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This paper gives an overview of the work of PIARC Working Group 3.1.1 ‘Specific road safety issues for LMICs’. The working group performed its activities in the period 2019–2023. We prepared two deliverables: (a) a literature review, and (b) an overview of illustrative examples. The review started from the notion that the road safety problem requires a multi-disciplinary approach. The safe system approach is generally considered as the central concept for this purpose and this starting point is also taken in this study. However new directions are needed to make the safe system concept work in LMICs. The period of the first UN Decade of Action for Road Safety has brought us a series of valuable problem analysis and overview articles prepared by a variety of institutions and institutes. As a PIARC working group we did not repeat this effort, but used it as a starting point to indicate which specific issues do require a boost in LMICs for the coming period up to 2030. We concluded that the following 12 issues deserve special attention. Strategical: (i) Sustainable Development Goals integral approach, (ii) safety culture, (iii) road safety management and leadership, (iv) building road safety expertise and science; Tactical: (v) transportation system as a whole, (vi) city design, architecture, land use, rural planning, (vii) cost effectiveness, (viii) legislation and enforcement; Operational: (ix) speed, (x) sustainable safe roads, (xi) vehicles as a safe system component, (xii) post-crash health care. As a result of our discussions and analyses we also concluded that it is worthwhile and necessary to make a distinction between the issues in terms of levels of approach. Making roads and vehicles safe may be considered as operational safety measures on a component level, whereas city design and transport system issues do represent a more tactical approach. On top of that, organisational and cultural aspects do have a more strategical nature. As in many managerial and planning tasks the distinction between strategical, tactical and operational levels of approach is needed in the road safety field. It illustrates that the Safe System concept asks for a multi-level vision, thus preventing a silo approach with a limited focus on human behaviour, safe roads or vehicle safety. A further analysis for each of the selected issues resulted in priority areas, i.e. topics that deserve special attention in the LMIC context. In a similar line of reasoning we also described illustrative examples, i.e. LMIC related before-after studies that show the perspective of certain measures on an evidence basis. Although we found some illustrative cases for each of these issues, our search for evidence based cases confirmed the findings from recent overview articles indicating the lack of LMIC related road safety research. A more widespread implementation of effective road safety measures in LMICs would require a stronger national commitment and leadership from the road safety agencies point of view in the first place. Moreover an evidence based policy asks for a strong national and regional knowledge infrastructure. Ultimately road safety policies and road safety research programs are to be considered as inseparable. A strong local knowledge infrastructure may thus become the basis for an effective national road safety policy.

Road crashes continue to be a major cause of death and serious injury for low- and middle-income countries (LMICs). At the global level, 90% of traffic fatalities occur in these countries with a dramatic daily amount of 3 260 road deaths, many of whom are children. The first UN Decade of Action for Road Safety 2011–2020 was designed to develop a massive movement towards a decrease of these numbers. This resulted in many initiatives to introduce the safe system approach in LMICs, i.e. to implement road safety management, make roads, road users, and vehicles safer, and improve post-crash health care. International organisations together with NGOs and universities prepared road safety guides and manuals, gave courses and webinars, introduced auditing and inspection systems, with the overall intention to build capacity in LMICs. Together these actions contributed to a variety of road safety developments in LMICs but the overall results were still modest. At the third Global Ministerial Conference on Road Safety in Stockholm, 2020, and in the Global Status report by the World Health Organization, 2023, the results of all efforts were presented and evaluated. Many countries made progress through road safety management and better legislation addressing risk factors such as speeding, drinking and driving, failing to use seatbelts, and poor infrastructure design. However, the reduction in road deaths strongly lagged behind the original goals. Continued implementation of programs and development of new approaches are needed to make a breakthrough, and to reach the goals of the 2nd Decade of Action, i.e. a 50% reduction in fatalities by 2030, and the same percentage reduction in injuries. The present position paper argues that despite the enormous amount of road safety information, which has been and is ‘sent’ to LMICs, and despite the quality and robustness of international organisations behind these programs, there is a shortfall in the scale of the knowledge and research infrastructure currently existing in LMICs, which is needed to ‘receive and transfer’ this knowledge. In order to develop evidence-based policy, LMICs need research programs that are able to transfer safe system principles to the local context and culture. Several literature overviews illustrate the lack of such research in LMICs, i.e. the limited number of programs at local universities and research institutes. Although recently initiatives have been taken in some countries, the implementation of such programs is urgently needed. Based on this observation we call on international organisations to establish a special program for the development of a sustainable road safety knowledge and research infrastructure in LMICs. Such structural local capacity is a prerequisite to translate international road safety knowledge into local guidelines and to develop an evidence-based road safety policy. Most importantly, this local infrastructure will give countries a national knowledge bank, thus providing them with an urgently needed sustainable road safety memory.

Road crashes cause a huge problem of public health in low- and middle-income countries (LMICs). The Safe System approach is generally considered as the leading concept on the way to road safety. Based on the fundamental premise that humans make mistakes, the overall traffic system should be ‘forgiving’. Sustainable safe road design is one of the key elements of the Safe System approach. Road design and speed control should help prevent crashes with a high level of kinetic energy. However, the road design principles behind the Safe System approach are certainly not leading in today’s infrastructure developments in most LMICs. Cities are getting larger with increasing motorization and expanding road networks. Existing through-roads in local communities are upgraded, resulting in heavy traffic loads and high speeds on places, that are absolutely not suited for this kind of traffic. Furthermore, a Safe System would require that functional design properties of vehicles and roads would be conceptually integrated, which is not the case at all. Although advanced driver assistance systems are on their way of development for quite a long period, their potential role in the Safe System concept is mostly unclear and at least strongly underexposed. The vision on future cars is dominated by the faraway concept of automation. This paper argues that the way to self-driving cars should take a route via the concept of guidance, i.e. vehicles that guide drivers, both on self-explaining roads and on more or less unsafe roads. Such an in-vehicle guidance system may help drivers to choose safe transport mode, a safe route and a safe speed, based on criteria related to safety and sustainability. It is suggested to develop driver assistance systems using relatively simple and cheap technologies, particularly for the purpose of use in LMICs. Such a guide may make roads self-explaining—not only by their physical design characteristics—but also by providing in-car guidance for drivers. In the future, the functional characteristics of both cars and roads may be conceptualized into one integrated Safe System, in which the user plays the central role. Such a guidance system may serve as the conceptual bridge between the roadway, the vehicle and the driver, and thus be considered as an indispensable component of the Safe System approach. It is argued that such a development is necessary to bring a breakthrough in road safety developments in LMICs and also give an acceleration towards zero fatalities in high-income countries.