The results are presented in 2 thematic topics from the data analysis namely: the state of pedestrian safety in Uganda and challenges in implementing pedestrian safety interventions in Uganda. The categories and codes from which the themes arose are presented in Table 2.
Table 2 Emerging themes from the Desk review, Key informant interviews and focus group discussions
CODE
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CATEGORY
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THEME
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· Lead agency is the Ministry of Works and Transport
· Parliamentary Forum for road safety
· Stakeholders (Uganda police, Kampala Capital City Authority, Uganda National Roads Authority, Non-governmental organizations, private sector, International agencies e.g. iRAP WHO, UN)
· Poor crash data systems for pedestrian crashes
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Road Safety Management
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State of pedestrian safety
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· Pedestrian safety infrastructure interventions
· Inadequate pedestrian facilities (Mixing of motorized and pedestrian traffic)
· Inadequate operation and maintenance of pedestrian facilities
· Road safety audits
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Safer Roads and Mobility
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· Legislation and policies (Non-motorized transport policy; Road safety act)
· Enforcement on speed limits
· Road safety campaigns and sensitization
· Intervention implementation and Evaluation
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Safer Road Users
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CODE
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THEME
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• Low priority for pedestrian safety
• Political interference
• Financial constraints
• Lack of collaboration mechanism among stakeholders
• Limited community engagement in pedestrian safety
• Inadequate capacity by police to enforce
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Challenges in implementation
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Theme 1: State of pedestrian safety in Uganda
We identified 3 categories that explained the state of pedestrian road safety in Uganda. Similar codes were categorised under the pillars contained in the global plan for the UN Decade of Action of road safety and they included a) Road safety management, b) Safer roads and mobility and c) safe road users (17, 18)
Road safety management
We found that the Ministry of Works and Transport was established as the lead government agency for coordination of all road safety activities operationalized by the National Road Safety Council (19). Uganda also has a parliamentary forum on road safety whose core mandate is to develop legislative action plans on road safety and participation in road safety campaigns. The Uganda Police was reported to be engaged in several enforcement activities such as vehicle inspection and enforcement on the road. We found several stakeholders including the Kampala Capital City Authority, Ministry of Health, Uganda National Roads Authority, civil society, the private sector, NGOs, international organizations who were directly or indirectly involved in pedestrian safety. We noted siloed implementation among the stakeholders with efforts to create multi-sectoral partnerships mostly visible during national events such as the United Nations and the Uganda national road safety weeks. We found that pedestrian safety activities within Kampala were largely done by Kampala Capital City Authority and the Uganda Police playing the key role of enforcement.
“…Uganda Police give strategic directives to ensure that it achieves its mandate of reducing crashes and we do it by enforcing regulations educating road users and coordinating with other stake holders to ensure crushes are addressed in the country”. Key informant
“It’s the traffic police officer who helps the pedestrians to cross the road”. Commuter taxi driver—FGD participant
The document review revealed that data systems to support on-going monitoring and evaluation of pedestrian safety do not provide a true estimate of the burden of road traffic crashes, injuries, deaths, and their economic impact. Existing data management systems by the Ministry of Health and the police report different estimates for pedestrian injuries (19)
Safer roads and mobility
The pedestrian safety interventions and activities identified from the documents and interviews included operation and maintenance of road infrastructure, road audits, and provision of pedestrian facilities especially within urban areas. However, some roads were poorly maintained, lacked pedestrian crossings and markings, and delays were reported in carrying out periodic maintenance works. In some areas, roads were reported to be narrow with inadequate safe walking facilities. Roads were designed and constructed without considering the needs of pedestrians and other non-motorized modes of transport.
“There are planners who think that roads are for vehicles and there are some designers who design with the thinking that roads are for vehicles only”. Key informant
The pedestrian facilities are also encroached on by other activities like street vending, parking and motorists who drive on the few available pedestrian walkways. Competition for the limited space puts pedestrians at risk.
“… Our roads are narrow and congested. For instance, there is mixing of hawkers, boda-boda riders, someone is crossing and as you try to dodge a pothole you knock pedestrians”. Commuter taxi driver—FGD participant.
Safer road users
The Uganda National Road Safety policy and Non-Motorised Transport policy outline priority areas for action to improve road safety for vulnerable road users like pedestrians. The guidelines have provisions for safe pedestrian infrastructure. Pedestrian interventions include provision for pedestrian access routes, prohibition of parking on kerbs, and keeping walkways safe, clear, and well lit. For roads without provisions for pedestrians, it is stipulated that pedestrians walk as far as practically possible from vehicular traffic and against traffic flow. However, implementation of the Non-Motorised Transport policy has been limited. There is also a policy on compulsory insurance against third party risk which is used to make claims for post-crash care for pedestrian victims.
The Uganda Police was reported to be engaged in several enforcement activities like vehicle inspection, blood alcohol content limit and speeding checks. The “Fika Salama” operation (a road safety campaign launched by the Uganda Police in August 2016) was reported to have improved road use discipline although no evaluation on effectiveness was available.
“….if the drivers know that the police officer is there, they reduce the speed”. Commuter taxi driver—FGD participant.
“When we started Fika Salama [a road safety intervention] you no longer hear people say that the accidents happen on some roads because they are slippery. They now agree that some of the crashes were due to poor road user behaviour”. Key informant
Sensitization and road safety campaigns were carried out among car drivers, motorcycle drivers, and school children. Children were targeted through their curriculum on road safety because they were willing to learn and were an avenue for passing on pedestrian road safety information to their peers and parents. However, road safety awareness is sporadic and carried out whenever there is a pedestrian crash tragedy or during the national road safety week. The 2017 national road safety week was themed “Think! We are all pedestrians”
“... These children of primary school when they learn to respect the road they grow with it [the road safety discipline]”. Key informant
Uganda has several existing guidelines, rules and regulations (table 1) with a bearing on pedestrian safety that guide implementers during the design of road safety interventions as noted by the key informant. Sources of data that led to the formulation of various interventions include the Uganda Police traffic crash report and statistics from the United Nations and the World Health Organization. However, there are instances where interventions were implemented due to public demand e.g. if a spot has many pedestrian crash incidents then a hump is placed.
“...usually when we are planning we use the physical planning standards and these standards have the size of the road, you know that the road should be of a minimum size, And we know that this road is in position to cater for a carriage way, to cater for services and infrastructure and even to cater for the pedestrians walk ways and so on depending on the planning which is available”. Key Informant
“If for example there is an accident spot and people are complaining about it many times, we come in with something [intervention] like a road hump to slow down traffic”. Key informant
There is no formal monitoring and evaluation mechanism for the effectiveness of existing pedestrian safety interventions.
“…there is quite some work to do in that area, we don’t have very robust monitoring and evaluation. All we know is that when we do some intervention we get some feedback from the public that now the danger has been averted”. Key informant
Theme 2: Challenges in implementation of pedestrian road safety interventions
Pedestrian safety is of low priority considering other public health threats and therefore vulnerable road users receive inadequate consideration during planning and resource allocation for interventions.
“Government priority for road safety is still low. Let me tell you, about 30 or more people died last week in crashes. If these were from nodding disease [a disease that has affected children in parts of northern Uganda], Parliament would be up in arms for money for nodding disease”. Key informant
There were some instances of political interference identified as a deterrent to enforcement and implementation of pedestrian interventions.
“…there are scenarios where the enforcement officers can go [to enforce road safety regulations], and they are not allowed to do that [by the politicians]” Key informant
The document review revealed weak institutional framework and low capacity at almost every level and this hindered implementation of many policies and regulations like the Non-Motorised Transport policy. Implementation for some pedestrian safety interventions was reported to have been done partially. Limited financial resources allocation was the major hindrance to the implementation of pedestrian safety interventions and policies.
“The most common one [hindrance] would be finances because with road safety you need a lot of finances - you need posters, you need fliers, you need to write the message…”. Key informant
The National Road Safety Council has limited capacity to coordinate all road safety activities including provisions for vulnerable road users. The lead agency did not have a concrete multi-sectoral action plan, and there were no targets for the reduction of pedestrian injuries and deaths in the country. In some instances, various stakeholders involved in pedestrian safety were reported to duplicate interventions already being implemented by others.
“The challenge we get is that some of the interventions are not coordinated (hmmm) so you have this one [stakeholder] is doing something similar to another, so the programs are not coordinated. They all compete for visibility”. Key informant
Community involvement in decision making about pedestrian road safety interventions was minimal as reported from the focus group discussion. Some interventions were implemented without community involvement and consultation and this affects their adoption.
“There is a flyover which was put in Nakawa road for pedestrians to use but since they were not sensitized about its importance, they don’t use it; they all use the road. The same applies to the Kalerwe roundabout, the pedestrians use the road yet a flyover is there, but generally, it was not well positioned, it would have been [better] near the market”. Commuter taxi driver—FGD participant.
Document reviews indicated inadequate capacity and lack of equipment for the National Road Safety Council, other government agencies, and the police to implement and enforce pedestrian safety