ADDIS ABABA, 8 November 2011 (IRIN) - Improved access to emergency medical care and compulsory third-party insurance coverage could help to lower Ethiopia's high road-traffic accident death toll, say officials.

"At least one person dies out of [every] five car accidents occurring in this country," said Bamlaku Alemayehu, inspector of Ethiopia's National Road Safety Coordination Office. "Most of these victims die due to a lack of proper medical services, such as getting immediate medical assistance on time."

At least 70 people die in every 10,000 vehicle accidents annually in Ethiopia, according to government reports; the average fatality rate is 60 per 10,000 vehicles across sub-Saharan African countries, according to the World Health Organization.

A study by a member of the Swedish Medical University of Lund, Road Traffic Accidents in Ethiopia: magnitude, causes and possible interventions, published in the Advances in Transportation Studies journal, also suggests the numbers could be "in excess of 100 fatalities per 10,000 vehicles", noting that official statistics are susceptible to under-reporting.

As of 2007-2008, Ethiopia had 95 traffic accident fatalities per 10,000 vehicles, states a 2009 UN Economic Commission For Africa report.

According to the Lund study, inadequate communication to immediately inform officials and hospital emergency services about traffic accidents in rural areas is a problem, implying "that many accidents and the number of victims cannot be registered".

Poor emergency medical services and the absence of compulsory liability insurance laws are among reasons contributing to the high fatality rates, it says, adding that "in the urban areas, although traffic police and hospitals are available, accident victims are usually evacuated by bystanders who [have] neither the necessary skills nor equipment in pre-hospital care.

"And many of the victims are underprivileged people and they can neither afford out-of-pocket payments nor do they have health insurance to receive healthcare services, [thus many such casualties] are not reported."

A poor road network and limited enforcement of existing traffic laws and the poor condition of vehicles are other factors.

Under the National Road Safety Strategy Plan, launched in July 2011, Ethiopia hopes to halve the fatality rate by 2020. The plan will tap into more than 30,000 health extension workers, enabling them to provide first-aid services to accident victims.

"These kinds of care-givers could save many lives [lost] as a result of blood loss, since they are living within the community," said Bamlaku.

The Ministry of Health is also expected to distribute some 800 ambulances to each Woreda (district), train paramedics and strengthen health facilities at the Woreda level through trained emergency medical service personnel.

"At the moment, the consequences of car accidents [are] terrible considering the capacity of the country's medical services," he said.

Insurance laws

Ethiopia is one of very few countries in the world where third-party liability insurance is not a legal obligation. If and when they become compulsory, such policies will provide compensation for road accident survivors who can neither afford out-of-pocket payments nor health insurance.

"It might seem a bit late to start this kind of mechanism compared to other countries but it's better late than never," said Byleyegn Bekele, spokesperson for the Insurance Fund administering the compensation scheme.

A mix of revised laws that set a uniform standard in the issuance of driving licences, empower organizations such as the federal transport authorities and impose heftier fines for traffic violations could also help, according to officials.

Over half of road traffic accident deaths in Ethiopia involve pedestrians, of whom 20 percent are children younger than 18 years old.

Globally, at least 1.2 million people die on the road every year, with low- and middle-income countries accounting for 90 percent of the deaths, despite having only 48 percent of the world's vehicles, according to a WHO global status report on road safety.

Nearly half of those killed are pedestrians, motorcyclists, cyclists and passengers in public transport.

Ethiopian police records show that between 2003 and 2007, at least 76 percent of fatal accidents were due to driver error, 6 percent due to vehicle defects, 5 percent due to pedestrian error, 2 percent due to road defects and the balance due to other causes.

"Unless the present trend is arrested, the social and economic problem of road accidents is bound to become more and more serious as the number of cars increases," warns the National Road Safety Strategic Plan.

Road traffic accidents help perpetuate poverty as families struggle with rehabilitation costs or funeral expenses after the loss of breadwinners. The Lund University study noted that the accidents led to "families being deprived or trapped by a cycle of poverty, in a country where there are no social security services".

According to the study, pedestrians and passengers of commercial vehicles were the most vulnerable in Ethiopia, whereas in high-income countries accidents mainly involve private vehicles, with the driver being the main occupant injured or killed.

WHO projects road traffic injuries will be the fifth-leading cause of death globally by 2030.

Source:  Integrated Regional Information Networks (http://www.irinnews.org )