South Africa bears a high burden of road fatalities in Africa, accounting for 25.1 fatalities per 100 000 population . The total number of road fatalities have fluctuated over the years, reaching an all-time high of 15 000 fatalities in 2006 . A study in 2015 found that road traffic crashes* (RTCs) have continued to be the 9th leading cause of death for 15 years in the country (1997-2012), claiming an average of 3,5 per cent of overall deaths during those years .
However, road fatalities portray only part of the problem. Although precise information on the number of injuries caused by RTCs is unknown, historical data suggests that for every fatality on the road, there are 4.6 serious injuries and 14.9 slight injuries . If these ratios are considered, in 2017, 287 000 fatal and non-fatal injuries were caused as a direct result of RTCs on South African roads.
It has been estimated that these crashes cost the South African road network an estimated ZAR 142,95 billion every year – equating to 3.4 per cent of the country’s GDP . In comparison, cost of road traffic crashes in low- and middle-income countries is found to be 2.2 per cent of their GDP. Road fatalities and injuries also place a high financial burden on individuals involved in crashes. The average hospital care provided to a pedestrian or passenger involved in a crash costs approximately ZAR 80 000 per admission .
Road deaths also leave an emotional gap in the hearts of loved ones, and no value can be placed on this impact. From 2015 to 2017, approximately 1 300 children were killed on South African roads each year. This child was a daughter, a son, a brother, a sister... a friend. Each child’s future lay ahead of them, with the promise of a potential unfulfilled.
Who is vulnerable?
South African roads impact certain groups more than others, and consequently, these groups are at a higher risk than others. A child born in South Africa is more likely to be killed walking on the roads, with pedestrian crashes being the leading cause of injury death for children under the age of 15 .
Overall, young breadwinners, aged 20-34, are the leading victims of this road safety epidemic, whether they use the South African roads as pedestrians, passengers, drivers or cyclists . Males are four times more likely to be killed on the road than females 
As road users, pedestrians constitute the majority (37.6 per cent) of road deaths in South Africa, followed by passengers (32 per cent) and drivers (27 per cent) . Considering this, pedestrians are considered vulnerable road users in the South African context. In the case of Cape Town, most of the pedestrian deaths have been found to occur in low-income areas , where a significant majority walk more than 10 minutes (in certain cases 60 minutes or more) to access their destination .
This is observed to be the norm across African countries, with the vulnerable found to come from low-income households that depend on walking as their primary mode of transport to access services and public transport .
The risk of road fatalities varies depending on the province considered as well, meaning that residents of certain provinces are at a higher risk than others. This is found to be the case in Mpumalanga, where the road fatality rate is the highest at 37.9 fatalities per 100 000 population . Northern Cape and Free State closely follow, with a fatality rate of 36.3 and 35.3 fatalities per 100 000 population.
Alternatively, the Western Cape has the lowest fatality rate (20.9) in the country, despite being the fourth most populous province in the country.
What are the major causes?
Contributory factors to road fatalities vary between rural and urban regions. For instance, in rural areas, stray animals on the road are seen to cause road fatalities, while in urban areas this kind of problem is minimal or non-existent entirely. However, in the specific case of South Africa, certain risk factors are found to be the leading cause of fatalities and injuries on the road. These factors include:
According to the World Health Organisation, a 1 km/hr increase in average speed results in a 3% higher risk of injury due to a crash, and a 4-5% higher risk of a fatality due to a crash. This is because higher speeds require a greater stopping distance, resulting in increased stopping times .
Increased speed particularly impacts the injury severity for all road users. For car passengers, the likelihood of death is 20 times more in a car that is travelling at 80 km/hr on impact, rather than a car travelling at 30 km/hr. The risk is higher for pedestrians, who have shown to have a 90% chance of survival when hit with a car travelling at 30 km/hr, but less than 50% survival chance when hit with a car travelling at 45 km/hr. Pedestrians are also considered vulnerable road users because of this fact, since they have less protection on them when hit with a car.
In South Africa, it has been found that majority of South Africans tend to exceed the posted speed limits . Another area that is of concern is that in residential and urban areas, where pedestrian traffic is high, the posted speed limit is found to be 60 km/hr, which is excessively high for such areas. At this speed, and considering the statistics above, pedestrians are given a very minimal chance of survival.
A drunk driver or a drunk pedestrian has impaired senses, which results in slower reactions on the road. The WHO’s findings state that an alcohol impaired driver is 17 times more likely to be involved in a crash than an unimpaired driver .
South Africans have a long standing battle with alcohol consumption, which has been found to be the number one public health and safety issue . This is apparent from the statistics: every festive season, a number of drivers are caught as a result of driving under the influence . An international WHO survey found that South Africa had the highest number of drunk driving incidents , and the key reason for this is the lack of stigmatisation amongst the public for those who practice these habits.
3. Seatbelt and child restraint usage
A study conducted by Arrive Alive found that seatbelt usage varied from 45 – 60% among drivers in South African provinces. The seatbelt usage was especially lower in Central Business Districts (CBDs), suggesting that road users tend to believe that in low speed environments, a seatbelt is unimportant. In terms of Child Restraints, the Red Cross War Memorial Hospital treats an average of 20 child passengers every month as a result of an RTC.
In every crash, there are three collisions that occur when occupants are unrestrained . The first collision is between the vehicle and another object. The second collision is between unbelted occupant and the vehicle interior. Finally, the third collision is when the internal organs of the body hit the chest wall. It is the second collision that results in majority of the injuries that occur, and seatbelts for passengers and child restraints for children have found to greatly reduce the injury risk.
4. Unsafe vehicles
Vehicle unroadworthiness, due to gross neglect of elementary maintenance, causes defects to the tyres, brakes and lights. These defects have been found to cause approximately 9% of road accidents . A survey in eThekwini municipality, KwaZulu-Natal, found that vehicle defects are widespread with tyre defects being the most common . The study also found that closer vehicle inspection would provide better perspective on whether crucial components of a vehicle are safe for use. At first glance, it might seem that minibus taxis – one of the main forms of public transport  – are the major culprit in this regard. However, South Africa’s aging vehicle population are also contributors and these vehicles require mandatory roadworthiness tests.
Due to the legacy of Apartheid planning, fragmentated and segregated development in South Africa continues to dominate. Households and people living in townships and other low-income areas have been the real victims. These areas lack proper road and pedestrian infrastructure such as pedestrian pathways; street lighting is poor even though pedestrian movement is high; and inadequate open spaces prevent the use of areas for recreational purposes . There is also the establishment of further formal and informal settlements near highways, where high-speeds are norm, that is increasing the risk of RTCs.
What can be done?
Road safety is a major challenge in South Africa – one that requires a multisectoral, multigovernmental approach that is evidence-based to reduce this increasing burden. The WHO suggests a safe systems approach to this, which considers road safety a shared responsibility between all stakeholders, from the politicians to the government departments to the traffic officers to the road user. An important aspect of this approach is that humans make mistakes, but these mistakes do not, and should not, result in a fatality or a serious injury on the road.
In the South African context, where majority of road users are pedestrians who walk to access their destination or to access public transport, it is important that all road safety interventions are oriented towards the pedestrians. This is also crucial since the data clearly states that they are the vulnerable road user in the country. Considering this, and the main factors that impact road safety, certain interventions should ideally be prioritised. These include:
- Reducing the speed limit on residential, urban and school areas, where pedestrian movement is high. As mentioned above, the lowest speed limit in SA is 60 km/hr and by reducing this to 30 km/hr, the risk of a road fatality or a serious injury can be reduced significantly.
- Introducing a zero tolerance to drunk driving. The United Kingdom (UK) has a comparatively higher alcohol blood limit than South Africa – 0.08 vs 0.05, but have one of the lowest road deaths in the world . There are mainly two manners in which the UK has been able to achieve this. One is through random police checkpoints that are accompanied by breath-testing, and second is stigmatisation of the habit itself. Society needs to look down upon the very act of getting behind the wheel, or using the road, when drunk. And this can be done through traffic officers imposing strict penalties on offenders and using education campaigns to instil knowledge on the extremely negative impact of being under the influence while driving.
- Educating drivers and car users on the importance of using the seatbelt and restraining a child when driving. While there is norm among drivers that seatbelts are unimportant in low-speed environments, there is also a misunderstanding on how seatbelts can save one’s life rather than harm one’s life during an accident. In terms of child restraints, it should be the driver’s responsibility to ensure that all children are restrained in the vehicle.
- Enforcement! A major challenge that SA faces today is the lack of enforcement of existing laws. Even if our country reduces the speed limits in residential and urban areas, as recommended above, without adequate enforcement, drivers are more likely to disobey these laws. This can be tackled through the deployment of visible policing that are working on the road to ensure that laws are followed. Coordination is also important among the various police officer agencies to ensure that all are working towards the same goal of achieving safer roads for all.
- Designing roads and cities with pedestrians in mind, as they are the majority of our road users and therefore, have the right to live in cities made for them. While this is not possible to achieve for all existing roads, as a priority, it should be ensured that in areas where pedestrian fatalities are high, the infrastructure should be evaluated to improve pedestrian accessibility and tackle the road fatalities.
In most cases, the solution requires a combination of the above interventions to tackle the local challenges. Therefore, stakeholder coordination is of utmost importance to achieve safer roads, safer spaces, and safer cities for all road users.
*The term ‘road traffic crash’ with its acronym ‘RTC’ is intentionally aligned with the definition as in SANS/ISO 39001 and is used throughout this article. ‘Road Traffic Crash’ imparts the same meaning as “accident” noted in the National Road Traffic Act, Act 93 of 1996.
List of references
 World Health Organization, Global Status Report on Road Safety 2015, WHO Libr. Cat. Data Glob. (2015) 340. doi:10.1136/injuryprev-2013-040775.
 OECD/ITF, Road Safety Annual Report 2015, 2015. doi:http://dx.doi.org/10.1787/irtad-2015-31-en This.
 V. Pillay-van Wyk, W. Msemburi, R. Laubscher, R.E. Dorrington, P. Groenewald, T. Glass, B. Nojilana, J.D. Joubert, R. Matzopoulos, M. Prinsloo, N. Nannan, N. Gwebushe, T. Vos, N. Somdyala, N. Sithole, I. Neethling, E. Nicol, A. Rossouw, D. Bradshaw, Mortality trends and differentials in South Africa from 1997 to 2012: second National Burden of Disease Study, Lancet Glob. Heal. 4 (2016) e642–e653. doi:10.1016/S2214-109X(16)30113-9.
 Road Traffic Management Corporation (RTMC), Cost of Crashes in South Africa, Research and Development Report, Pretoria, SA, 2016.
 F. Labuschagne, E. De Beer, D. Roux, K. Venter, THE COST OF CRASHES IN SOUTH AFRICA 2016, 2004 (2017) 474–485.
 F. Parkinson, S.J.W. Kent, C. Aldous, G. Oosthuizen, D. Clarke, The hospital cost of road traffic accidents at a South African regional trauma centre: A micro-costing study, Injury. 45 (2014) 342–345. doi:10.1016/j.injury.2013.04.007.
 N. Arendse, L.-A. Swart, A. van Niekerk, S. Van As, 2 PEDESTRIAN SAFETY, Crime, Violence Inj. South Africa 21st Century Solut. Child Safety. Psychol. Soc. South Africa (PsySSA), Hought. (2012) 8–22.
 Road Traffic Management Corporation (RTMC), Road Traffic Report, 2015. www.rtmc.co.za%5Cnwww.aartosa.co.za.
 M. Vanderschuren, M. Zuidgeest, 4 Road safety and non-motorized transport in African cities, Non-Motorized Transp. Integr. into Urban Transp. Plan. Africa. (2017) 57.
 A.M. Janmohammed, Unpacking road safety at a district level-the case of Cape Town, South Africa, (2018).
 R. Behrens, Accommodating walking as a travel mode in South African cities: Towards improved neighbourhood movement network design practices, Plan. Pract. Res. 20 (2005) 163–182. doi:10.1080/02697450500414686.
 Amend, FIA Foundation, Step Change: An Action Agenda on Safe Walking for Africa’s Children, 2016.
 A. Janmohammed, M. Vanderschuren, D. Roux, A.B. Van As, Vulnerability of Childre, Young Breadwinners and Mature Adults on Western Cape Roads, in: SaVI Conf., Cape Town, 2018.
 World Health Organisation, Road Safety- Speed Factsheet, (2004).
 C.G. Wilmot, M. Khanal, Effect of Speed limits on speed and safety: A review, Transp. Rev. 19 (1999) 315–329. doi:10.1080/014416499295420.
 Arrive Alive, Speed Limit, (n.d.). https://www.arrivealive.mobi/speed-limits (accessed November 6, 2018).
 Western Cape Government, It Won’t Kill You To Slow Down, (2017). https://safelyhome.westerncape.gov.za/campaigns (accessed November 6, 2018).
 World Health Organisation, Road Safety - Alcohol, (2002).
 Western Cape Government, Alcohols and Roads Dont Mix, Saf. Home. (2017). https://safelyhome.westerncape.gov.za/campaigns/1583 (accessed November 6, 2018).
 eNCA, Over 2,000 nabbed for drunk driving during festive season, (2017).
 FIA Foundation for the Automobile and Society, Seat-belts and child restraints: A road safety manual for the decision makers and practitioners, (2009).
 G. Kinsey, Contribution of unroadworthy vehicles to accidents, in: 2nd Conf. Natl. Inst. Transp. Road Res. Pietersburg, South Africa, 1976.
 S. Moodley, D. Allopi, AN ANALYTICAL STUDY OF VEHICLE DEFECTS AND THEIR CONTRIBUTION TO ROAD ACCIDENTS, (2008) 469–479.
 2014 Statistics SA, National Household Travel Survey Febrauary to March 2013, (2014) 1–179.
 H. Ribbens, P. Everitt, M. Noah, Impact of an adequate road environment on the safety of non-motorised road users, in: Medical Research council-University of South Africa, 2008.