Workshop Summary

Introduction: Workshop Objectives and Program

The National Academies held a workshop in Washington, D.C., on January 26–27, 2006, entitled “Improving Road Safety in Developing Countries: Opportunities for U.S. Cooperation and Engagement.” The participants were from U.S. government agencies, nongovernmental organizations, international organizations, and academic research institutions. The workshop discussions focused on defining U.S. interests in the problem of road safety in developing countries, identifying current U.S. government activities aimed at addressing the problem, and determining which U.S. capabilities could contribute to efforts of developing countries to reduce traffic casualties. The National Highway Traffic Safety Administration (NHTSA) of the U.S. Department of Transportation (USDOT) and the Centers for Disease Control and Prevention (CDC) provided funding for the workshop.

The workshop represented a continuation of the National Academies’ activities on this topic. An informal preliminary meeting held in May 2005 included representatives of the U.S. Departments of Transportation, State, Defense, Health and Human Services, and Commerce; the U.S. Agency for International Development; the U.S. Peace Corps; the U.S. Trade and



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Improving Road Safety in Developing Countries: Opportunities for U.S. Cooperation and Engagement Workshop Summary Introduction: Workshop Objectives and Program The National Academies held a workshop in Washington, D.C., on January 26–27, 2006, entitled “Improving Road Safety in Developing Countries: Opportunities for U.S. Cooperation and Engagement.” The participants were from U.S. government agencies, nongovernmental organizations, international organizations, and academic research institutions. The workshop discussions focused on defining U.S. interests in the problem of road safety in developing countries, identifying current U.S. government activities aimed at addressing the problem, and determining which U.S. capabilities could contribute to efforts of developing countries to reduce traffic casualties. The National Highway Traffic Safety Administration (NHTSA) of the U.S. Department of Transportation (USDOT) and the Centers for Disease Control and Prevention (CDC) provided funding for the workshop. The workshop represented a continuation of the National Academies’ activities on this topic. An informal preliminary meeting held in May 2005 included representatives of the U.S. Departments of Transportation, State, Defense, Health and Human Services, and Commerce; the U.S. Agency for International Development; the U.S. Peace Corps; the U.S. Trade and

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Improving Road Safety in Developing Countries: Opportunities for U.S. Cooperation and Engagement Development Agency; and the World Bank. Participants in this meeting identified a need for their respective government organizations to seek opportunities to increase awareness within the U.S. government and in other sectors about the magnitude of the problem and to seek opportunities for the United States to offer assistance that would improve traffic safety globally. The workshop planning committee, appointed by the National Academies, arranged the agenda and identified participants. (See Box 1 for the statement of task defining the scope of the committee’s activities, Appendix A for the workshop program, and Appendix B for the list of participants.) In preparation for the workshop, representatives of selected U.S. government agencies were interviewed, and their responses were used to compile an inventory of federal agencies’ activities and interests related to road safety in developing countries. Results of the inventory were presented and discussed at the workshop and are summarized below. The goal of the workshop was to gain a more complete view than previously available of the diversity of U.S. interests affected by the problem of road traffic deaths and injuries in developing countries, the scope of activities of U.S. agencies addressing the problem, and opportunities for further U.S. engagement. This overview was to be derived from the agency interviews and from the discussions at the workshop among representatives of Box 1 Planning Committee for a Workshop on Traffic Safety in Developing Nations: Statement of Task The committee will develop the agenda and identify participants for a 2-day workshop on road traffic safety in developing countries. The workshop will frame (1) the U.S. interest in reducing the frequency of injuries and deaths resulting from road traffic accidents in developing countries and (2) U.S. capabilities that could be brought to bear in reducing these losses. An inventory of U.S. federal agency activities and expenditures (along with those of U.S.-based nongovernmental organizations to the extent possible) will be presented and discussed, and current activities and expenditures will be compared with U.S. interests and capabilities. The workshop will involve approximately 50 participants drawn mainly from the U.S. government, industry, trade, international tourism, academic, and nongovernmental communities.

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Improving Road Safety in Developing Countries: Opportunities for U.S. Cooperation and Engagement federal agencies and international organizations, as well as experts and practitioners from U.S. nongovernmental organizations and other countries. The workshop was intended to help the responsible government agencies gauge whether the U.S. response is proportional to the national interests affected by the problem and to identify next steps toward developing a more effective response. The four sections of this summary correspond to the sessions of the workshop program, which addressed the following topics: The scope and character of the global road safety problem and an overview of major international initiatives; U.S. activities in global road safety; Cooperation between high-income and developing countries: opportunities and obstacles; and General discussions and summary. Scope of the Road Safety Problem and International Initiatives John Flaherty, chief of staff, USDOT, opened the workshop by describing the high priority his agency places on the international traffic safety problem. He assured participants that the agency would receive the results of the workshop with great interest and stated that he expected the workshop would contribute to building the kind of durable coalition necessary to respond to the problem of global road traffic safety. He noted that Secretary of Transportation Norman Mineta, recognizing the significance of the problem, has in his international contacts frequently emphasized the mutual interests of the United States and the developing world in reducing the burden of road traffic injuries. He observed that the globalization phenomenon is compelling nations to acknowledge the linkage between their interests and well-being and global events. In transportation, this linkage has led to cooperation on security and economic issues; however, recognition of and action on this linkage in the area of road safety have been slower to occur. The challenge facing advocates of international action on road safety is to build on the dynamic that is driving international cooperation in security and economic matters. Mr. Flaherty’s remarks concerning specific U.S. interests and government activities related to global road safety have been incorporated in the summaries below devoted to these topics.

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Improving Road Safety in Developing Countries: Opportunities for U.S. Cooperation and Engagement John Flaherty, Chief of Staff, U.S. Department of Transportation, noted in his opening remarks that road safety was an important issue for Secretary Norman Y. Mineta. He also described the challenges of increasing the awareness of and the attention to the road safety problems experienced by developing countries. (Photo by Pam Risdon.) Two speakers then described the scope and character of the global road safety problem. David Bishai, the Johns Hopkins University, reviewed the economic and human costs of road crashes and the resulting deaths and injuries, while Anthony Bliss, the World Bank, outlined institutional and social obstacles that must be overcome to mount an effective global response. Dr. Bishai’s remarks are summarized in this section; those of Mr. Bliss are summarized in the section below on cooperation between high-income and developing countries. The Road Traffic Injury Problem and Its Economic, Social, and Human Costs David Bishai reviewed the established facts about the magnitude of the road traffic safety crisis in the developing world. The World Health Organization (WHO) estimates that 1.2 million people die each year from road traffic crashes—130,000 in high-income countries and 1.07 million in low- and middle-income countries. In addition, WHO estimates that on the order of 20 million people suffer serious injuries in road crashes annually. The death rate from road crashes is higher in low- and middle-income countries

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Improving Road Safety in Developing Countries: Opportunities for U.S. Cooperation and Engagement (20 deaths annually per 100,000 persons) than in high-income countries (13 deaths annually per 100,000 persons)—this despite much lower usage of motor vehicles in the former countries (see Figure 1). Road traffic injuries are the second-leading cause of death, after HIV/AIDS, among 15- to 29-year-olds in low- and middle-income countries, and the second-leading cause, after the childhood cluster diseases (diphtheria, tetanus, pertussis, polio, and measles), for 5- to 14-year-olds. WHO projects that in 2030, road traffic injuries will rank seventh among major disease and injury categories (up from eighth rank in 2002) in their contribution to the global burden of disease and injury, as measured by disability-adjusted life years (DALYs) lost. By this measure, the impact of road traffic injuries is comparable with that of cerebrovascular disease or heart disease (Mathers and Loncar 2005). The characteristics and consequences of road crashes resulting in deaths and injuries in developing countries differ from those in high-income countries. In the United States, 80 percent of those killed in road crashes are occupants of four-wheeled motor vehicles; in low- and middle-income countries, most fatalities are among pedestrians or cyclists. The fraction of FIGURE 1 Global mortality due to road traffic crashes (HIC = high-income countries; LMIC = low- and middle-income countries). (Source: Peden et al. 2002; used with permission of the World Health Organization.)

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Improving Road Safety in Developing Countries: Opportunities for U.S. Cooperation and Engagement crashes that result in deaths is much higher in low- and middle-income countries, and the population groups with the lowest incomes are particularly vulnerable. The family burden of a road injury can be catastrophic. For example, a survey found that when a member of a rural household in Ghana was injured in a road crash, average household income and consumption declined sharply, to the point that 28 percent of households were forced to reduce food consumption. According to one published estimate, the annual cost of road injuries worldwide is 1 percent of gross domestic product in low-income countries and 1.5 percent in middle-income countries. The frequency of road fatalities is declining in high-income countries today, despite traffic growth, because of improvements in vehicles, roads, traffic management, law enforcement, education, emergency services, and medical treatment. However, fatalities are rising in the developing world, especially where motor vehicle use is growing rapidly. World Bank projections suggest that if present patterns persist, by 2020 annual road fatalities will increase by 80 percent compared with 2000 levels in low- and middle-income countries and will decline by 30 percent in high-income countries. When fatality data are examined across countries and over time, a rough pattern emerges: as a country’s income rises, road traffic fatalities initially increase with growing use of motor vehicles; then, at higher incomes, the frequency of fatalities begins to fall (Kopits and Cropper 2005). Three factors presumably account for most of the decline: as motor vehicles become the dominant mode of transport, conflicts between motor vehicles and pedestrians and cyclists decrease; higher incomes lead to adoption of practices that reduce risk, such as better road designs, safer vehicles, and better traffic control; and travelers learn from experience over time how to reduce their risks. This pattern might appear to suggest that the rise in fatalities in developing countries is inevitable and ultimately will be self-correcting. However, such a view is unnecessarily fatalistic. The diversity of experience among countries shows that development alone will not necessarily solve the problem, and there is evidence that appropriate measures can be taken to reduce injuries and fatalities in countries at all stages of development. Estimates comparing the cost-effectiveness of injury prevention measures indicate that improved traffic law enforcement in low- and middle-income countries could save 1 DALY for every $5 spent and that installing speed bumps to slow vehicles at the most dangerous intersections could save 1 DALY for every $9 spent. In contrast, treating AIDS patients in Africa with the simplest regimen of active therapy costs $600 per DALY saved. In one example of an effective intervention, a speed enforcement program begun in 2004 in

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Improving Road Safety in Developing Countries: Opportunities for U.S. Cooperation and Engagement Uganda on main roads out of the capital has reduced deaths by more than 200 per year. The annual cost is $70,000, which was more than covered in the first year by the $400,000 in fines collected. Despite the availability of effective measures, almost nothing is spent on road safety in many developing countries. Annual government spending on activities aimed at improving traffic safety is estimated to be $0.07 per capita in Pakistan and $0.09 in Uganda, about 1 percent as much as health spending or 0.2 percent as much as military spending. Major International Initiatives Four presentations reviewed road safety initiatives of major international organizations: the WHO/World Bank World Report on Road Traffic Injury Prevention (Peden et al. 2004) and regional road safety efforts in the Americas the World Bank), and the United Nations (UN) Global Road Safety Collaboration (Maria Vegega, NHTSA). International organizations are leading efforts to marshal action to reduce road traffic deaths and injuries. In 2003, the UN General Assembly recognized road deaths and injuries as a global epidemic, and in May 2004 a special session of the General Assembly was dedicated to the road safety crisis. World Health Day, organized annually by WHO, focused for the first time in 2004 on road safety. However, growing international recognition of the problem has not yet been matched by growth in the resources devoted to assisting low- and middle-income countries to address the problem. The World Report on Road Traffic Injury Prevention, produced jointly by WHO and the World Bank and released on the occasion of World Health Day in 2004, is a comprehensive review of knowledge about road traffic injuries worldwide. It includes information on frequency and trends in crashes, injuries, and deaths; costs and social impacts; factors affecting risk; and effective interventions. The report’s recommendations (see Box 2) emphasize the need to build institutional capacity, particularly in developing countries, to manage road transportation systems safely. PAHO is promoting adoption of these recommendations in the countries of the Americas, where each year 130,000 deaths and 1.2 million injuries result from road crashes. The documents have been translated into Spanish and disseminated in each country. Mexico and Honduras have adopted the recommended measures as the basis for national planning, and other counthe World Bank’s Global Road Safety Facility (Maryvonne Plessis-Fraissard, [Alberto Concha-Eastman, Pan American Health Organization (PAHO)],

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Improving Road Safety in Developing Countries: Opportunities for U.S. Cooperation and Engagement Box 2 Recommendations of the World Repor t on Road Traffic Injury Prevention The World Report on Road Traffic Injury Prevention (Peden et al. 2004) recommends that governments take six actions to reduce road traffic injuries: Identify a lead agency in government to guide the national road traffic safety effort. Assess the problems, policies, and institutional settings relating to road traffic injury and the capacity for road traffic injury prevention in each country. Prepare a national road safety strategy and plan of action. Allocate financial and human resources to address the problem. Implement specific actions to prevent road traffic crashes, minimize injuries and their consequences, and evaluate the impact of these actions. Support the development of national capacity and international cooperation. The report notes (p. 160) that “in certain low-income and middle-income countries with limited human and financial resources, it may be difficult for governments to apply some of these recommendations on their own. In these circumstances, it is suggested that countries work with international or nongovernmental organizations or other partners to implement the recommendations.” tries have formed national committees to address the problem. PAHO has organized three international meetings in Latin America to disseminate the recommendations of the World Report and to discuss the need to strengthen the ability of the health sector to respond to the road safety crisis. The Global Road Safety Facility is the World Bank’s program to implement the recommendations of the World Report. About 15 percent of all World Bank–funded investment is in roads, but a small share of funds has been devoted specifically to road safety improvement. The Global Road Safety Facility will provide seed funding for projects through a multidonor trust fund. Present donors are the Netherlands, the FIA Foundation, and

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Improving Road Safety in Developing Countries: Opportunities for U.S. Cooperation and Engagement the World Bank. Seed funding of $12 million per year is expected to leverage much larger investments from the main development programs of the World Bank and others. The facility will support activities at the global level (including coordination, advocacy, and research) and at the regional and national levels. At the national level, an objective of the facility is to promote one “second-generation” road safety project annually in each of six world regions over the initial 5 years of the program. These projects (see Box 3 for one example) will reflect the multisector capacity-building approach recommended in the World Report. The World Bank believes that a reasonable goal for the program is to reduce the death rate from road traffic crashes by 30 percent and thereby avoid 2.5 million deaths in the next 15 years. No other World Bank program can claim a comparable potential health benefit. The UN Road Safety Collaboration is an association of national government agencies, international organizations, and private entities concerned with road safety. The transportation, health, and public safety sectors are represented. The collaboration was created in response to a May 2004 resolution of the UN General Assembly, which called on WHO to act as a coordinator on road safety issues within the UN systems. Participating international organizations include WHO, the World Bank, and UN commissions. NHTSA and CDC represent the United States. The collaboration’s periodic meetings are organized by WHO and are an opportunity to exchange information and to plan cooperative activities for all participants in the global initiative to improve road safety. The collaboration is organizing the production of a series of best-practice manuals and other tools to help public agencies develop effective interventions, including promotion of seat belt use and reduction of speeding and impaired driving. U.S.Activities in Global Road Safety Susan Gallagher of the Education Development Center, a consultant to the National Academies, had been engaged in preparing an inventory of activities and interests of U.S. government agencies related to road safety in developing countries and presented her preliminary findings at the workshop. This information was collected from interviews with the staff of 27 offices in seven cabinet departments and independent agencies. It was supplemented during the workshop by representatives of U.S. government agencies and nongovernmental organizations; the workshop program lists those who commented on the inventory and on their organizations’ activities. The information presented included the interests that motivate each agency’s activities (that is,

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Improving Road Safety in Developing Countries: Opportunities for U.S. Cooperation and Engagement how the activity is related to fulfilling the agency’s responsibilities). The goals of the inventory were to help government policy makers form a comprehensive picture of U.S. government interests related to road traffic safety in other countries, to aid in comparing the magnitude of these interests with the scope of current efforts directed at the problem, and to help agencies coordinate their efforts so as to allow a more effective governmentwide response. Because of the considerable scope of international involvement of U.S. government agencies, the interviews did not encompass every government Box 3 World Bank Iran Road Safety Project The World Bank is preparing a road safety project with the government of Iran that the bank regards as an innovative and experimental approach to the problem, building on the experience of past, generally less ambitious, projects. The project was designed in accordance with the recommendations of the World Report (see Box 2). The World Bank states the philosophy guiding the project as follows (World Bank 2006): Road accidents are due to a number of factors that are deeply rooted and reinforce each other, including, especially, drivers’ attitude and behavior, insufficient enforcement of traffic and transport regulations, physical inadequacies in the urban and interurban road networks, shortcomings in road safety information and education, inadequate driver training and testing, insufficient control of vehicles’ roadworthiness, weaknesses in the rescue and emergency service, underdevelopment of monitoring and evaluation systems, and a fragmented institutional setup. All these factors need to be addressed in a coherent and integrated way in order to bring about a sustained decrease in road accidents. The objectives of the project are to reduce crashes and related deaths and injuries in selected pilot interurban corridors and urban areas and, through the experience gained in the pilot projects, to permanently strengthen the institutional capabilities of all the sectors with main responsibility for road safety, including the roads agency, as well as police, health care, and general public administration. The budget is $105 million. The project has seven components:

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Improving Road Safety in Developing Countries: Opportunities for U.S. Cooperation and Engagement agency with potentially relevant programs. The agencies contacted were those with responsibilities most closely related to traffic safety and public health and to U.S. external relations. The list of agencies to be interviewed was based on the knowledge of the consultant and of the staff of the National Academies and the sponsors, as well as on information provided by interviewees. Appendix C presents the guide used for the interviews. The key questions were as follows: Safer road users (enforcement programs and training, driver training, and public information); Safer vehicles (including development of regulations for commercial vehicles); Safer roads (low-cost civil works in the pilot corridors and cities, such as signs, markings, and crash barriers, and development of procedures for conducting safety audits of roads)—the component receiving the majority of funding; Road safety monitoring and evaluation systems (establishment of both systems to evaluate the effectiveness of road safety activities and a national road crash data system); Improvements to postcrash rescue and relief and emergency medical services; Institutional development and support (including development of improved road safety legislation, guidelines for allocating funds to road safety, and safety planning); and Transport technical assistance (advice on improving the efficiency of operations of the road, rail, port, and transit systems). The project targets corridors and areas where the concentration of deaths and injuries is high and aims to bring all the relevant actors together to develop an appropriate response. The goal is to replicate the elements of good practice that are observed in countries with effective safety programs. The experience in the target areas will provide a model for the application of the same techniques throughout the country.

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Improving Road Safety in Developing Countries: Opportunities for U.S. Cooperation and Engagement through in obtaining funding for treatment in developing countries has led to increased resources for prevention, which is the more cost-effective intervention. In the case of road safety, a comparable social strategy has been adopted in the World Bank’s second-generation road safety projects, described above. In those projects, immediate and visible payoffs in reducing crashes and associated deaths and injuries are sought by concentrating initially on direct interventions (e.g., removing physical hazards and strengthening law enforcement) in locations with high crash frequency. The strategy is that demonstrating short-term successes will build political and public support and momentum for the needed long-term institutional reforms. General Discussions and Summary After the invited presentations, workshop chair Mark Rosenberg asked the participants to comment on four questions concerning the goals of the workshop in light of the insights gained from the presentations and related discussions: What is the U.S. interest in reducing the losses from road injuries in developing countries? What forms can U.S. assistance for road safety take, how can it be delivered, and how can the United States ensure accountability and measurable objectives in the projects it supports? How can collaboration on the problem among U.S. government agencies be promoted? How can U.S. organizations identify needs of developing countries? The workshop ended with a discussion of the next steps viewed by participants as necessary to a more effective U.S. response. U.S. Interest in the Problem The workshop presentations and the responses of U.S. government agency interviewees, as summarized above, form a consistent picture of the scope of U.S. interests affected by the problem of road safety in developing countries. Nearly all such interests can be grouped into four categories:

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Improving Road Safety in Developing Countries: Opportunities for U.S. Cooperation and Engagement Protection of U.S. travelers and employees abroad (including civilian and military U.S. government employees and employees of U.S. private organizations) from involvement in road crashes. Commercial interests of U.S. firms that may be affected by road safety conditions and safety regulations in other countries. For example, vehicle manufacturers have an interest in international harmonization of safety standards, and North American trade may be impeded by differences among countries in the safety standards and practices applied to commercial trucks. Indirect U.S. benefits from improved general welfare in low- and middle-income countries. Road injuries and fatalities, like any major public health problem, are an obstacle to economic development. U.S. welfare is enhanced by economic development in other countries: development brings more opportunities for trade and reduces problems arising from emigration and conflicts. Institutional capacity building for the sake of improving road safety (such as strengthening competencies for public administration, infrastructure planning, and law enforcement) probably contributes to development in more general ways as well that may also benefit the United States. (For example, strengthening capabilities for enforcement of traffic laws may help strengthen police capacity to combat international crime and may also decrease corruption, increase public acceptance of the police, and thereby promote democratic stability.) Development aid also serves as an instrument for gaining good will for the United States internationally. Altruism. U.S. government officials and the electorate may decide that contributing to relieving the road safety problem in the developing world is morally imperative. As the description of U.S. government agency activities showed, these various interests have motivated different forms of U.S. engagement. Concern for protecting U.S. citizens and commercial interests has led to narrowly focused actions, although it has also served to raise awareness of the global road safety problem among U.S. agencies and their constituents. The broader kinds of interests—in promoting economic development for the sake of indirect U.S. benefits or out of a sense of moral responsibility—can be served only through efforts aimed at general improvement in traffic safety in the developing world.

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Improving Road Safety in Developing Countries: Opportunities for U.S. Cooperation and Engagement Forms of Assistance, How Assistance Can Be Delivered, and How Accountability and Measurable Objectives Can Be Ensured The workshop presentations and discussions concerning cooperation between high-income and developing countries, as well as the conclusions of the World Report, clearly indicate the challenges of scaling up knowledge transfer, international cooperation, and assistance. The workshop presentations also provided examples of the objectives, content, and organization of cooperative international road safety programs. Elements of international assistance programs that probably will be critical to success include the following: Programs should take a long-term perspective aimed at institutional capacity building at the national level. Programs must be multisectoral; that is, resources and capabilities will be required not only by road agencies, but also by law enforcement, emergency response and medical services, education and research institutions, and agencies of general public administration responsible for infrastructure planning, data, and evaluation. Attaining the needed cooperation across sectors in developing countries was identified as a serious challenge and a difficulty encountered in most projects. Programs should have specific goals and incorporate monitoring and evaluation. The World Bank’s second-generation traffic safety projects are the prototype for projects aimed at satisfying these requirements comprehensively. However, participants described activities of more limited scope that are consistent with such a comprehensive framework, including the following: Activities that tie professionals to the international community of practitioners in research, education, engineering, and public administration so as to develop skills and promote awareness of best practices. The Road Traffic Injuries Research Network and activities of the Transportation Research Board that attract substantial international participation are examples. Assistance on data programs that can provide credible quantitative evidence of the economic and human costs of traffic-related deaths and

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Improving Road Safety in Developing Countries: Opportunities for U.S. Cooperation and Engagement A broken bicycle lies among shattered glass after a collision between a bus and a cyclist in Huangshan, China. Cyclists are among the most vulnerable road users when they must share the roads with cars, trucks, and buses. (Photo by Mark Rosenberg.) injuries in a country. The workshop presentations made clear that broad dissemination of facts on these costs to the leaders in a country is necessary to build local support for traffic safety initiatives. Creation of a standardized global data infrastructure could provide this information at the country level. Quantitative objectives could be set and progress monitored on both a country-specific and a global basis. Creating such a data infrastructure would require a large, collaborative project. Cooperation to develop the capacity of nongovernmental organizations and civil society in a country as a way to build general public awareness of and support for road safety initiatives. The project of the AAA Foundation and auto clubs of other countries to develop road assessment programs in developing countries as a means of stimulating public dialogue on the problem is an example of such a nongovernmental initiative. The initiative of the National Academies to support the development of African science academies, although not specifically related to road safety, is another illustration of this kind of engagement. That

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Improving Road Safety in Developing Countries: Opportunities for U.S. Cooperation and Engagement initiative is supporting African academies in building their capacity to provide independent, evidence-based advice to their governments and countries on health-related matters. Strengthening science academies in developing countries, and the scientific community they represent, can inform public policy and increase awareness of road safety issues. U.S. government cooperation with initiatives of nongovernmental organizations, in particular by undertaking the government-to-government communications that often are needed to facilitate such activities. If a private-sector safety initiative (e.g., the auto club road assessment programs described above) requires the support or participation of the host government, the necessary interaction with the host government can often be carried out more efficiently with the participation of the U.S. government than by the private parties acting alone. Participation in established international coordinating activities, including the UN Road Safety Collaboration described above, and in international forums such as the global and regional road safety stakeholder forums being planned by the UN as part of Global Road Safety Week in 2007. Efforts to ensure that infrastructure projects receiving U.S. aid incorporate safety in designs. For example, the U.S. government’s Millennium Challenge Corporation, which requires all projects it assists to have specific objectives and evaluation of results, is funding road projects in several countries. Safety improvement is an appropriate objective for any road project. Public communication. Further U.S. government action on global road safety will be likely only if a constituency outside government is calling for action. The role of government agencies in advocacy is circumscribed, but certain kinds of involvement might be appropriate. Efforts can be made to ensure that all potential constituencies and influential groups—for example, the engineering and medical professions, U.S. businesses affected by road safety conditions abroad, and journalists— are included in activities. The organizational forms of the assistance projects described during the workshop were diverse and included government-to-government

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Improving Road Safety in Developing Countries: Opportunities for U.S. Cooperation and Engagement bilateral aid; region-to-region aid (the Nordic countries’ program with southern African governments); projects in which an international intermediary organization (WHO or the World Bank) takes on management responsibility with the financial and institutional support of the donor country; and projects carried out largely among nongovernmental entities (e.g., the Road Traffic Injury Research Network and the auto club road assessment programs), sometimes with some government support. Several of the projects described involve partnerships with numerous participants: multiple agencies in donor and recipient governments, nongovernmental organizations and contractors in donor and recipient countries, universities, and the international organizations. Formation of such partnerships is facilitated by preestablished relationships among the parties and careful planning. Presenters made clear that attaining sustained results ultimately depends on the motivation and resources of the developing country and that the international role necessarily is limited to information dissemination and to the provision of technical and financial assistance when requested by those governments that have a commitment to action. It was noted that the character of U.S. bilateral aid projects is determined to a great extent by the priorities of the aid recipient; therefore, increasing U.S. involvement in road safety through projects delivered by USAID will require expressions of interest in the problem from the recipient governments. The presentations identified some keys to accountability for the outcomes of assistance projects. The first is ensuring that the developing country recognizes its ownership of the project—that the country has invested its own resources and that leaders and administrators are committed to getting results. Accountability also requires projects large enough that they can be expected to produce measurable results, and that the experience and training imparted by the project make a long-term contribution to building institutional capacity. Mixed traffic on a city street.

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Improving Road Safety in Developing Countries: Opportunities for U.S. Cooperation and Engagement Promotion of Collaboration Among U.S. Government Agencies Several presenters emphasized that the greatest road safety benefits can be attained only through the collaborative efforts of several sectors, including the roads agency, as well as public health, law enforcement, education, and public administration. The most effective U.S. aid programs will draw on the capabilities of each of these sectors in the United States and will seek to build competence in each of the corresponding sectors and establish ties among them in those countries receiving assistance. Because of the need for a multisectoral strategy, workshop participants from several U.S. government agencies suggested that the governmentwide response of the United States to the global road safety problem would be greatly strengthened by the creation of a permanent institutional structure with the participation of all the relevant agencies. This interagency body would be a mechanism for building working relationships, coordinating actions across agencies, and allowing agencies to benefit from each other’s efforts and knowledge; it would be a point of contact for nongovernmental organizations that might wish to partner with the government in road safety activities; and it could help ensure that U.S. government engagement in international activities is well organized and takes advantage of all available capabilities. The proposed interagency body would be in a position to formulate a governmentwide internal action plan and to propose national goals and timetables. Government participants discussed various forms the institutional structure of this body could take, including a joint program office and an official working group. These structures would differ in the formal funding commitments required from the participating agencies and in the seniority of agency staff who would be the principals of the group. In addition to collaboration across cabinet departments, coordination within departments is necessary. The inventory of agency interests and activities produced for the workshop revealed that some departments have many offices concerned with aspects of global road safety. USDOT has created an internal coordinating and planning mechanism for work on this issue, including designation of a lead agency (NHTSA) and lead staff within the department. That arrangement may be a useful model for other departments. Collaboration depends on transparency, participants noted. Agency staff who were interviewed sometimes hesitated to share information about their activities. A possible consequence of this attitude is that agencies may be unaware of common interests and opportunities for collaboration.

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Improving Road Safety in Developing Countries: Opportunities for U.S. Cooperation and Engagement Any administrative actions that could provide incentives for more open communication of agency activities, within the government and to the public, would contribute to overcoming this barrier. How to Identify Needs of Developing Countries Most participants commenting on this question emphasized that the needs most relevant to planning U.S. assistance activities are priorities articulated by the governments and institutions of the developing countries. Therefore, in contacts with other countries’ governments, U.S. parties should be prepared to listen, ask, and discuss so as to discover what kinds of initiatives are desired. Participants suggested a number of other guidelines for U.S. government interactions with governments of developing countries concerning road safety: Initiatives must be structured as cooperative efforts with all parties being equal around the table, rather than the developing country being relegated to a junior partner status. In communicating with other countries, the U.S. participant must clearly enunciate the nature of its interest and the scope of its commitment to cooperative initiatives. Establishing genuine local ownership of projects—through commitment of resources, control, and accountability—is key to attaining sustainable results. Car–motorbike crash.

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Improving Road Safety in Developing Countries: Opportunities for U.S. Cooperation and Engagement In discussions with other countries, U.S. participants should cite the relationship of safety to infrastructure development and show appreciation for the need to focus on vulnerable users as a priority. U.S. initiatives should reflect the recommendations of the World Report, which refer to the fundamental needs existing in most developing countries. Activities that help other countries better identify their needs, such as building data and monitoring systems and developing research capacity, are a valuable form of assistance. The experience gained in successful assistance projects, that is, projects that yield results valuable to the country receiving aid, should be seen as an indicator of needs. Some earlier, small-scale safety assistance projects that failed to produce sustainable benefits evidently were not targeting critical needs. The World Bank’s second-generation projects are structured according to a hypothesis about needs; if they are successful, the hypothesis is supported. It was suggested that case studies of ongoing major cooperative international road safety activities are needed to document the history of each project’s development, organizational structure and participants, objectives and methods, and results to date. These case studies would ensure that the lessons learned in each initiative are preserved. A particularly valuable case study would be a history of the development of international cooperative health and road safety programs in Vietnam. The critical elements involved in organizing a U.S. contribution in that country were the leadership of State Department officials and partnership among the State Department, DHHS, and U.S. nongovernmental organizations. Next Steps Several participants suggested immediate next steps that U.S. government agencies could take toward developing a more effective U.S. response to the global road traffic safety problem. Creation of the permanent interagency body described above would be the first step. Several other suggested immediate actions could form the initial agenda of the interagency body. These include the following:

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Improving Road Safety in Developing Countries: Opportunities for U.S. Cooperation and Engagement Completing the task begun in this workshop of defining and documenting the U.S. interest in the problem of international road safety and identifying the agencies and programs already concerned with addressing it. Engaging U.S. nongovernmental organizations in determining their relevant interests and resources and establishing good communications on the problem. Conducting the above-discussed case studies of recent significant international road safety initiatives. Coordinating a process of practical, governmentwide planning, following two tracks: first, to identify opportunities for more effective U.S. contributions using existing resources; and second, to identify initial elements of a U.S. program if new funds were made available. Plans would demonstrate that U.S. participation could support cost-effective interventions, including interventions with immediate short-term payoffs, and that the benefits would contribute to achieving overall development-related policy objectives. The above discussion of possible forms of U.S. road safety assistance includes specific activities that could be elements of these plans. References Kopits, E., and M. Cropper. 2005. Why Have Traffic Fatalities Declined in Industrialized Countries? Implications for Pedestrians and Vehicle Occupants. Policy Research Working Paper 3678. World Bank, Aug. Mathers, C. D., and D. Loncar. 2005. Updated Projections of Global Mortality and Burden of Disease, 2002–2030: Data Sources, Methods, and Results. World Health Organization, Oct., pp. 5–8. Peden, M., K. McGee, and G. Sharma. 2002. The Injury Chart Book: A Graphical Overview of the Global Burden of Injuries. World Health Organization, Geneva, Switzerland. Peden, M., R. Scurfield, D. Sleet, D. Mohan, A. A. Hyder, E. Jarawan, and C. Mathers (eds.). 2004. World Report on Road Traffic Injury Prevention. World Health Organization, Geneva, Switzerland. World Bank. 2006. Project Information Document (PID) Appraisal Stage. Report AB2155. Feb. 8.

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