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Posted: January 1st, 1970
RTAs are the direct cause of three-quarters of all accidental deaths of people between the ages of 15 and 24 years (ROP, 2005). In 2005,688 men, women and children were killed and 6,500 injured in 9247 crashes. There have been nearly 45,000 injured since the year 2000. For every death in a road accident, 2 to 3 young people are permanently disabled (ROP, 2010).
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In the last three decades, a large economic growth in the Arabian Gulf countries including Oman took place, due to the discovery of oil. Many aspects of life changed shortly after that. There was a sudden increase both in population and in the number of vehicles and that was also accompanied by a rapid expansion of road construction. All these economic factors have changed many aspects of life and have given the public the opportunity to own private cars ( Bener and Jadaan, 1992), which consequently led to the increased number of accidents around the country. However, the different socioeconomic family condition within the country had its effect on the likelihood of a child or young adult being killed or injured in an RTA. From my personal experience, as a native Omani, children and young adults from a rich families will be using private transport to get to school while the low socioeconomic state family children go to school either by walking or using public transport which, according to WHO (2007) put them at a higher risk of being involved in an RTA.
The behaviour of the road user clearly constitutes an important risk factor for RTAs. In Oman careless driving and excess speed are identified as the main causes of RTAs ( ROP, 2010), especially among the age group 15 to 25 years. This age is identified with its complex interaction in terms of physical, cognitive, and psychosocial developmental processes, which result in greater risk-taking (Johnson and Jones 2010). On the other hand, women in Oman are over cautious drivers, which is likely to confuse other road users by their hesitation and thus precipitate a RTA (ROP, 2010).
The law and the road legislative authority have established a lot of regulations to improve road users’ safety, like the compulsory wearing of front seat belts, implementation of speed limits and the prohibiting the use of mobile phones during driving (ROP, 2010). However, based on my knowledge and experience, those legislations are loosely applied, which leads to a poor compliance by the community. A study was carried out to examine seat belt wearing in cars entering the Sultan Qaboos University complex on a single day. The study showed that 90.1% of drivers and 80.9% of front seat passengers wore their seat belt. However, only 1.4% of rear seat passengers wore a seat belt. The adherence of the front seat passengers was not as that of the drivers although there were police staff at the gates to the campus and spot checks on the roads frequently result in fines. “Researchers also reported that they could see front seat occupants putting on their seat belts as they approached the gates” (McIlvenny, 2006 p.3).
The Emergency Medical Services (EMS) is a new service in Oman. It has been developed due to the increase in the prevalence of RTAs. Currently, it is run by trained Emergency Medical Technicians under the sponsorship of the ROP Ambulance Division. The service covers most of the country and responds mainly for trauma emergencies. It is free of charge for all people in Oman. There are plans to increase its coverage to the whole country by 2012. The EMS in Oman has hard challenges especially in terms of geographical constraints (Alshaqsi, 2009). In addition, Oman has one large trauma centre, which opens the discussion for equity in the country in terms of differences in accessibility between urban and rural areas.
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Islam is the dominant religion in Oman with small representations of Christian, Hindu and Bodehies. Religion in Oman forms a vital part of the community life. In Islam violating the legislation is unacceptable, thus death caused by a RTA is considered to be a murder or a suicide, which are major sins not only in Islam but in all religions. However a Fatwa, which is a reliable regulation on a point of Islamic law, was declared by the highest religious authority in the country; this Fatwa represented the Islamic point of view on the RTA, yet there have been no changes or decrease in the prevalence of the RTAs since the initiation of this Fatwa (AlKalili, 2011).
Most of the factors mentioned above are, in fact, enabling if mobilized effectively within the community to reduce the prevalence of RTAs. Thus, this section will highlight improvements to be considered in order to strengthen the public policy, health services and health education to control RTAs in Oman. Although the priorities in road safety policies cannot be global in nature because of the differing patterns of traffic and RTAs around the world, he supporting evidence on the effectiveness of the suggested interventions is mainly from western countries, which constitute a lot of differences in terms of context. That is because of the very small amount of road safety research that is done in Oman and neighboring countries, especially in the interventions that are suggested in the next section. However, the implementation of these interventions is feasible in the context of Oman.
The strict application of the existing legislation and its penalties is very essential, then benchmarking of some other safety legislations, which were shown to be effective in other countries, could be adopted. One of these legislation, for instance, is the mandatory use of rear seat-belts and child restrainers, which proved effective in reducing the seriousness of injuries thus reducing the of fatality, especially among the most vulnerable age groups, children and young adults. (Kendall and Bodiwala,1994).
Readjusting the speed limits according to the international recommendation and then strict enforcement of it will result in fewer injuries. A good example of the effect of such legislation is the introduction of speed cameras in London over a six year period, which resulted in a remarkable reduction in deaths and serious injuries (West,1998).
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Safer design of roads and roadside environments is also important, especially in the rural areas of Oman where the roads are narrow and not straight, have no lights at night and no side guardrails or crash barriers. These interventions have resulted in fewer injuries when implemented in other countries (Elvilc, 1995).
Although the health service in Oman has a well established infrastructure, there are some interventions that could improve RTA survivals when implemented and these can be categorized in to three stages, pre-hospital, in hospital and post-hospital trauma care;
Although the EMS in Oman is functioning well since it was started a few years ago geographical constrains do play a major role in the speed of arrival of the EMS to the place of the RTA, as the small population of the country is scattered in a large land area; there are people who live on the mountains and others deep in the deserts, and due to these constraints a community based pre-hospital strategy was suggested by WHO (2005). Basically, it is teaching some interested community members the basic first aid and pre-hospital trauma care techniques. Those first responders can be taught to call for help and provide the first aid until health-care personnel arrive to give the necessary care. These individuals could be, for instance, taxi drivers, high school students river, high school students or the community leaders.
One large trauma centre for the whole country is situated in the capital. However, the north side of the country is as far as 12 hours driving or a two-hour flight, which constitutes a high risk in transporting RTA traumatised patients to this national trauma centre. Thus providing this kind of services at the secondary hospitals that are situated almost in all the regions of the country can play a major role in speeding up the necessary interventions and improving the survival of the RTA victims.
The centralised rehabilitation care for the RTA patients needs to be decentralised and made easily accessible to all the population and in this respect the equity issue, between the urban and rural, should be considered. In summary, in providing health services for the RTAs, to improve survival rates an integrated approach between the three levels of care is strongly recommended in the literature and has proven its effectiveness (Hedstrom and Garneski 2006)
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Many educational programs have been established for the prevention of RTAs in Oman. However, there is no significant statistical data related to the effect of those programs. On the other hand, Wood and Bellis (2010) argue that comprehensive interventions that engage the community at large and combine strategies such as education programmes and traffic calming measures have shown their effectiveness in Australia, USA and UK. in reducing the incidence of RTAs.
RTAs are a major public health issue in Oman. In order to develop a health promotion approach to it, community mobilisation and empowerment along with improvements, reinforcement of public health policies and the health care services is the key to prevention and the reduction in injuries.
Roads: A Health Promoting Setting
Road traffic accidents (RTAs) is a growing public health problem in Oman; from the discussion in part one of this assignment, evidence showed the significant impact of changing and promoting the road settings as well as the enforcement of road safety regulations. This document will present a health promotion strategy taking the roads as the setting to be addressed in order to make roads safer for everyone.
To establish a sustainable infrastructure that promotes road safety, and to empower the community to make the appropriate health protecting decisions through advocating healthy public policies on road safety.
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To increase the level of knowledge and skills of RTAs prevention through the mass media.
To address inequalities in health services for RTA casualties in Oman due to geographical reasons, and empower the community to build their capacity to reduce and prevent RTA injuries.
To encourage young adults in the community (15 to 25) to change their aggressive driving behavior and adopt healthier attitudes towards road safety.
Although the literature studied did not directly discuss roads as a setting for health promotion, the majority of RTA prevention and health promoting strategies are directly linked to the roads and the road users. Thus I strongly believe that in the case of RTA prevention, roads are the appropriate setting for a road safety health promotion programme. This programme is going to target all the road users (drivers, passengers, cyclists and pedestrians) at a national level. Moreover, the programme will constitute multiple integrated approaches; firstly, the medical approach, which will aim to reduce.
the premature fatality due to RTAs by advocating for community, participation in the provision of first aid for RTA victims in the rural areas, where the emergency medical services EMS could be delayed due to geographical constraints. Secondly, the educational approach, which will aim to provide the knowledge and skills to the targeted group in order to assist them to make an informed choice to adapt a healthy behaviour when using the roads. Thirdly, social change approach which will aim to focus on the public health policy changes and physical infrastructure changes and improvements of roads that will eventually lead to safer roads for every one (Naidoo and Wills 2009; Bener and Crundall 2004)
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Tones’ framework model on health promotion (1994) explains the relationship between health education and health promotion. However, this framework could be adapted in this assignment to also explain the relationship of the different approaches used in order to eventually empower the community.”Working for empowerment enhances individual autonomy and enables individuals, groups and communities to take more control over their lives”(Naidoo and Wills 2000 pp.108-109).
HEALTH
Lobbying, Advocacy
Health services
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Health promotion organisations
Critical consciences arising
Agenda setting
Empowered participating community
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Public pressure
Empowerment
Health choices
Professional education
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Education for health
Healthy social and physical environment
Healthy public policy
(Adapted from Tones and Tilford 1994, cited in Naidoo and Wills 2000 p.108
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To identify and compile existing best practices in road structure, which promote road safety for all road users.
Arrange meeting with the stakeholders involving experts to agree on the means of researching and gathering evidence
Involve the community leaders to give their input
Introduction of new speed limit legislation
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Introduction of rear seat belt legislation
Introduction of child restrainers in cars
Advocate for new legislation, providing the evidence of its effectiveness in promoting the road safety and prevention of RTAs.
Improve the community understanding of safety road usage, to enable them to change their behavior toward safer roads utilization
Road safety campaigns using the mass media
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Radio drama and road posters on the following issues;
Use of seat belts, front, rear and child restrainers
Speed limits, the consequence of adherence to legislated limits.
Compulsory regular breaks for the bus drivers
-Director of the media in the country
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-Police authority
– Community leaders
– Experts in the field
Expand the EMS for all the country
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Empower some of the community members to participate in pre-hospital care.
Train motivated community members like high school students, taxi drivers and community leaders in providing first aid and trauma life saving techniques.
Short courses provided by trainers from paramedical training institution in a community setting like schools or the social gathering places (common in rural areas).
Legal authority
Training institutions
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Police authority
Community leaders
Schools managers
Introduce a road safety programme in high schools
To adopt criteria for licensing which includes the attitude of the driver .
Road safety school curriculum for high school students
Thought materials for driving schools
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Education authority
Police authority
School managers
Driving training institution managers
According to Naidoo and Wills (2000), the value of a health promotion intervention can be judged by considering the following criteria: effectiveness; were the aims and objectives met and to what extent (reduction of the RTAs), appropriateness; were the suggested interventions relevant to the problem, acceptability; were the interventions culturally and religiously sensitive, efficiency; how a resource was spent and equity; since it is a national programme did it cover all the country with the consideration of high vulnerability areas.
To assess short term outcomes: attitudes of the drivers on the roads in terms of adherence to the speed limits and seat belt regulations.
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To evaluate mid-term: process of implementation.
To assess the long term outcomes: achievement of the goals
The short term evaluation of the programme will be done after one year to evaluate the process of the implementation and after four years to assess the impact of the programme in the prevention of RTAs and reducing the severity of injuries
Number of stakeholders who participated in the planning process
Number of the community leaders who participated in the traffic legislation changes
Number of the new traffic legislations initiated
Number of mass media programmes initiated
Number of traffic offences due to poor compliance with the seat belt and speed regulations.
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Number of community volunteers enrolled in the trauma first aid programme
Number of road infrastructure changes, improvements and maintenance projects planned and budgeted
School road safety curriculum implementation
Percentage of RTA reduction from all the regions in the country.
Percentage of deaths, injuries caused by RTAs and the type and severity of the injuries.
Sustainability of all the initiated interventions
Research of changes in high school students’ behavior in regard to aggressive driving and speed limits.
Changes and improvements in experts’ inspection and evaluation of the roads infrastructure.
Safer Roads for Everyone is a health promoting programme that will include many detailed interventions, but it is not intended to be a rigid plan. The plan and targets will be reviewed periodically to take account of new ideas from all stakeholders and the community, also to consider new evidence based interventions and new technologies. A Road Safety Advisory board will be initiated to assist in the review of the whole process.
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