A 'safe Systems' Approach For Enabling Traffic Injury Prevention in Nepal (SAFE TrIP Nepal)

Research question

How can we understand and address policy and practice barriers to inter-sectoral collaboration for the prevention and care of road injured patients in Nepal? Background

Road traffic collisions cause 1.3 million deaths and 50 million injuries globally each year, with 90% occurring in low- and middle-income countries. They mostly affect the disadvantaged in society, and are an important cause of poverty and disability. A ‘safe systems’ approach is the most effective way to reduce road traffic injuries and deaths.

It requires cross-sectoral ownership of the factors underpinning current policy and practice, and the development and implementation of agreed and coordinated action. Nepal is one of the poorest countries in the world but experiencing rapid economic and social change. With no system-wide action on safety, a massive road building programme and increasing vehicle ownership have led to a rapid rise in road traffic injuries and deaths.

Aims and objectives

The aim of our research is to reduce road deaths and injuries by bringing together stakeholders to achieve shared understanding of the system dynamics, and to agree actions. Our objectives build on stakeholder priorities and community engagement, and are to: (1) understand current policy and stakeholder involvement leading to a policy gap map; (2) co-design a road safety toolkit for local governments; (3) understand factors resulting in unsafe public transport and agree recommendations for action; (4) collect evidence of the economic and social arguments for investment in road traffic injury prevention; (5) co-design protocols for the handover of road traffic injured patients between ambulance and emergency department staff; (6) strengthen capacity for road safety research in Nepal.

Methods

We will use applied systems thinking methods across three work packages; (1) Closing the evidence-policy-practice gap, will review current policy and practice and complete a stakeholder analysis. Working with local communities we will support development and networking of Local Road Safety Committees, and co-design a toolkit to support scale up of Road Safety Committees in other areas. (2) Safer public transport will collectively agree a process map of current public bus services provision.

Co-production workshops will agree recommendations for action to improve bus safety (3) Improving post-crash care will explore patient costs and quality of life after injury, and use mixed methods to map current handover practices between emergency medical services and emergency departments. Protocols for verbal and written handover of road traffic injured patients will be co-produced and assessed for acceptability.

A capacity strengthening programme will support the development of a team of Nepali early career researchers, including three PhD studentships. Timelines for delivery: November 2022 – October 2026 Anticipated impact and dissemination

The Nepal Injury Research Centre is an established collaboration with a track record of research and government engagement. Supported by a SafeTrip Nepal Advisory Group comprising government and National Road Safety Council representatives, evidence generated by our programme will enable those with authority to act to improve road safety, save lives and reduce injuries and disability.

Community engagement activities, policy briefs and videos will reach diverse stakeholders, while publications and conference presentations will reach academic audiences.