Title: A 'safe Systems' Approach For Enabling Traffic Injury Prevention in Nepal (SAFE TrIP Nepal)
Funder: Department of Health and Social Care

Abstract: Aim Our aim is to improve collaboration between health and other agencies to reduce road traffic deaths and injuries in Nepal. Background Road traffic injuries are the 12th most common cause of death globally, and the leading cause of death in 5-29 year olds. Approximately 1.3 million people die and over 50 million people are injured in road traffic crashes each year, with over 90% of victims being from low- and middle-income countries. Nepal, one of the poorest countries in the world, has recently had a big road building programme and there has been a large increase in vehicle ownership. However, without good road safety leadership, coordination and funding, the number of road traffic injuries has increased and there is no national ambulance service to provide prehospital care to those injured. Road traffic injuries are one of the most preventable causes of death, injury and disability. A ‘Safe Systems’ approach, in which all agencies work together to create an environment which keeps road users safe, can lead to significant reductions in rates of road traffic injuries. Design and methods used Our research will be conducted through three work packages that will support a ‘safe system’ in Nepal and will map to two of the United Nations Sustainable Development Goals; 3.6 (halve global road traffic deaths and injuries) and 11.2 (provide access to safe, affordable, accessible and sustainable transport systems for all, and improving road safety). The work packages focus on: (i) Supporting leadership and action for road safety at local and provincial government levels; (ii) Strengthening public transport safety (particularly bus travel); and (iii) Improving post-crash care for those with injuries. Using applied systems thinking methods, we will generate evidence with the potential to inform policy and action. Intended outcomes include identification of system ‘gaps’, a road safety toolkit developed for local and provincial governments, agreed policy recommendations for safer bus travel, estimates of the economic burden of road traffic injuries on families, and a standardised care pathway for the handover of road traffic injury patients from ambulance staff to hospital services. Community engagement and involvement Our research plan has been informed through engagement with road traffic injury patients, bus users, local community leaders, and a Delphi study that involved 93 stakeholders including road users, advocacy campaigners, road design, construction and management experts, and senior decision makers. The Delphi study identified the most important and urgent research questions that needed to be addressed to improve road safety in Nepal. The public will be involved in each work package; through community road safety forums, a bus user advisory group and a road traffic injury victim advisory group. Dissemination An impact plan, and a National Advisory Board of senior Nepali professionals with decision making authority, will enable integration of research findings into policy and practice. Our research will be made available to national, provincial and local levels of the Government of Nepal, the National Road Safety Council, NGOs and communities. We will present our findings at scientific conferences and through published research papers.

Lay abstract: 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 has 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: May 2022 – April 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 National Advisory Board 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.

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES;8.2 HEALTH AND WELFARE ECONOMICS;8.3 POLICY, ETHICS AND RESEARCH GOVERNANCE
Health categories: INJURIES AND ACCIDENTS