Publications
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Post-Crash Health Care
Beyond the Numbers: Estimating the Disability Burden of Road Traffic Injuries
November 2023
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Post-Crash Health Care
Transport for Health: The Global Burden of Disease from Motorized Road Transport
August 2021
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- reasons for taking action
- the main elements of post-crash response
- examples of best practice
- helpful resources.
- government departments and policymakers
- local and regional government
- emergency service managers and professionals
- paramedics and community responders
- laypeople and members of the community
- crash survivors, families, and organizations representing them.

This GRSF-funded study explores the medical, economic, and social costs of road traffic accidents (RTAs), particularly focusing on individuals with permanent disabilities. According to the World Health Organization (WHO), RTAs are a global public health crisis, ranked as the 12th leading cause of death and the primary cause of mortality among children and young adults. While the UN's Decade of Action for Road Safety (2021–2030) aims to reduce RTA deaths, the study argues that more focus is needed on injuries and the long-term impact on those left disabled by RTAs.
Building on GRSF’s report Beyond The Numbers: Estimating the Disability Burden of Road Traffic Injuries (Mitra et al., 2023), this project examines data from Namibia and South Africa and interviews with experts to highlight the often-overlooked challenges faced by RTA-related disability survivors. These individuals encounter unique issues—such as brain injuries, psychological trauma, and sudden financial burdens—that require specific support mechanisms beyond general disability frameworks.
Economic losses from RTAs are substantial, with WHO estimating global costs up to $1.8 trillion annually. However, existing research focuses mainly on medical costs and productivity losses, neglecting broader social impacts. Data on the prevalence of permanent disabilities varies, underscoring the need for standardized research.
The study calls for integrating disability concerns into road safety policies, emphasizing that improved enforcement in low- and middle-income countries could prevent disabilities and reduce societal costs. Ultimately, it advocates for recognizing RTA-related disabilities as a critical issue within global health, disability policy, and development agendas.

Road traffic injuries (RTIs) are a critical public health issue in Jordan, as highlighted in the 2022 Annual Report of Traffic Accidents from the Jordan Public Security Directorate. With 169,409 crashes recorded in 2022, resulting in 562 deaths and 11,510 injuries, RTIs have emerged as the leading cause of death for children and young people, and the second-leading cause for adults aged 20–64.
This analytical research study aims to understand RTI-induced disabilities in Jordan, identify contributing factors, and assess the associated costs for road traffic crash victims. Using a mixed-methods approach, the research included quantitative and qualitative data collection through hospital-based surveillance and follow-up surveys at one- and three months post-injury. The study involved six public and private hospitals across Jordan. Key informant interviews with stakeholders from various sectors were conducted to gain comprehensive insights.
The study's findings reveal that most RTI patients were male (79%) with an average age of 34 years. Crashes predominantly occurred during early mornings and night hours, involving mainly cars (72%) and motorcycles/bicycles (40%). A significant number of patients (74%) received prehospital care, primarily from ambulance staff. Most patients (66%) were fully conscious upon arrival at the emergency room.
Injury analysis showed that 58% of patients had a single injury, with extremities being the most affected area. Financially, 49% of patients incurred immediate costs upon hospital admission, and follow-up care also resulted in out-of-pocket expenses, particularly for physiotherapy and medications.
The study indicated that 79% of patients experienced some disability at the one-month follow-up, with varying degrees from mild to extreme. By the third month, 73% reported no disability, though 26% continued to experience mild impairments.
This study underscores the significant burden of RTIs and associated disabilities in Jordan, highlighting the need for targeted interventions to reduce injuries and robust long-term care to support affected individuals.

It is well-documented that road crashes claim around 1.35 million lives each year and rank as the eighth leading cause of death globally, causing huge burdens for economies, health systems, and transport networks. However, beneath the sobering fatality statistics lies a largely unexplored landscape: the staggering toll of disabilities induced by road crashes. Until now, the focus of road safety research and policy discourse has predominantly revolved around fatalities, which has limited our understanding of traffic-related injuries and disability burdens at the individual, community, and national level.
To address this critical knowledge gap, this pioneering study—involving over 2,300 patients hospitalized for road crash injuries—provides valuable insights into the prevalence, causes, and long-term impacts of crash-related disabilities. By broadening the discussion beyond fatalities to the often-overlooked issue of disability, the report paves the way for a more holistic perspective on road safety impacts, which can inform more effective road safety policies.
This report is a call to action for comprehensive and context-specific interventions that encompass both the transport and health sectors. Effective measures may include implementing safety regulations, enhancing emergency services, strengthening rehabilitative care, and expanding social safety nets to ease the financial burden on crash survivors. Collaborative efforts between governments, global and regional organizations, civil society, and other stakeholders will be indispensable.

Durante muchos años se han implementado diversas intervenciones basadas en los usuarios de las vías, con ejemplos efectivos que incluyen prácticas supervisadas en la vía y/o sistemas de licencias graduales como parte del sistema de licencias de conducir, aumento de la edad para la obtención de la licencia de conducir, capacitación y pruebas de percepción de riesgos, educación pública y campañas como parte de una estrategia integrada (especialmente la comunicación de la aplicación de la ley para aumentar la disuasión general), aplicación de la ley, sanciones, dispositivos de bloqueo de alcoholemia, monitoreo de fatiga y velocidad y mayores tasas de uso del casco.
Las intervenciones clave basadas en vehículos incluyen la aplicación de estándares mínimos de seguridad y calificaciones de vehículos (a través del Programa Global de Evaluación de Autos Nuevos o “NCAP”), cinturones de seguridad, mantenimiento periódico de vehículos, luces de circulación diurna, protectores antiempotramiento en camiones, control electrónico de estabilidad y otras tecnologías avanzadas para vehículos.
Una mejor atención posterior a un accidente también puede producir mejores resultados en materia de seguridad vial, incluidos sistemas para mejorar el tiempo de respuesta ante emergencias, mejor atención de emergencia, mejores habilidades de primeros auxilios para el público y mejor atención hospitalaria.
Igualmente importante es que el informe también identifica ejemplos claros en los que las intervenciones no son efectivas. Las peores de ellas son las intervenciones que aumentan el riesgo. Entre ellas se encuentran el aumento de la velocidad de los viajes sin mejorar la calidad de la infraestructura de seguridad, la mayoría de las formas de educación y formación para conductores y motociclistas posteriores a la obtención de la licencia y muchas (pero no todas) formas de educación para conductores en las escuelas (como las que buscan mejorar las habilidades de manejo del automóvil). El aumento del riesgo se debe normalmente a que dichas iniciativas aumentan el nivel de confianza, lo que lleva a un aumento de la asunción de riesgos. Hay que evitar otras intervenciones que no han demostrado tener beneficios en materia de seguridad, como los programas de licencias mediante solicitud o pago, los programas de formación o educación en las escuelas que tienen como objetivo mejorar el conocimiento de la seguridad vial (incluidas las visitas ad hoc de expertos o entusiastas de la seguridad vial) y las campañas de educación realizadas de forma aislada.
Existen intervenciones alternativas eficaces para cada una de estas, como se describe en este documento, y se deberían aplicar en su lugar. Es extremadamente importante que no se desperdicien recursos en intervenciones ineficaces en nombre de la seguridad vial, sino que se empleen intervenciones de seguridad vial basadas en la evidencia.
Hay una variedad de documentos disponibles sobre el tema de la eficacia de las intervenciones de seguridad vial, muchos de los cuales se citan aquí. Sin embargo, esta guía contiene algunos puntos clave que diferencian y aportan valor añadido, como una síntesis de la evidencia sobre una amplia gama de intervenciones y un contraste entre intervenciones eficaces e ineficaces, lo que permite a los lectores comparar las opciones. Cuando se identifican intervenciones ineficaces, se ofrecen intervenciones eficaces viables, lo que respalda la toma de decisiones. La guía también ofrece asesoramiento directo a quienes trabajan en países de ingresos bajos y medios, basándose en fuentes de información clave cuando están disponibles. Es importante destacar que se ofrece evidencia concisa pero sólida sobre cada uno de los pilares del Sistema Seguro.
Es necesario seguir construyendo la base de conocimientos sobre intervenciones eficaces en materia de seguridad vial, en particular en los países de ingresos bajos y medios, donde hay una serie de lagunas en el conocimiento. El contenido de esta guía representa un resumen útil y actualizado del conocimiento actual para su aplicación.

Les accidents de la route entraînent environ 1,35 million de décès et 50 millions de blessures dans le monde chaque année, dont plus de 90 % se produisent dans les pays à revenu faible ou intermédiaire (PRFI). Outre la douleur et la souffrance évidentes que cela inflige aux individus et aux communautés, ces décès et blessures représentent également un lourd fardeau financier, en particulier pour les PRFI, en ralentissant la croissance économique.
L’ampleur de la réponse actuelle à cette crise continue ne correspond pas à l’ampleur du problème. De plus, les ressources limitées consacrées à la sécurité routière sont souvent dépensées pour des interventions inefficaces ou sous-optimales. Bien que les connaissances en matière de sécurité routière se soient améliorées au cours des dernières décennies, il est encore nécessaire d'améliorer la prise de décision lors de la sélection et de l'application d'interventions efficaces basées sur des preuves. Les interventions efficaces sont celles qui réduisent les blessures mortelles et graves.
Le Global Road Safety Facility (GRSF) de la Banque mondiale a élaboré ce guide basé sur des preuves intitulé « Ce qui fonctionne et ce qui ne fonctionne pas » en matière de sécurité routière en réponse au besoin critique de solutions efficaces basées sur des preuves.
Ce guide a été préparé pour aider les lecteurs à comprendre que toutes les interventions en matière de sécurité routière ne sont pas également efficaces et que ce qui semble être des approches « de bon sens » pour choisir des interventions de sécurité routière ne sera souvent pas le meilleur choix. Bien que certaines apportent des avantages, d'autres ont des impacts très limités voire négatifs, malgré le fait qu'elles soient couramment – et à tort – recommandées ou acceptées. Le guide offre une gamme de recommandations en mettant l'accent sur les interventions dans les PRFI, bien que les informations puissent également être pertinentes pour tous les pays. Le contenu sera précieux pour ceux qui travaillent sur la sécurité routière au niveau des politiques ou des praticiens, y compris les chefs d'équipe techniques de la Banque mondiale et d'autres personnes cherchant à établir, développer ou améliorer des programmes de sécurité routière dans les PRFI.
Le guide situe les connaissances sur les interventions basées sur des preuves dans un contexte de « Système sûr », en fournissant des conseils sur chacun des piliers du Système sûr (gestion de la sécurité routière, routes sûres, vitesses sûres, véhicules sûrs, usagers de la route sûrs et soins post-accident) tout en reconnaissant que les solutions basées sur des preuves doivent être tirées de tous les piliers pour produire des résultats efficaces en matière de sécurité routière. Au cœur de ce document se trouve un tableau récapitulatif avec un aperçu des interventions bénéfiques et non bénéfiques basées sur des preuves scientifiques solides. Cela est suivi d'informations plus détaillées, y compris des études de cas et des références à la base de preuves pour soutenir le résumé.
De nombreuses interventions sûres sur les routes sont recommandées pour adoption, y compris les transports publics intégrés, les systèmes de barrières latérales et centrales, les médianes, les infrastructures pour soutenir une vitesse de fonctionnement appropriée pour les usagers de la route, les giratoires, la séparation de niveau et les interventions pour réduire l'exposition aux risques aux intersections, les trottoirs et passages piétons, les installations séparées pour les bicyclettes et les motocyclettes, et les panneaux de signalisation et le marquage au sol (y compris le marquage tactile-audio). Certaines de ces interventions sont très efficaces, avec une réduction allant jusqu'à 70 ou 80 % des décès et des blessures graves (par exemple, les barrières de sécurité et les giratoires).
Diverses interventions liées à la vitesse produisent également des avantages significatifs, certaines étant capables de presque éliminer les décès et les blessures graves. Des exemples d'interventions efficaces sur la vitesse incluent le ralentissement de la circulation (y compris les ralentisseurs et les chicanes), les giratoires, les intersections et passages surélevés, les traitements d'entrée, les limites de vitesse inférieures (y compris les zones de 30 km/h (20 mph) pour les piétons) et les radars automatiques.
Diverses interventions basées sur les usagers de la route ont été mises en œuvre au fil des ans, avec des exemples efficaces incluant une pratique supervisée extensive sur la route et/ou des systèmes de permis de conduire gradués dans le cadre du système de délivrance des permis de conduire, une augmentation de l'âge d'admissibilité au permis de conduire, une formation et des tests de perception des dangers, l'éducation et les campagnes publiques dans le cadre d'une stratégie intégrée (en particulier la communication sur l'application de la loi pour augmenter la dissuasion générale), l'application de la loi, les pénalités, les verrous d'alcool, la surveillance de la fatigue et de la vitesse, et l'augmentation des taux de port du casque.
Les principales interventions basées sur les véhicules comprennent l'application de normes minimales de sécurité des véhicules et les évaluations des véhicules (via le Programme mondial d'évaluation des voitures neuves, ou « NCAP »), les ceintures de sécurité, l'entretien périodique des véhicules, les feux diurnes, les pare-chocs arrière sur les camions, le contrôle électronique de la stabilité et d'autres technologies avancées pour les véhicules.
Les soins post-accident améliorés peuvent également produire de meilleurs résultats en matière de sécurité routière, y compris des systèmes pour améliorer le temps de réponse d'urgence, de meilleurs soins d'urgence, une amélioration des compétences en premiers secours pour le public et une amélioration des soins hospitaliers.
Tout aussi important, le rapport identifie également des exemples clairs où les interventions ne sont pas efficaces. Les pires de ces interventions sont celles qui augmentent le risque. Cela inclut l'augmentation de la vitesse de déplacement sans améliorer la qualité des infrastructures de sécurité, la plupart des formes d'éducation et de formation des conducteurs et motocyclistes après l'obtention du permis, et de nombreuses (mais pas toutes) formes d'éducation des conducteurs en milieu scolaire (telles que celles qui cherchent à améliorer les compétences de conduite). L'augmentation du risque est généralement due au fait que ces initiatives augmentent le niveau de confiance, conduisant à une prise de risque accrue. D'autres interventions qui n'ont pas démontré de bénéfices pour la sécurité doivent être évitées. Cela inclut les systèmes de permis via demande ou paiement, les programmes de formation ou d'éducation dans les écoles visant à améliorer les connaissances en matière de sécurité routière (y compris les visites ad hoc d'experts ou d'enthousiastes en sécurité routière), et les campagnes d'éducation menées isolément.
Il existe des interventions alternatives efficaces pour chacune de celles-ci comme décrit dans ce document, et elles devraient être appliquées à la place. Il est extrêmement important que les ressources ne soient pas gaspillées sur des interventions inefficaces au nom de la sécurité routière, mais plutôt que des interventions de sécurité routière basées sur des preuves soient mises en œuvre.
Il existe une variété de documents disponibles sur la question de l'efficacité des interventions en matière de sécurité routière, dont beaucoup sont référencés ici. Cependant, il existe quelques points clés de différence et de valeur ajoutée dans ce guide, y compris une synthèse des preuves sur un large éventail d'interventions et un contraste entre les interventions efficaces et non efficaces, permettant aux lecteurs de comparer les options. Lorsqu'une intervention non efficace est identifiée, des interventions efficaces viables sont fournies, soutenant ainsi la prise de décision. Le guide offre également des conseils directs à ceux qui travaillent dans les PRFI, en s'appuyant sur des sources d'information clés lorsque celles-ci sont disponibles. De manière importante, des preuves concises mais robustes sont fournies pour chacun des piliers du Système sûr.
Il est nécessaire de continuer à renforcer la base de connaissances sur les interventions efficaces en matière de sécurité routière, en particulier dans les PRFI où il existe un certain nombre de lacunes en matière de connaissances. Le contenu de ce guide représente un résumé utile et à jour des connaissances actuelles pour application.

Acidentes de trânsito resultam em cerca de 1,35 milhão de mortes e 50 milhões de feridos no mundo todo por ano, com mais de 90% deles ocorrendo em países de renda média e baixa (LMICs). Além da dor e do sofrimento óbvios que isso inflige a indivíduos e comunidades, essas mortes e ferimentos também representam um grande fardo financeiro, especialmente para os LMICs, ao desacelerar o crescimento econômico.
A escala da resposta atual a essa crise contínua não corresponde ao tamanho do problema. Além disso, recursos limitados de segurança no trânsito são frequentemente gastos em intervenções ineficazes ou abaixo do ideal. Embora o conhecimento sobre segurança no trânsito tenha melhorado nas últimas décadas, ainda há necessidade de melhorar a tomada de decisões ao selecionar e aplicar intervenções eficazes de segurança no trânsito baseadas em evidências. Intervenções eficazes são aquelas que reduzem ferimentos fatais e graves.
O Global Road Safety Facility (GRSF) do Banco Mundial desenvolveu este guia baseado em evidências sobre "O que funciona e o que não funciona" na segurança no trânsito em resposta à necessidade crítica de soluções eficazes baseadas em evidências.
Este guia foi preparado para ajudar os leitores a entender que nem todas as intervenções de segurança no trânsito são igualmente eficazes e que o que parecem ser abordagens de "senso comum" para selecionar intervenções de segurança no trânsito muitas vezes não serão as melhores. Embora algumas forneçam benefícios, outras têm impactos muito limitados ou mesmo negativos, apesar de serem comumente — e erroneamente — recomendadas ou aceitas. O guia oferece uma série de recomendações com foco em intervenções em países de baixa e média renda, embora as informações também possam ser relevantes para todos os países. O conteúdo será valioso para aqueles que trabalham com segurança no trânsito em níveis de política ou profissional, incluindo líderes de equipe técnica do Banco Mundial e outros que buscam estabelecer, expandir ou melhorar programas de segurança no trânsito em países de baixa e média renda.
O guia define o conhecimento sobre intervenções baseadas em evidências dentro de um contexto de "Sistema Seguro", fornecendo conselhos sobre cada um dos pilares do Sistema Seguro (gestão de segurança no trânsito, estradas seguras, velocidades seguras, veículos seguros, usuários seguros das estradas e cuidados pós-acidente), ao mesmo tempo em que reconhece que soluções baseadas em evidências devem ser extraídas de todos os pilares para produzir resultados eficazes de segurança no trânsito. No centro deste documento está uma tabela de resumo com uma visão geral de intervenções benéficas e não benéficas com base em evidências científicas sólidas. Isso é seguido por informações mais detalhadas, incluindo estudos de caso e referências à base de evidências para dar suporte ao resumo.
Muitas intervenções rodoviárias seguras são recomendadas para adoção, incluindo transporte público integrado, sistemas de barreiras centrais e de beira de estrada, medianas, infraestrutura para dar suporte à velocidade operacional apropriada para usuários da estrada, rotatórias, separação de nível e intervenções para reduzir a exposição ao risco em cruzamentos, caminhos e travessias de pedestres, instalações separadas para bicicletas e motocicletas e sinais de trânsito e marcação de linhas (incluindo marcação de linhas áudio-táteis). Algumas delas são altamente eficazes, com uma redução de até 70 ou 80 por cento em fatalidades e ferimentos graves (por exemplo, barreiras de segurança e rotatórias).
Várias intervenções relacionadas à velocidade também produzem benefícios significativos, com algumas capazes de quase eliminar mortes e ferimentos graves. Exemplos de intervenções eficazes de velocidade incluem acalmia de tráfego (incluindo lombadas e chicanes), rotatórias, cruzamentos e cruzamentos elevados, tratamentos de entrada, limites de velocidade mais baixos (incluindo zonas de 30 km/h (20 mph) para pedestres) e radares de velocidade.
Uma variedade de intervenções baseadas em usuários de estradas foram implementadas ao longo de muitos anos, com exemplos eficazes incluindo ampla prática supervisionada na estrada e/ou sistemas de licenciamento graduados como parte do sistema de licenciamento de motoristas, aumento da idade para elegibilidade da carteira de motorista, treinamento e teste de percepção de risco, educação pública e campanhas como parte de uma estratégia integrada (especialmente comunicando a fiscalização para aumentar a dissuasão geral), fiscalização, penalidades, bloqueios de álcool, monitoramento de fadiga e velocidade e aumento das taxas de uso de capacetes.
As principais intervenções baseadas em veículos incluem a aplicação de padrões mínimos de segurança de veículos e classificações de veículos (por meio do Global New Car Assessment Program, ou “NCAP”), cintos de segurança, manutenção periódica de veículos, luzes diurnas, protetores contra atropelamento em caminhões, Controle Eletrônico de Estabilidade e outras tecnologias avançadas de veículos.
O atendimento pós-acidente aprimorado também pode produzir melhores resultados de segurança nas estradas, incluindo sistemas para melhorar o tempo de resposta a emergências, melhor atendimento de emergência, melhores habilidades de primeiros socorros para o público e melhor atendimento hospitalar.
Igualmente importante, o relatório também identifica exemplos claros em que as intervenções não são eficazes. As piores são as intervenções que aumentam o risco. Isso inclui aumentar a velocidade de viagem sem melhorar a qualidade da infraestrutura de segurança, a maioria das formas de educação e treinamento de motoristas e passageiros pós-licença e muitas (mas não todas) formas de educação regular de motoristas em escolas (como aquelas que buscam aumentar as habilidades de manuseio de carros). O aumento do risco ocorre normalmente porque tais iniciativas aumentam o nível de confiança, levando a um aumento na tomada de riscos. Outras intervenções que não têm benefícios de segurança demonstrados devem ser evitadas. Isso inclui esquemas de licença por meio de solicitação ou pagamento, programas de treinamento ou educação dentro das escolas que visam melhorar o conhecimento sobre segurança no trânsito (incluindo visitas ad hoc de especialistas ou entusiastas em segurança no trânsito) e campanhas educacionais conduzidas isoladamente.
Existem intervenções alternativas eficazes para cada uma delas, conforme descrito neste documento, e elas devem ser aplicadas em vez disso. É extremamente importante que os recursos não sejam desperdiçados em intervenções ineficazes em nome da segurança no trânsito, mas sim que intervenções de segurança no trânsito baseadas em evidências sejam empregadas.
Há uma variedade de documentos disponíveis sobre a questão da eficácia das intervenções de segurança no trânsito, muitos dos quais são referenciados aqui. No entanto, há alguns pontos-chave de diferenças e valor agregado neste guia, incluindo uma síntese das evidências sobre uma ampla gama de intervenções e um contraste entre intervenções eficazes e não eficazes, permitindo que os leitores comparem as opções. Onde intervenções não efetivas são identificadas, intervenções efetivas viáveis são fornecidas, apoiando assim a tomada de decisões. O guia também fornece aconselhamento direto para aqueles que trabalham em países de baixa e média renda, com base em fontes-chave de informação, onde isso está disponível. É importante ressaltar que evidências concisas, porém robustas, são fornecidas em cada um dos pilares do Sistema Seguro.
Há uma necessidade de continuar construindo a base de conhecimento sobre intervenções efetivas de segurança no trânsito, particularmente em países de baixa e média renda, onde há uma série de lacunas no conhecimento. O conteúdo deste guia representa um resumo útil e atualizado do conhecimento atual para aplicação.

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.

An evaluation of the various Emergency Medical Services (EMS) models and mechanisms in place in Sub-Saharan Africa (SSA) is critical in order to have a better understanding of what can be improved upon for effective pre-hospital and emergency care services (PECS). With grant funding provided by the World Bank’s Global Road Safety Facility (GRSF), this report aims explore the State of EMS Systems in Sub-Saharan Africa through a review of the models and mechanisms being developed across various States.
The premise of the report focuses on the fundamentals for effectively providing satisfactory treatment to those in need of urgent medical care, while also recognizing that there are multiple pathways, framed by the respective legislative, legal and regulatory enabling environments, towards a more formal and sustainable EMS model. It represents an effort to identify the major similarities and differences, as well as potential opportunities for greater coordination or collaboration, that can lead to the development of sound policy recommendations for fostering and expanding post-crash response services in the region.
High-level system information has been collected through questionnaires distributed to National Respondents in each country, for which 25 of 44 countries substantially responded as of April 2019 (collectively hereinafter referred to as SSA countries): Botswana, Burkina Faso, Burundi, Cabo Verde, Cameroon, Central African Republic, Chad, Comoros, Congo Brazzaville, Gabon, Lesotho, Liberia, Madagascar, Malawi, Mauritania, Niger, Rwanda, Senegal, Sierra Leone, Sudan, Tanzania, Togo, Uganda, Zambia and Zimbabwe. Missing data and discrepancies triggered a detailed review of laws and other regulatory acts, policy and plan.
The Report does not consider the advantages and disadvantages for the EMS models adopted by SSA countries, nor does it take a position on which regulatory approach should be applied, or measure the degree of EMS standards implementation and the success or failure of implementing various EMS policies. The principal aim of this report is to capture the current range of the standards and regulations in key areas of EMS systems across SSA.
The State of Emergency Medical Services in Sub-Saharan Africa is supported by UK Aid through the World Bank’s Global Road Safety Facility.

This report summarizes the findings of a long and meticulous journey of data gathering and analysis to quantify the health losses from road deaths and injuries worldwide, as part of the path-finding Global Burden of Disease (GBD) study. It is important, first, to acknowledge the profound contribution made by the lead authors and global team of injury prevention professionals to estimate the disease burden of road trauma, before absorbing their findings and recommendations. Without their dedication and tenacity, the way forward would be less certain.
The first GBD study, published nearly two decades ago, signaled an emerging road safety crisis in developing regions of the world. It triggered a remarkable program of global advocacy that culminated in the United Nations decade of action for road safety and a global plan to bring road safety outcomes under control in these regions by 2020. However, limited investment has been mobilized so far to implement the UN initiative. The second GBD studies, and related analyses presented in this report, confirm the importance of road safety as a global development priority and the urgency with which it must be addressed.
The report's findings highlight the growth in road deaths and injuries globally, and their substantial impacts on maternal and child health, despite sustained reductions over the last three to four decades in high-income countries. Combined with the deaths arising from vehicle pollution, the road transport death toll exceeds that of, for example, HIV/AIDS, tuberculosis, malaria, or diabetes. This statistic further reinforces the call for global action. Without these GBD estimates, we would not have a clear picture of the true situation because official country data in the developing world vastly understate the scale of road transport health losses.

What is this toolkit?
This toolkit sets out the key elements of effective post-crash emergency response. The toolkit covers:
Who is this toolkit for?
The toolkit is for all stakeholders with an interest in post-crash response. This includes:
How to use it
The toolkit describes basic good practices for organizing an effective post-crash response. It is a starting point for dialogue and discussion, aimed at identifying goals for improving post-crash services. Every country has different structures and challenges, so the toolkit is not “one-size-fits-all.” However, certain elements of good post-crash response apply everywhere: the need for strategic planning and investment, good coordination, communication, equipment, and training.
To learn more about this project, click here.