Make road traffic accidents a top public health issue 

ROAD ACCIDENTS

By John Arube-Wani

As the year 2017 rapidly closed and the new year 2018 dawned on us, and I took stock of the Christmas season and beginning of the new year, there seemed to be no let-up on a top news item last year - road traffic or motor accidents on our highways - that took heavy tolls on their victims, many were left dead or barely escaped deaths, and many more left with severe injuries and longer-lasting effects such as loss of economic productivity. 

Talk of bodabodas, small and big personal cars, big or monstrous trucks, taxis, cyclists, pedestrians, are all involved. This year, the most recent accidents on our highways only served as a reminder of how far we, as a country still have to go; that there is just too much indiscipline, poor quality roads infrastructure, unwillingness of enforcement of laws, and many other things to talk about. The recent Gaagaa bus carnage was one of the worst and just another most regrettable massacre!   

Uganda is rated among the top or leading countries in road traffic accidents (RTAs) or incidents (RTIs) in the world, according to World Health Organization (WHO) road safety assessments. Given that negative repute as a leading cause of mortality, morbidity or disability, one would like to know, where on the scale of priorities, does the Ministry of Health strategically place the carnage of road traffic accidents on both the policy and health care delivery system agenda?

The economic and social costs of RTAs on the health system and victims is incalculably enormous, and consequently should be seriously addressed and taken into account. No longer should prevention of RTAs and/or mitigation of their consequences be just a traffic Police enforcement matter alone. 

For recent studies on RTA/Is in Uganda suggest that the rising trend of road traffic accidents and injuries give equally rising morbidity and mortality trends, as well as increased health care costs and budgets. Time and again, many Hospitals along the major highways, and Mulago National Teaching and Referral Hospital in particular, get overwhelmed with serious motor/traffic accident cases. 

This brings me to how I would like to build my idea that it is high time that motor-traffic accidents should be put high on the agenda as a top public health issue that requires much more attention than it does.

My keen interest goes way back to 1988/89, when I pursued a master of public health (community medicine) degree at the University of Glasgow, though my research interest was not on this topic. As our class was international, and each student had to present a profile of one's country's health system during the first introductory week, and my topic was not RTAs. 

In the early ‘80s, Uganda was fast ‘making news' with the emergence of the new ‘slim disease', and there was a lot of the ‘bad press' about Uganda, and in particular about this previously ‘unknown' disease, that had seriously affected the health of communities around Lake Victoria's border areas, and fishing communities in particular. 

At that time, if one sought sources from the MOH, most reports on the country's health profiles were prepared by International Agencies like UNICEF, WHO, USAID, and other partners. Depressing as it was, Uganda's health care system had previously been acclaimed as one of the best in Sub-Saharan Africa; and that was the picture I had in mind to present to the class. 

Fortunately, Uganda's early opening-up to the HIV/AIDS problem was astounding and it generated not only much interest and admiration, but also a lot of indignation both inside and outside the country. For example, when I had finished my presentation, fellow African classmates, especially from Nigeria did not take kindly to Uganda's openness to the HIV/AIDS problem.

For in their view, how could one expose a fellow African country so negatively before a largely foreign audience? Fortunately, given the highest level of exemplary leadership by our President himself, Government of Uganda quickly ‘owned-up' to the situation, and massively mobilized the country's health system in conjunction with international agencies and leading health experts, including Uganda's own doctors and scientists.

Working fervently, Uganda was to lead the world in bringing much awareness among its population and beyond its borders, about the HIV/AIDS epidemic.

Around the same time, outside the country our own Philly Lutaya Bongoley, was putting a spirited effort through music; mustering whatever energy he was left with, before returning home to a population that received him so enthusiastically and lovingly, whereby not only in Uganda, but also in his host country Sweden, where he lived his last days, he was widely acclaimed for his advocacy songs, including ‘Alone and frightened'.

That the HIV/AIDS story and journey in Uganda has made a huge difference is well known; which is why therefore, this country's top leadership can equally rally around RTAs and with concerted efforts join and lead in the fight to reduce the scourge.   

Still in Glasgow when one of the Nigerian classmates who later became a close friend, made his research presentation, it was on road traffic accidents in Nigeria.  At that time, it seemed rather odd to me that a medical doctor would go in for such a topic; other than say, on an infectious tropical disease, or some treatment protocol, for some form of intervention.

As it turned out, road traffic accidents were indeed a major public health problem in Nigeria, that made the country widely renown in international health circles.  Fast-forward: years into my retirement from teaching at Medical School, another Nigerian student wrote through the health research network in Africa (Afro-nets) seeking for help on a topic for his post-graduate research from anyone who could help him make a final decision. 

I wrote back drawing his attention to my Nigerian friend, Dr. Mohammed's study in Glasgow on RTAs in his country back in 1988; and on that advice only days later, he replied to my e-mail that he decided to take my advice and would take RTAs as the topic for his research.  Happily, for him, he had received a similar advice from his research advisor in India.

For both Nigeria and Uganda, RTAs remain top public health challenges, that should call for joint research collaboration. Today, Uganda has indeed come full-square like Nigeria; both leading in road traffic accidents that cause such untold suffering to many innocent civilians and road users; virtually making the whole population vulnerable.  Both executive and legislative measures to stem the scourge of RTAs just as was the case with HIV/AIDS, should be taken to penalize all serious offenders by instituting joint "contributory offences" for all parties involved like in the Gaagaa bus accident case.

Besides instituting new statutory measures, more ongoing research e.g. on causes of accidents, vehicle types most involved, and different other multi-purpose/multi-disciplinary perspectives, should be undertaken. Whilst the Ministry of Health should come up with its own requisite policy, budgetary, service delivery measures, and research agenda, others like Transport, Works, Internal Affairs, Police, and statutory bodies like UNRA, URA, UNBS, and those concerned with importation of vehicles should institute strict quality-standard measures.

A statutory ‘National Road Traffic Accident Prevention and Enforcement Authority' should be set up; with a mandate to introduce more effective traffic-offence penalties; take lead and engage research on traffic accidents from many fronts; soliciting studies and involving stakeholders, like the Makerere University School of Public Health, College of Health Sciences, and similar institutions.  

 The UNRA Board for example, has already taken concerted measures in dealing with offenders who park and leave their vehicles, especially heavy trucks, buses, and commercial vehicles on the highways after accidents, or those left unattended after break-down.

Disciplines in motor vehicle manufacturing, design engineering, transport and roads industry, vehicles inspection; public health experts, health economists, behavioural scientists, health policy and systems researchers, should all be engaged in finding answers. Equally, Parliament should revise existing laws with a view to making new or adding mandatory statutory penalties for offenders to curb the unnecessary RTA menace in our country.

The Judiciary through the courts should be enabled to pass deterrent statutory penalties prescribed by the law on blatant offenders. While accidents may not be stopped from occurring altogether, I believe more can be done to reduce and/or mitigate their effects on the health and well-being of the people.


 The writer is an elder/retired public servant and a resident in Kyambogo, Kampala