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Child and Adolescent Road Safety in South Asia
Low to lower-middle income nations bear 78 per cent of child road traffic injuries. Conversely high-income countries with robust safety measures account for just 3 per cent. This report outlines South Asia’s status country profiles assessment tools and guidance for effective action under the Safe Systems framework regarding child and adolescent road injuries. In 2019 injuries accounted for at least 9 per cent of the 12.2 million deaths in South Asia with approximately a quarter attributed to road traffic collisions. Among children and adolescents 171468 died from injuries with 29859 due to road traffic collisions the primary cause of injury-related death alongside drowning. The overall road traffic death rate was 6 per 100000 population though Afghanistan reported rates exceeding 16 per 100000. The region lost 2.5 million disability-adjusted life years (DALYs) due to such collisions among those under 20. With over 708 million children and adolescents in South Asia urgent governmental action is imperative given the substantial economic impact estimated to be billions of US dollars or 0.3 to 7.5 per cent of GDP. This report is intended to provide relevant information about the burden risk factors and interventions to address road traffic injuries among children and adolescents in the region. The target audience includes UNICEF staff in country and regional offices country level road safety and public health practitioners policy makers advocates and academics.
What puts children and adolescents more at risk?
Children and adolescents are more vulnerable to road traffic injuries than adults for a range of reasons. These reasons or risk factors can be classified as being non-modifiable or modifiable. In addition there are post-crash factors that place children at elevated risk of preventable serious injury or death in the event of being involved in road traffic crash.
Introduction
The 2018 WHO Global Status Report on Road Safety called for a ‘shift in the current child health agenda which has largely neglected road safety’ (1). The call for this shift is not new having been a central theme of the 2008 ‘World report on child injury prevention’ (2) but the burden of road trauma on the lives of children and their families continues to be huge. Road traffic injuries are a leading cause of death to children and young people worldwide (3).
What are good practices?
It is recommended that strategic planning for child and adolescent road safety follow three principles of best practice: Adopt a Safe Systems approach employ evidence-based child-specific strategies (alongside evidence-based all ages strategies) and include cost-effective interventions where possible. These principles are outlined below – and further details can be found in the documents listed in the section ‘Global attention and resources for regional action on child and adolescent road safety.
Why road traffic collisions need to be addressed
As the world struggles to address multiple global health issues it is possible to overlook the causes of death and disability that might be considered endemic. Road traffic injuries (RTIs) have been a leading cause of death of children over the age of one for many decades but we are now equipped with ample evidence to reduce this preventable cause of death and disability.
Child and adolescent road traffic situation in South Asia
The South Asian nations under the regional office of South Asia (Afghanistan Bangladesh Bhutan India Maldives Nepal Pakistan and Sri Lanka) have an estimated combined population of 1.856 billion or just under a quarter of the world’s 7.9 billion. This includes 708054 million children and young people under the age of 20.
Acknowledgements
This child and adolescent road safety report is a product of the UNICEF Regional Office of South Asia. The report was researched and prepared by Margie Peden Jane Elkington and Pratishtha Singh of The George Institute for Global Health.
Country profiles
Country specific information is included in the following profiles. The data included have been obtained from published information (see Appendix) and through a brief survey completed by UNICEF country surveys.
What should be done?
In order to reduce road traffic injuries and deaths among children in the nations of South Asia road safety decision-makers and practitioners should agree a strategic approach that will optimize lives saved while simultaneously addressing practical considerations costs and local policy and planning contexts.
Introduction
At a time when an unwarranted fear of the African migrant in the Sahel and across the Mediterranean Sea had taken over public narratives on immigration the first edition of the Africa Migration Report was published to change dominant discourses. The imperative was clear: we must “protect the millions of people who have been forcibly displaced by conflict and disaster and create opportunities for Pan-African solidarity rather than constrain them” (African Union and IOM 2020:10). This urgency remains as critical today as it was then because African people are on the move across the continent in search of both safety and opportunities. Beyond disasters and conflicts migration has always been “woven into the DNA of African communities economies and societies” (ibid.:3).
Missing migrants in and from Africa: A look into the data and policy gaps
More than 12000 deaths during migration have been documented in Africa since 2014 and at least 20000 African nationals have died or disappeared during migration worldwide. While these figures are certainly a gross underestimate of the true number of missing migrants in the African context they nonetheless indicate the urgency of addressing this issue. This chapter discusses the far-reaching impacts that these disappearances and deaths have on families and communities on the continent and beyond and urges action on three core areas: prevention of further deaths and disappearances; resolution of cases of missing migrants (including the identification of unknown bodies whose migratory status is undetermined); and support for families directly impacted by these tragedies. With tens of thousands of Africans directly affected by these tragedies across the continent the time for Africa to take the lead on resolving the crisis of missing migrants is now.
The digital transformation of Africa and the flow of people and goods
In a period in which many African citizens and migrants are not fully aware of their digital rights and do not have the instruments to understand the complexity of data-driven technology the top-down deployment of new technologies in the African migration policy cycle has caused concerns over the quality of existing regulatory and legal systems as well as worries about the risk of exacerbating persistent forms of marginalization. Against this backdrop this chapter adopts an integrated approach to the study of the relationship between digital infrastructures and the movement of people goods and services from within and to Africa. First it offers an overview of the digital transformation in Africa. Second it studies the movement of people and goods. Based on the best available evidence and in line with key continental and regional policy documents it identifies four policy priorities: strengthening the digital rights of African citizens; fostering cooperation between African countries on the issue of data protection; considering and recognizing that different degrees of digital literacy exacerbate existing hierarchies; and creating a social and cultural ecosystem for the digitalization of basic services.
Free movement of persons, informal trade and the African continental free trade area
Nearly 85.8 per cent of Africa’s employed population works in the informal sector. In some countries in sub-Saharan Africa the informal sector accounts for over 90 per cent of employment while informal output is as high as 62 per cent of official GDP. Despite this large size and its contribution to the growth of African economies the sector remains significantly untapped. The African Continental Free Trade Area (AfCFTA) can play a significant role in optimizing the benefits of informal trade particularly informal cross-border trade. For this to happen however the AfCFTA would need to be accompanied by the liberalization of the movement of persons across borders through the elimination or at least the reduction of the stringent travel requirements. This chapter analyses how the AfCFTA impacts informal trade particularly informal cross-border trade. It also highlights how the free movement of persons can help Africa maximize the benefits of informal cross-border trade and in the long run integrate the sector into formal structures of trade for sustainable economic growth.
A critical appraisal of labour mobility trends and their impact on regional integration in Africa
This chapter analyses the multifaceted nature and realities of international labour mobility in Africa in the context of regional frameworks regarding such issues as the free movement of persons free trade labour migration and labour market access. Primarily it evaluates the impact of these frameworks on regional integration and sustainable development. It considers gendered perspectives and the underlying drivers of labour migration within and from Africa. Furthermore it explores the current state of migration on the continent as well as selected operational arrangements to facilitate free movement free trade and liberalized labour migration as well as the limitations of such arrangements particularly in addressing skills mismatches and unemployment. Last it underscores critical areas that require concerted attention from policymakers and practitioners to holistically enhance the implementation of free movement regimes and address the highlighted disparities to promote a balanced approach to temporary seasonal and permanent labour mobility from and within Africa.
Migration governance in Africa: Insights from the migration governance indicators data
This chapter examines the implementation of the African Union’s revised Migration Policy Framework for Africa (MPFA) and its eight thematic pillars by conducting a descriptive analysis of national and local data from the IOM Migration Governance Indicators (MGI) for 35 African Union Member States and for the years 2018–2022. The analysis identifies well-established policy areas as well as those with untapped potential for development. Areas that are well developed in some cases with results better than global averages include the adoption of national migration strategy documents and their harmonization with development- gender- and environment-related efforts the establishment of interministerial coordination mechanisms and the creation of emigration- and diaspora-related structures (in line with the MPFA Pillar 1). Areas with the greatest potential for future development include the collection of migration-related questions beyond national censuses (Pillar 1) the improvement of migrants’ access to education and vocational training (Pillar 2) and the inclusion of displacement in national development plans (Pillar 7).
Migration-sensitive health-system planning to support implementation of the African union’s migration policy framework
Health is a cross-cutting issue within the African Union’s Revised Migration Policy Framework for Africa and Plan of Action (2018–2030) (MPFA). As well migration is recognized as being key to development benefiting not only those who move but also countries of origin and of destination. However for these benefits to be achieved migration must be managed in ways that will maintain the health of migrants. To address this migration-sensitive responses to health are needed whereby population mobility is embedded in the design of health-related interventions policy and research with health benefits addresseed at both the individual and population levels. Unfortunately health systems across the continent have largely failed to engage with the realities of migration jeopardizing efforts to effectively implement African Union policies addressing migration and health whilst simultaneously limiting progress towards international health and development goals including universal health coverage (UHC). In this context this chapter outlines two key areas for action to support the development and implementation of effective responses to migration and health: improving governance responses to migration and health; and addressing the social and structural determinants of health. Recommendations include establishing continental and subregional forums to strengthen migration and health governance in ways that are responsive to existing strategic plans including the MPFA.
Human mobility trends in Africa: A snapshot of available evidence
Building on various data sources this chapter provides an overview of the main migration trends in Africa examines the impact of the COVID-19 pandemic on human mobility across the continent and analyses emerging and future needs to enhance the availability and quality of migration data. In 2020 in Africa there were an estimated 25.1 million international migrants which translated into having 1.9 per cent of the African population – or around one in 50 people – living outside of the country in which they were born. One of the key characteristics of African migration is that the majority of African international migrants do not leave the continent and mostly engage in intra-African migration. Refugee movements and internal displacements are also key features of African migration. The chapter further examines the need to enhance the collection and analysis of high-quality disaggregated accurate timely and reliable data which are crucial to ensure evidence-based policy and programming and provide insights or predictions about future trends. In recent years considerable progress has been made in this regard in Africa. However more investment in strengthening data ecosystems is needed while innovation closer collaboration and better coordination remain essential to respond to emerging data demands.