Nepal’s rapid road building and rising vehicle ownership are killing and injuring people at an accelerating rate, with no coordinated national action to stop it. Road traffic collisions cause 1.3 million deaths and 50 million injuries globally each year, 90% of them in low- and middle-income countries. Nepal, one of the world’s poorest countries, lacks the cross-sector collaboration needed for a proven “safe systems” approach—one that treats roads, vehicles, speeds, and post-crash care as a single, shared responsibility. This project brings together government, transport operators, health services, and local communities to break down the policy and practice barriers that keep these groups working in isolation. If successful, the research will produce a road safety toolkit for local governments, agreed recommendations for safer public buses, and standardised protocols for handing injured patients from ambulances to emergency departments. These are concrete changes to the infrastructure and systems that quietly determine whether a crash victim lives or dies. The project also trains a cohort of Nepali early-career researchers, building the country’s own capacity to study and solve its road safety crisis long after this grant ends.
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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.
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