd ed.)
November 2022
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- international literature and good practices on motorcycle safety;
- assessment of motorcycle crashes, regulations, risk exposure data, risk indicators in African countries (with more detailed analysis of Burkina Faso, Cameroon, Rwanda, and Uganda); and
- consultations with stakeholders.
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This manual provides guidance and evidence for decision-makers and practitioners that should lead to an increase in the use of vehicle occupant restraints, such as seat-belts for adults and car seats for babies and children. It draws on experience from countries that have succeeded in achieving and sustaining high levels of vehicle occupant restraint use, and builds on new evidence, including from low and middle-income countries.

Safe, quality helmets reduce the risk of death in a road crash by over six times, and reduce the risk of brain injury by up to 74%. Head trauma is the leading cause of death for riders, and motorcycles continue to proliferate rapidly. Yet the use of helmets in many low and middle-income countries remains low.
The second edition of the Helmets Manual offers guidance to help decision makers and practitioners put in place the comprehensive set of laws, regulations and actions needed to increase the use of safe, quality helmets to save lives.

This manual provides guidance for decision-makers and practitioners to reduce the prevalence of drink driving and associated road trauma. It draws on experience from countries that have succeeded in achieving and sustaining reductions in alcohol-related road trauma, and includes recommendations for developing and implementing drink driving legislation, and advice on how to monitor and evaluate progress.

In developing countries with inadequate public transport and road infrastructure, motorcycles present a fast, cheap, and efficient transport alternative. Motorcycles are widely used in many African countries for personal and public transport, as well as for service delivery. In some African countries, motorized two and three-wheelers constitute the largest proportion of the motorized vehicle population. However, despite their benefits, motorcycles expose their riders and passengers to a high risk of serious injury or death in the event of crashes. Motorcycle safety is therefore a significant problem in Africa. On average, 22.5% of road traffic deaths in 2016 involved riders/passengers of two- and three-wheelers, according to the last data published by World Health Organization (WHO, 2018).
This research study presents comprehensive strategic recommendations on how to improve motorcycle safety in Africa. The study will serve as policy advice and technical assistance to the Bank’s regional member countries (RMCs). The study focuses on motorcycle safety conditions in Cameroon, Burkina Faso, Rwanda, and Uganda, where the use of motorcycles for daily activities is reputedly high. Recommendations are predicated on an examination of the major causes of motorcycle crashes and injuries, as well as an extensive body of knowledge from various sources, notably:

Road traffic crashes result in an estimated 1.35 million deaths and 50 million injuries worldwide per year with over 90 percent of these occurring in Low-Middle Income Countries (LMICs). Aside from the obvious pain and suffering this inflicts on individuals and communities, these deaths and injuries also place a large financial burden particularly on LMICs, by slowing economic growth.
The scale of the current response to this continuing crisis does not match the size of the problem. In addition, limited road safety resources are often expended on ineffective or suboptimal interventions. While road safety knowledge has improved over recent decades, there is still a need to improve decision making when selecting and applying effective evidence-based road safety interventions. Effective interventions are those that reduce fatal and serious injuries.
The World Bank's Global Road Safety Facility (GRSF) has developed this evidence-based guide on “What Works and What Does Not Work” in road safety in response to the critical need for effective evidence-based solutions.
This guide has been prepared to help readers understand that not all road safety interventions are equally effective and that what appear to be “common-sense” approaches to selecting road safety interventions will often not be the best. Although some provide benefits, others have very limited or even negative impacts, despite being commonly—and mistakenly—recommended or accepted. The guide offers a range of recommendations with a focus on interventions in LMICs, although the information may also be of relevance to all countries. The contents will be valuable to those working on road safety at policy or practitioner levels, including World Bank technical team leaders and others who seek to establish, expand, or improve road safety programs in LMICs.
The guide sets knowledge on evidence-based interventions within a “Safe System” context, providing advice on each of the Safe System pillars (road safety management, safe roads, safe speeds, safe vehicles, safe road users, and post-crash care) while recognizing that evidence-based solutions must be drawn from across pillars to produce effective road safety outcomes. At the core of this document is a summary table with an overview of beneficial and non-beneficial interventions based on sound scientific evidence. This is followed by more detailed information including case studies and references to the evidence base to support the summary.
Many safe road interventions are recommended for adoption, including integrated public transport, roadside and central barrier systems, medians, infrastructure to support appropriate operational speed for road users, roundabouts, grade separation and interventions to reduce exposure to risk at intersections, pedestrian footpaths and crossings, separated bicycle and motorcycle facilities, and traffic signs and line marking (including audio-tactile line marking). Some of these are highly effective, with up to a 70 or 80 percent reduction in fatalities and severe injuries (for example, safety barriers and roundabouts).
Various speed-related interventions also produce significant benefits, with some able to almost eliminate death and serious injury. Examples of effective speed interventions include traffic calming (including humps and chicanes), roundabouts, raised intersections and crossings, gateway treatments, lower speed limits (including 30 km/h (20 mph) zones for pedestrians) and speed cameras.
A variety of road user-based interventions have been implemented over many years, with effective examples including extensive supervised on-road practice and/or graduated licensing systems as part of the driver-licensing system, increased age for driving license eligibility, hazard perception training and testing, public education and campaigns as part of an integrated strategy (especially communicating enforcement to increase general deterrence), enforcement, penalties, alcohol interlocks, fatigue and speed monitoring, and increased helmet wearing rates.
Key vehicle-based interventions include applying minimum vehicle safety standards and vehicle ratings (through the Global New Car Assessment Program, or “NCAP”), seat belts, periodic vehicle maintenance, daytime running lights, under-run guards on trucks, Electronic Stability Control, and other advanced vehicle technologies.
Enhanced post-crash care can also produce better road safety outcomes, including systems to improve emergency response time, better emergency care, improved first aid skills for the public, and improved hospital care.
Equally important, the report also identifies clear examples where interventions are not effective. The worst of these are interventions that increase risk. These include increasing travel speed without improving quality of safety infrastructure, most forms of post-license driver and rider education and training, and many (but not all) forms of regular school-based driver education (such as those that seek to increase car-handling skills). The increase in risk is typically because such initiatives increase the level of confidence leading to an increase in risk taking. Other interventions that have no demonstrated safety benefits are to be avoided. These include license schemes through application or payment, training programs or education within schools that aim to improve road safety knowledge (including ad hoc visits by road safety experts or enthusiasts), and education campaigns conducted in isolation.
There are effective alternative interventions for each of these as described within this document, and these should be applied instead. It is extremely important that resources are not wasted on ineffective interventions on behalf of road safety but rather that evidence-based road safety interventions are employed.
There are a variety of documents available on the issue of road safety intervention effectiveness, many of which are referenced here. However, there are some key points of differences and added value in this guide, including a synthesis of the evidence on a broad range of interventions and a contrast between effective and noneffective interventions, allowing readers to compare options. Where noneffective interventions are identified, viable effective interventions are provided thereby supporting decision making. The guide also provides direct advice to those working in LMICs, drawing on key sources of information where this is available. Importantly, concise yet robust evidence is provided across each of the Safe System pillars.
There is a need to continue building the knowledge base on effective road safety interventions, particularly in LMICs where there are a number of gaps in knowledge. The contents of this guide represent a useful, up-to-date summary of current knowledge for application.

Nearly 30% of all road traffic deaths reported to WHO involve powered two- and three-wheeled vehicles, such as motorcycles, mopeds, scooters and electrical bikes (e-bikes). As these vehicles become increasingly widespread, particularly in low-and middle-income countries, the proportion of deaths involving them is increasing.
The second edition of the Powered- Two and Three-Wheeler Safety Manual offers guidance to help decision makers and practitioners put in place the comprehensive set of laws, regulations and actions needed to save lives. Rooted in new case studies and evidence, including from low- and middle-income countries, it includes guidelines on developing safer roads, ensuring safer mobility for all road users, vehicle safety standards, and actions to improve emergency responses to crashes.

Based on 2018 findings of the World Health Organization (WHO), the number of deaths due to road crashes is 1.35 million deaths per year. While this number is quite high and increasing every year, the rate of road crash deaths per 100,000 of population has remained constant, at around 18 deaths, over the years. This rate of deaths is however not distributed proportionately amongst the different regions and countries. The high-income countries have recorded lowest average rate at 8.3 per 100,000. In contrast to this number, low-income countries have the highest annual road traffic fatality rates averaging at 27.5 deaths per 100,000– more than three times the average for high-income countries.
ROAD CRASH AND IMPACT
Most of the deaths and injuries from road crashes are of the working age population, which negatively impacts both the economy and the demography of the region. Road traffic injuries are currently the 8th leading cause for death for all age groups, and further compounding the demographic impact is the fact that road crashes are the leading cause of death for children and young adults, between the ages of 5 and 29 years.
Road traffic crashes have a high economic impact, costing 3 percent of a country’s GDP on average. They also cause a significant impact on the individuals as well as their families. Injuries arising due to road crashes can lead to trauma for the individual and loss in productivity. Along with costs of treatment, economic challenges may further be increased due to temporary or permanent loss of income as well. Along with the victim, road crashes take an emotional toll on the immediate family members and caregivers during the treatment process or any deaths and add to the economic burden as they may need to take time off work or school to care for the injured.
The distribution of road users varies within different regions and income groups of countries. This impacts the variations in death rates amongst the users. The low- and middle-income countries have a significantly high proportion of pedestrians, cyclists and two- or three-wheeler motorized vehicles. Overall, the global road traffic deaths for pedestrians and cyclists is at 26% and another 28% for two- and three-wheeler motorcyclists, totaling nearly 54% of vulnerable road users. This proportion varies in comparison between the economic group of countries, with a high percentage of road crash victims being car occupants.
Globally, a significant percentage of road crash victims being car occupants is also an indicator of insufficient infrastructure for controlling traffic speeds and volumes. Furthermore, when people use private cars more for their daily activities, it results in a higher level of total vehicle-kilometers traveled (VKT). Choice of using personal vehicle over using non-motorized transport or public mass transport may be attributed to the car-centric planning and design of road infrastructure. Many countries lack adequate protected infrastructure for pedestrians and cyclists. This discourages users to walk or bicycle to their destinations.
Mode-choice plays a critical role in road safety. Public mass transit systems not only provide faster and safer transportation mode choices, they also help reduce dependency on privately owned vehicles on the road. Public mass transit services typically follow designated routes as well, thereby minimizing interferences between different types of road users. While many countries still have to develop mass transit infrastructure such as metro rails, public bus system is quite prevalent, with bus rapid transit (BRT) and bus only lane infrastructures being developed. Absence of proper first and last mile connectivity to the transit stations poses security threats for road users and discourages them from using public transport.
SAFE SYSTEM APPROACH
The Safe System approach derives from the Swedish Vision Zero and Dutch Sustainable Safety strategies that have a long-term goal for a road traffic system to be eventually free from fatalities and serious injuries. It represents a shift away from traditional approach of preventing collisions to a more forgiving approach of preventing fatalities and mitigating serious injuries in road crashes. The traditional approach emphasizes the responsibility of road users to avoid crashes rather than the responsibility of system designers to provide a safe mobility system.
The Safe System approach takes into account that humans are vulnerable and fallible, and errors are to be expected. It aims at ensuring these mistakes do not lead to a crash, and if a crash does occur, it is sufficiently controlled to not cause a death or a life-changing injury. Thereby with a “zero-harm goal”, it places a strong emphasis on road builder/operator and vehicle manufacturer accountability for road safety performance.
The Safe System approach emphasizes shared responsibility. Government agencies at different levels and a range of multisectoral agencies and stakeholders – including policy makers, road engineers, planners, vehicle manufacturers, enforcement officers, emergency medical agencies, road safety educators etc. – are accountable for the system’s safety and all road users – drivers, cyclists, and pedestrians are responsible for complying with the system rules.

Cycling has many health and environmental benefits. Yet every year 41 000 cyclists die in road traffic-related crashes worldwide. Many leave their homes as they would on any normal day – for school, work, worship, or meeting friends – never to return. Millions more people are injured in road traffic-related crashes while cycling, some of whom become permanently disabled. These incidents cause much suffering and grief, as well as economic hardship for families and loved ones.
However, the growing focus on sustainable mobility – an increasing effort to shift more travel from motorized transport to the use of public transport, walking and cycling – makes cyclists’ safety an increasingly important component of road safety efforts. Cyclist collisions, like other road traffic crashes, are predictable and preventable and therefore should not be accepted as inevitable.
Cyclist safety: an information resource for decision-makers and practitioners describes the magnitude of cyclist death and injury, the key risk factors, and effective interventions. The document stresses the importance of a comprehensive, holistic approach that includes legislation, enforcement and behavioral measures specifically for cyclists; design of the built environment; as well as integrating cyclist safety into overall road safety and transport strategies. It also draws attention to the benefits of cycling, which should be promoted as an important mode of transport given its potential to improve health and preserve the environment.
We hope that this resource, which is designed for a multidisciplinary audience including engineers, planners, law enforcement officers, public health professionals and educators, will contribute towards strengthening national and local capacity to implement cyclist safety measures in various settings worldwide. We encourage all to bring this resource to the attention of those who will use it to save the lives of cyclists.
The World Health Organization (WHO) coordinated the production of this resource. Soames Job, Head GRSF and Global Lead Road Safety, World Bank was one of the principal writers of this document. GRSF contributions to this document were supported by UK Aid.