Islamic Republic of Iran – World Bank Transport Sector Review Improving road safety in the Islamic Republic of Iran 27 April 2004 Tony Bliss Senior Road Safety Specialist Transport Unit Transport and Urban Development Department The World Bank

Overview Findings and recommendations of the World Report on Road Traffic Injury Prevention. Country capacity checklist. Questions to be addressed. Safety investment guidelines.

World Report on Road Traffic Injury Prevention The World Report on Road Traffic Injury Prevention was jointly issued by the World Health Organisation and the World Bank on World Health Day World Health Day 2004 was dedicated by the World Health Organisation to the improvement of global road safety.

World Report on Road Traffic Injury Prevention (cont’d) Following its launch on World Health Day, the findings of the World Report were endorsed at the United Nations General Assembly meeting on the Global Road Safety Crisis, where a strong commitment to global action was unanimously supported. These findings highlight the growing public health burden of road deaths and injuries in low and middle-income countries.

World Report on Road Traffic Injury Prevention (cont’d) The World Report makes a powerful case for concerted and urgent action by governments and their strategic partners to address this burden, as a global development priority. Every year on the world’s roads an estimated 1.2 million people are killed and up to 50 million more people are injured or disabled.

World Report on Road Traffic Injury Prevention (cont’d) World Bank modeling of traffic fatalities and economic growth predicts that global road fatalities will increase by more than 65% between 2000 and This trend will vary across regions of the world. Fatalities are predicted to increase by more than 80% in low and middle-income countries, but decrease by more than 30% in high-income countries.

World Report on Road Traffic Injury Prevention (cont’d) World Bank Region% change South Asia144% East Asia & Pacific80% Sub-Saharan Africa80% Middle East & North Africa68% Latin America & Caribbean48% Europe & Central Asia18% Sub-total83% High-income countries- 28% Global total66%

World Report on Road Traffic Injury Prevention (cont’d) By 2020, road deaths and injuries are predicted to be the third leading contributor to the global burden of disease and injury. Low and middle-income countries already bear about 90% of the current burden and they will experience the greatest growth in casualty rates over this period. A large proportion of their crash victims will continue to be more vulnerable road users such as pedestrians, cyclists and children.

Disease or Injury 1. Lower respiratory infections1. Ischaemic heart disease 2. HIV/AIDS2. Unipolar major depression 3. Perinatal conditions3. Road traffic injuries 4. Diarrhoeal diseases4. Cerebrovascular disease 5. Unipolar major depression5. Chronic obstructive pulmonary diseases 6. Ischaemic heart disease6. Lower respiratory infections 7. Cerebrosvascular disease7. Tuberculosis 8. Malaria8. War 9. Road traffic injuries9. Diarrhoeal diseases 10. Chronic obstructive pulmonary diseases10. HIV/AIDS

World Report on Road Traffic Injury Prevention (cont’d) These predictions assume that current safety management policies and practices will continue into the future. The challenge for low and middle-income countries and their global partners is how to rapidly create the vision and build the capacity to prevent what is otherwise going to be a truly disastrous death and injury toll.

World Report on Road Traffic Injury Prevention (cont’d) The World Report highlights road safety as a social equity issue. Road crashes have a disproportionate impact on the poor who experience limited access to post-crash emergency care and face costs and loss of income that can push families into poverty.

World Report on Road Traffic Injury Prevention (cont’d) Estimates of the economic costs of road deaths and injuries put them at an average of 1% of GNP for low-income countries, compared with 1.5% for middle-income countries and 2% for high-income countries. These costs could be far higher in low and middle-income countries, especially if all injuries were reported and the social costs of pain and suffering were fully accounted for.

World Report on Road Traffic Injury Prevention (cont’d) A key message of the World Report is that road crash costs can be avoided, because successful programs in high-income countries have demonstrated that road deaths are predictable and can be prevented. However, in low and middle-income countries investment in road safety does not match its growing public health priority.

World Report on Road Traffic Injury Prevention (cont’d) The World Report emphasizes that road safety is a responsibility shared by government, industry, nongovernmental organizations and international agencies. It also stresses the importance of active participation by professionals from many disciplines and by people representing the wider community.

World Report on Road Traffic Injury Prevention (cont’d) The World Report emphasizes the complexity and hazardous nature of the road transport system, which must be understood as a whole and designed and operated to compensate for human vulnerability and fallibility. Vision Zero in Sweden and Sustainable Safety in the Netherlands are promoted as leading examples of good practice.

World Report on Road Traffic Injury Prevention (cont’d) The World Report stresses the importance of establishing reliable data systems, but also observes that their poor quality in low and middle-income countries should not be any impediment to immediate action. Quick results can be achieved by adapting and targeting proven safety practices.

World Report on Road Traffic Injury Prevention (cont’d) The World Report invites governments to assess the status of road safety in their countries and makes recommendations to be used as guidelines to assist this process. Countries lacking resources to fully apply these recommendations are encouraged to seek partnerships with international organizations and other supportive entities to assist their implementation.

Recommendation 1 “Identify a lead agency in government to guide the national road safety effort.” This recommendation stresses the importance of institutional leadership which derives from a designated legal authority to make decisions, control resources and coordinate the efforts of all participating sectors of government.

Recommendation 1 (cont’d) Lead agencies can take different institutional forms, but they must be adequately funded and publicly accountable for their performance. Lead agencies must also engage and collaborate with all groups in society that can contribute to improved safety outcomes. The effectiveness of lead agencies is enhanced by strong and sustained political support for the initiatives that they promote.

Recommendation 2 “Assess the problem, policies and institutional settings relating to road traffic injury and the capacity for road traffic injury prevention in each country.” This recommendation underscores the complexity of managing for safety across the road transport network and the vital role played by reliable data and effective institutional structures in sustaining safety improvements.

Recommendation 2 (cont’d) Simple, cost-effective data systems that are consistent with international standards for recording and classifying road deaths and injuries should be established. Institutional capacity to implement effective injury prevention measures at a country level must also be strengthened.

Recommendation 3 “Prepare a national road safety strategy and plan of action.” This recommendation emphasizes the multisectoral and multidisciplinary dimensions of an effective national road safety strategy.

Recommendation 3 (cont’d) A national road safety strategy must address the safety of all road users and engage all stakeholders across government, the private sector, nongovernmental organizations, the media and the general public. A national road safety strategy should also be linked to strategies in other sectors and set ambitious but realistic targets, complemented by a national action plan setting out specific interventions to achieve them.

Recommendation 4 “Allocate financial and human resources to address the problem.” This recommendation highlights the importance of cost-benefit analysis in setting expenditure priorities for road traffic injury prevention, drawing on the evaluation of interventions by countries worldwide.

Recommendation 4 (cont’d) To achieve safety targets, additional funding sources may have to be found for the required level of investments. Priority will also have to be given to training programs, to build the skills required to develop and implement a national road safety strategy. Participation in global and regional training networks and international conferences can contribute to this process and further strengthen country capacity.

Recommendation 5 “Implement actions to prevent road traffic crashes, minimize injuries and their consequences and evaluate the impact of these actions.” This recommendation summarizes the range of ‘good practice’ interventions that could be considered by all countries.

Recommendation 5 (cont’d) Specific country-based interventions should be based on sound scientific evidence. Specific country-based interventions should be culturally appropriate. Specific country-based interventions should form part of a national road safety strategy and be evaluated for their effectiveness.

Recommendation 6 “Support the development of national capacity and international cooperation.” This recommendation calls for a substantial scaling up of international efforts to build a partnership focused on strengthening capacity at the country level to deal with the growing road safety crisis.

Recommendation 6 (cont’d) United Nations agencies, nongovernmental organizations, multinational corporations, philanthropic foundations and donor countries and agencies all have an important role to play in increasing support for improved global road safety to levels provided for health problems of comparable magnitude. Leadership, coordination and ongoing engagement of relevant government ministers will be required to develop and endorse a global plan of action that is consistent with other global initiatives such as the Millennium Development Goals.

Action at the country level The World Report recommendations focus on road safety management issues at the country level. They emphasize the importance of national strategies and action plans, agency accountability for safety results, multi- sectoral collaboration, capacity building and a supportive global partnership.

Managing for results The World Report recommendations are well aligned with the results management agenda of the World Bank. This agenda seeks sustained improvements in country development outcomes through stronger partnerships and systematic management attention to results at all stages of the development cycle: planning, implementation and completion.

Country capacity checklist Before preparing country road safety investment strategies and operations it is important to conduct a systematic review of national road safety management capacity. Safety management systems are complex, but their capacity can be reviewed over three best practice dimensions: their focus on results, their safety interventions and their implementation arrangements.

Safety results Design and operation of the network Interventions Implementation arrangements The road environment Standards and rules Standards and rules Standards and rules The vehicle The road user Conditions of entry and exit Compliance Education Enforcement Incentives Education Enforcement Incentives Education Enforcement Incentives Funding Legislation Coordination Monitoring Analysis Promotion

Social cost Final outcomes Results: in terms of material losses and pain and suffering. Results: in terms of fatalities and serious injuries. Intermediate outcomes Results: in terms of mean speeds, proportion of drunk drivers, seat belt wearing rates, helmet wearing rates, road conditions, standard of the vehicle fleet, etc. Outputs Interventions: in terms of police patrols, km. of safety engineering features, vehicle inspections etc. Structure and culture Implementation arrangements: in terms of institutional structures and processes

Country capacity findings Safety management capacity in low and middle-income countries is generally weak, as highlighted by the findings and recommendations of the World Report. A focus on achieving measurable road safety results is usually absent. Targets are rarely set and little is known about the effectiveness of safety interventions, given the absence of reliable performance data.

Country capacity findings (cont’d) Agencies are rarely held to account for safety outcomes that fall within their sphere of responsibility and influence. The social and economic costs of road deaths and injuries remain largely unmeasured and inadequately accounted for in transport and health sector evaluations.

Country capacity findings (cont’d) Safety interventions are also deficient. Standards and rules governing the safety of roads, vehicles and road users are often fragmented and not based on best practice. Compliance regimes are often ineffective and unduly reliant on education alone to ensure standards are met and rules abided by.

Country capacity findings (cont’d) Enforcement lacks purposeful direction and incentives to comply are weak. Poor road user, agency and industry safety performance can be readily observed in the road environment, as can the deaths and injuries that result. Institutional implementation arrangements remain the biggest impediment to progress.

Country capacity findings (cont’d) Funding and legislation are inadequately matched to the task of improving road safety nationwide. Coordination arrangements are often ineffective and hampered by limited agency accountability for safety performance. Monitoring and evaluation of safety results is at best superficial.

Country capacity findings (cont’d) Safety promotion and programs are often confined to special days of the year and are usually focused on road user responsibilities alone. However, the identified deficiencies in safety management systems in low and middle-income countries cannot be corrected quickly, especially the building of effective implementation arrangements.

Country capacity findings (cont’d) In high income countries this building of institutional capacity has evolved over a long period of motorization and successive governance reforms. Without equivalent institutional structures and processes, best practice safety interventions implemented in low and middle-income countries are unlikely to live up to their promise.

Improving road safety in Iran The first step is to systematically review existing safety management capacity. It is important to officially reach a consensus on country capacity weaknesses and how to best overcome them. To assess national preparedness to successfully manage road safety, some key questions must be answered.

Results focus What data are readily available to identify road deaths and injuries? Which group of road users face the biggest risk of being killed and injured in the road transport system? What is officially considered to be an acceptable and achievable level of safety for all road users?

Results focus (cont’d) Have national and provincial targets been set for improving safety performance? Which agencies are responsible for achieving this level of safety? How are they held to account for the results achieved?

Interventions Have comprehensive safety standards and rules been set for roads, vehicles and road users? Are compliance regimes in place to ensure adherence to identified safety standards and rules?

Interventions (cont’d) Do the identified standards and rules and related compliance regimes clearly address the safety priorities of high-risk road user groups? How favorably do identified standards and rules and related compliance regimes compare with international best practice?

Implementation arrangements Are funding mechanisms established, sufficient and sustainable? Are legislative instruments well matched to the road safety task? Are interventions being coordinated to maximize efficiency and effectiveness?

Implementation arrangements (cont’d) Are interventions monitored, evaluated and adjusted accordingly? Are government, business and community responsibilities to ensure a safe road system being actively promoted?

Safety investment guidelines All relevant sectors must be engaged: especially the Transport, Health, Education and Justice sectors. Alignment with public sector reform objectives should be considered: especially in terms of managing for results and institutional capacity building.

Safety investment guidelines (cont’d) Investment should be of sufficient scale to contribute to long-term sustainable safety objectives, while achieving measurable road safety results in the short-term. Short-term results can be achieved by targeting road sections with high densities of death and injuries and deploying sufficient resources to make an impact.

Safety investment guidelines (cont’d) The sequencing of safety investments must be aligned with the institutional capacity to deliver them. Large-scale, multisectoral demonstration projects may be appropriate to launch an investment strategy and rapidly generate the success needed to engender greater momentum for the longer-term.

Safety investment guidelines (cont’d) Different operational responses will be required for different types of roads, reflecting their different institutional settings and traffic and land use functions. Inter-city and urban corridor operations may be considered where excessive speeding contributes to high fatality rates.

Safety investment guidelines (cont’d) Area-wide operations may be suited to urban settlements, where they can contribute to development strategies seeking better integration of traffic and land use functions, to improve overall urban amenity. In high-speed environments priority must be given to the creation of a sustainable police enforcement capacity, by introducing specialized highway patrols.

Safety investment guidelines (cont’d) Safety interventions can be adapted from successful measures taken in best practice countries, as described in the World Report. These measures address road engineering, speed management, safety belts and helmets, drink driving, novice drivers, vehicle safety, commercial vehicle operations, child safety and emergency medical services.

Safety investment guidelines (cont’d) The timing of expected pay-offs from safety interventions must be considered. Enforcement of high-risk behaviors and low- cost engineering remedial measures can bring benefits in the short-term. Improved safety design of new roads and systematic retro-fitting of safety features across the existing network can bring benefits in the medium-term.

Safety investment guidelines (cont’d) Improved vehicle safety standards and safety education for children can bring benefits in the long-term. Planning measures taken to reduce road transport trips and exposure to risk through improved land use – transport interactions and mode switching to public transport can also bring long-term benefits.

Safety investment guidelines (cont’d) Road safety investments must be monitored and evaluated, in terms of targets set for results to be achieved. Results can be measured by a combination of final outcomes, intermediate outcomes and outputs. In some instances results can be measured by outputs alone, where no measurable linkage with outcomes can be made.

Final outcomes consist of fatalities and serious injuries. They are what we seek to avoid and are the main components of social cost. Intermediate outcomes are not desired for themselves but for what they entail - better final outcomes. Outputs represent physical deliverables, for instance the number of police patrols and the amount of advertising delivered. Alternatively they could correspond to milestones showing that a specified task has been completed. Social cost is the aggregate measure of all costs that crashes inflict on the community. It includes not just material losses but pain and suffering. Social cost and final outcomes (but not intermediate outcomes and outputs) can be broken down by road user group and local government region. Separate targets could be set for different road user groups. Individual targets could be developed for local government regions each made up of a number of local authorities.

Next steps Meet with road safety agencies and make further presentations if appropriate. Review road safety situation. Prepare short and medium-term plan of action for further discussion. Commence consulting exercise.