State of pedestrian road safety in Uganda: are interventions failing or absent?

Introduction In Uganda, pedestrians are the most frequently injured category of road users, accounting for 40% of road traffic fatalities and 25% of serious injuries every year. There is paucity of information on existing pedestrian interventions and challenges that affect their implementation in Uganda. In this paper, we ascertain the state of pedestrian road safety interventions in Uganda and explore the challenges in the process of design, implementation, monitoring and evaluation of existing interventions. Methods We conducted a qualitative study that started with a desk review of existing policy documents, police statistics, media reports, non-governmental organization reports, and published research. We supplemented the review with 14 key informant interviews and 4 focus group discussions. Participants were drawn from various agencies and stakeholders responsible for road safety. In total, we collected and synthesized data on the design, implementation, and evaluation of pedestrian safety interventions from 25 documents. Data were analyzed using qualitative thematic content analysis. Results The National Road Safety Council within the Ministry of Works and Transport is the lead agency tasked with coordinating all road safety efforts, while the Uganda Police is largely engaged in enforcing pedestrian safety. We identified several existing policies and regulations for pedestrian safety like the Non-Motorized Transport policy whose implementation has been inadequate. Implementation is constrained by weak institutional capacity and limited resources. Moreover, road safety stakeholders operated in silos and this hindered efforts to coordinate pedestrian safety activities. Interventions like road designs were implemented with limited reference to any supporting data and therefore did not cater for pedestrian needs. Conclusion There are interventions targeting pedestrian safety in Uganda, but effective implementation is lacking or failing due to constraints related to weak institutional capacity. This necessitates strategies to mobilize resources to strengthen the capacity of the lead agency to effectively coordinate road safety interventions.


Methods:
We conducted a qualitative study that started with a desk review of existing 23 policy documents, police statistics, media reports, non-governmental organization reports, and 24 published research. We supplemented the review with 14 key informant interviews and 4 focus 25 group discussions. Participants were drawn from various agencies and stakeholders 26 responsible for road safety. In total, we collected and synthesized data on the design,

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implementation, and evaluation of pedestrian safety interventions from 25 documents. Data

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were analyzed using qualitative thematic content analysis.

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Results: The National Road Safety Council within the Ministry of Works and Transport is 30 the lead agency tasked with coordinating all road safety efforts, while the Uganda Police is 31 largely engaged in enforcing pedestrian safety. We identified several existing policies and 32 regulations for pedestrian safety like the Non-Motorized Transport policy whose 33 implementation has been inadequate. Implementation is constrained by weak institutional 34 capacity and limited resources. Moreover, road safety stakeholders operated in silos and this 35 hindered efforts to coordinate pedestrian safety activities. Interventions like road designs were 36 implemented with limited reference to any supporting data and therefore did not cater for 37 pedestrian needs.  pedestrian road safety were included in the study ( Figure 1 and Table 1). An inventory of all safety. In addition, we reviewed existing plans, policies and programs. We extracted data on 104 pedestrian interventions, intervention implementation, and monitoring and evaluation.  injuries and deaths, and challenges impeding implementation. The interviews and discussions 120 were audio recorded after seeking permission from the participants and field notes taken.

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Probes were applied based on responses of the participants. We conducted key informant 122 interviews and focus group discussions until no new data was attained and saturation was 123 reached.

Data management and analysis
125 For the document review, a harmonized summary was created through consensus between 126 the two reviewers and where there were still areas of disagreement, a third reviewer was 127 consulted. The KIIs and FGDs were transcribed verbatim and cleaned. Where discussions 128 were done in Luganda, these were directly translated into English in preparation for analysis.

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The transcripts were exported to ATLAS.ti Version 7 software tool for coding and analysis 130 qualitative data. For both the KIIs and FGDs, topical codes were created from the guides while 131 others emerged from the data. The codes were then applied by 2 groups in the study team to 132 the transcripts using a qualitative thematic content analysis approach (13, 14) with categories 133 and themes arising from the data.

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The results are presented in 2 thematic topics from the data analysis namely: the state of 136 pedestrian safety in Uganda and challenges in implementing pedestrian safety interventions 137 in Uganda. The categories and codes from which the themes arose are presented in Table 2. Road safety management 145 We found that the Ministry of Works and Transport was established as the lead government 146 agency for coordination of all road safety activities operationalized by the National Road Safety

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Council (17). Uganda also has a parliamentary forum on road safety whose core mandate is 148 to develop legislative action plans on road safety and participation in road safety campaigns.

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The Uganda Police was reported to be engaged in several enforcement activities such as 150 vehicle inspection and enforcement on the road. We found several stakeholders including the instances where implementation of pedestrian safety activities was in silos or duplicated.

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Findings from other studies show that the absence of a clear empowered lead agency for road 309 safety affects resource allocation which in the long run hinders the implementation of 310 pedestrian safety interventions and policies(1). There is need to strengthen coordination of 311 road safety through multisectoral collaboration and advocating for additional resources for 312 road safety.

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We noted that Pedestrian safety was a low priority in light of other public health challenges 314 and often suffered political interference during implementation. This is contrary to high income 315 countries that have political commitment and dedicated institutional effort to manage road 316 safety (23). Dealing with pedestrian RTIs can be achieved through concerted efforts at 317 national level(15). Achieving national pedestrian safety management requires political and 318 economic commitment that is demonstrated through effective institutional leadership within 319 responsible agencies for road safety(1, 23). The challenge in Uganda remains to generate 320 sustained political will and long term investment programs for road safety. One of the limitations of the study is that we did not use a comprehensive search strategy to 322 identify the documents included in the review and might have missed out some literature on 323 pedestrian safety in Uganda. However, we addressed this by supplementing the desk review 324 with a qualitative component to obtain thick descriptions, utilising key informant interviews and 325 focus groups with people knowledgeable and involved in pedestrian safety.

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The study found existing interventions including a Non-Motorised Transport policy, and 328 guidelines and regulations aimed at reducing the incidence of pedestrian road traffic injuries 329 in Uganda. The lead agency did not have a concrete multi-sectoral action plan, and there were 330 no targets for the reduction of pedestrian injuries and deaths in the country. Many interventions 331 were being implemented with no evidence for their effectiveness, and no formal evaluations.

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This necessitates strategies to mobilize resources to strengthen the capacity of the lead 333 agency to coordinate the planning and implementation of evidence-based interventions by all 334 key stakeholders involved in pedestrian road safety.