Balance road safety and public health

Africa has two percent of the world’s registered vehicles but a disproportionate 16 percent of the world’s road traffic deaths. Africa has more than twice the rate of road fatalities that occur in Europe where there are 10 deaths per 100,000.

In a business-as-usual scenario road fatalities will surpass the number of malaria related deaths in sub-Saharan Africa. According to a World Bank report, road fatalities in sub-Saharan Africa are predicted to rise by 80% by 2020. Seven countries – DR Congo, Ethiopia, Kenya, Nigeria, South Africa Tanzania and Uganda – will account for two-thirds of road deaths in the region.

 The rate of urbanization has gathered momentum. The overflow in our streets, gridlock in woefully inadequate roads and unplanned urban sprawl underline the pain and dis-ease of Africa’s unprecedented demographic and economic change. Furthermore, our planning systems are woeful; land use, urban and road infrastructure planning are neither coordinated nor integrated.

Rapid urbanization and the consequent explosion of vehicles, high population, unplanned suburban growth and inadequate public transport infrastructure now undermine public health and safety. A majority of Nairobi’s commuting public does so on foot. However, although the urban poor have environmentally friendly or “green” travel habits they bear they pay with life, limb and blood.

Inadequate public transport dictates travel options, constrain a majority of urban residents into choosing high-risk transport options. Owing to unplanned urban expansion in cities like Nairobi, Mombasa and Kisumu, public transport is unreliable or expensive or does not serve rapid expanding sub-urban settlements. It is not surprising that a majority the victims of road traffic fatalities in urban areas are vulnerable road users – pedestrians, cyclists and boda boda riders.

High fatality rate among pedestrians is attributable to poor road design in dense urban neighborhoods where walking is the main form of transport. Exacerbating the traffic fatalities is the fact that city planners and those who design road infrastructure do not think seriously about the majority of urban residents who do not use motorized transport. Urban form and function is hostile to the non-driving public.

Most traffic accidents occur in urban and sub-urban areas, where there is a more complex traffic environment and a predominance of road users that are more susceptible to death or injury in the event of an accident. For example, motorists along the Thika Superhighway have killed more than 209 road-crossing pedestrians.  Another 278 have been injured in while trying to cross this massive highway.

The cause of an accident is never established. This is because of lack of capacity to rigorously investigate and analyze traffic accidents. The police often arrive too late, when the accident scene is contaminated, and all they end up doing is rescue, retrieval and restoration of traffic flow. Besides data on fatalities, casualty information, crucial for more comprehensive analysis, is often missing. Moreover, the police seldom seek eyewitness or survivor accounts. And to make matters worse, data records held by the police or hospitals or the Kenya Red Cross.

Society or the hospitals are not linked or integrated. In the absence of reliable data and evidence a balance between the competing goals of sustainable urbanization urban such as mobility, efficiency, security, safety and air quality standards will be difficult to achieve. And our roads will not be safer.

 Nevertheless, the relationship between vehicle speed and accidents has long been established. Speeding is the number one road safety problem, especially in densely populated, high pedestrian traffic urban neighborhoods. Studies have shown that reduction in average speeds of approximately 5 percent could yield a reduction in fatalities by as much as 20 percent. Over the last five years the authorities have acted to enforce speed limits on Kenyan roads.

However, it is not clear whether road accidents and associated fatalities or injuries have budged. More recently, the National Transport and Safety Authority has prescribed a speed limit of 50-kph or 30-mph in urban neighborhoods. However, enforcement is feeble and amateurish.

However, we need to balance road safety and public health. A study conducted by the Edinburgh Centre for Carbon Innovation shows that cutting speed limits below 65-kph was likely to increase emissions such as carbon dioxide and nitrogen oxides as well as particulate matter.

As if by coincidence, pneumonia – strongly linked to emissions – is a leading cause of death in Nairobi. Seriously, the 50-kph speed limit in high-density urban neighborhoods needs urgent review.

Do we have the audacity to bet on our children?

A woman poured very precious ointment on Jesus’ head. In indignation, his apostles asked, “To what purpose is this waste?’” In their view the ointment could have been sold for much and the money given to the poor.

But Jesus defended the woman and praised the good work that she had wrought upon him. Matthew 26:11 record these eternal words, “ For ye have the poor always with you; but me ye have not always”.

Many people – academics, clerics, journalists and politicians – often read Jesus’ words out of context and use the scripture to justify or tolerate depressing depravation in society. A majority of those who invoke this verse believe that poverty cannot be eradicated.

Poverty is neither inevitable nor pre-ordained. There is, in my view, a constellation of structural, and hence modifiable conditions, which cause poverty to thrive. That every year, according to WHO, eight million people die because they are too poor to stay alive is unconscionable. A majority of these people die of hunger, malnutrition, diseases such malaria, diarrhea, respiratory infections and measles. All of these diseases can be treated or prevented.

Recent estimates by the World Bank put the population of global poor at 1.44 billion people, based on the $1.25 daily expenditure. However, Nobel Laureate Amartya Sen, based on a multidimensional poverty index (MPI), estimates that there are about 1.7 billion poor people. The MPI takes into account living standards ranging from quality of dwelling house, sanitation, child mortality and years in schooling. Based on the MPI, our poverty rate surpasses 50 percent.

But poverty is not only multidimensional. Poverty is produced by a confluence of interacting and mutually reinforcing conditions. The interplay among the legion of factors that cause poverty invariably creates a “poverty trap”. Columbia University’s Jeffery Sachs defined a poverty trap as the overwhelming interconnected burden of disease, illiteracy, lack of capital, hunger, malnutrition, low agricultural productivity, etc. Poverty is a wicked condition, not amenable to straightforward, technocratic or expert or silver bullet solutions.

Kenya’s new status as a middle-income economy is undermined by what many analysts as well as ordinary folk perceive as pockets of extreme wealth in vast and deep Ocean of poverty. The enduring puzzle is why the tide of economic growth has failed to lift millions of Kenyans out of poverty. What happened to the notion of “trickle down economics”? Have markets failed to distribute or allocate prosperity equitably?

Think about the more than one million children of school going age who are out of school because their parents cannot afford to clothe or feed them. Think about the millions of children who go to school but do not have a desk or a book or a teacher or a decent classroom or toilet or clean water to drink. Think about the hundreds of thousands of kids who will sit KCPE this year and yet cannot read at the level of a child in class three who attends a private school. Think about 40 percent of our children who enter school ready to fail because their cognitive capacity has been damaged by years of hunger and malnutrition.

The plight of Kenya’s less privileged children, and there are tens millions of them, reminds us that the greatest driver and purveyor of poverty is not wealth or income but the unconscionable gap of opportunity. A lack of opportunity creates differential life outcomes and often produces insurmountable divergence in life achievement, which is intergenerational. The most effective way to break the poverty trap is to deploy fiscal and social policy tools to ensure equitable access for every Kenyan child. For many years we imagined that free primary education alone was the best way to deliver equal educational opportunity for all Kenyan children. We were wrong. We forget that equally important was the health and socio-economic wellbeing of the children in the home environment.

We can learn from Brazil’s conditional cash transfer program, which has reduced child mortality, improved nutritional outcomes for children and bolstered school attendance among poor children.

We need to turn the plight of millions of children who lack opportunity today into a business proposition.  A rough calculation shows that if 75 percent of the 906,000 children sitting KCPE in 2014 graduated from tertiary education with skills, they would add about $10 billion to our economy annually. Do we have the audacity to bet on our children?

Moribund rural economies could undermine Africa rising momentum

In 2000 The Economist magazine painted the portrait of a continent riddled with corruption, ravaged by conflict, poverty, debilitated by hunger and disease. Africa was ‘The Hopeless Continent’. But in 2011, with a cover titled ‘Africa rising’ and an illustration of a boy flying a rainbow-colored kite the shape of the continent, The Economist magazine released a revised edition of Africa.

In the revised edition The Economist magazine wrote not about the abundance of brutality or disease or poverty in Sierra Leone. The revised edition was about the pulsating Onitsha market in Nigeria, with shops stacked high with goods and streets jammed with buyers and sellers. It was about Africa having a real chance to follow in the footsteps of the Asian tigers.

The Economist’s Africa rising saga was preceded by Lions on the move: The progress and potential of African economies, a 2010 McKinsey Global Institute (MGI) report on Africa. The report showed that the year 2000 was an inflection point, heralding Africa’s growth acceleration with 27 of its 30 largest economies expanding more rapidly after 2000. MGI projected that services and products industries, agriculture, extractive resources and infrastructure could generate $2.6 trillion in revenue by 2020.  

In 2012 TIME, with an ‘Africa rising’ title of its own, described Africa as the “world’s next economic powerhouse”.  But it cautioned that hundreds of millions were at risk of being left behind. Similarly, in its Africa rising story, the Economist warned that optimism about Africa must be taken in small doses because things remained exceedingly bleak across the continent. 

That African economies are on the upswing is undeniable. The cities are throbbing. The energy and the hustle and bustle in the streets of African cities is tangible. Perpetual traffic gridlock, chronic water shortages, and eruption of informal housing in a majority of African cities, underscores the fact that growth has outpaced the capacity for planning and management. But there is some hope. There is infrastructure frenzy across many African cities – elevated highways, ring roads and by pass corridors are under construction – especially to deal with traffic congestion.

But something else is happening. The rural economy is pretty stuck. The intensity of rural poverty has not eased. Rural economies are predominantly sustained by remittances from the cities. Rural infrastructure is in a veritable state of decline. Agriculture is comatose. Land values are lowest in rural Africa. And for the most part, most rural landowners do not have land title deeds or proof of property ownership. So land is essentially dead capital. The returns on labor and land are too low. Women, who often lack the power to make critical decisions about land operations or choice of crop or use of technology, manage agriculture.

Moreover, the burden of disease is highest in most of rural Africa. Infant and maternal mortality are highest in rural Africa. The prevalence of stunting and other nutrition related problems are highest in rural areas. It is not surprising that rural districts have the worst education outcomes. For example, only 16 percent of Kenya’s rural population has post-secondary education. Enrollment, retention and completion rates in rural schools are deplorable. Numeracy and literacy scores among children in rural schools are consistently lower than for children in urban schools. Teacher absenteeism is worse in rural schools compared to urban schools.

Africa’s growth is really a tale of two economies. The first economy is the vibrant, pulsating urban economy. What happens in this economy is what feeds the Africa rising hysteria. Urban areas are home to the emerging middle class, which has got the global services and products aficionado all excited about Africa’s emerging consumer market.

The second economy is rural. It is largely characterized by socio-economic stagnation and decline. Over 50 percent of Kenya’s rural population lives below the poverty line, compared to 33.5 percent in urban areas. Only 3 –10 percent of Kenya’s rural population works for pay. Describing his community, a young pastoralist from northern Kenya wrote: “The youth in my community are idle and mostly indulge in reckless consumption of alcohol. Teen pregnancies are rampant and young men marry too early.

Inclusive growth and shared prosperity will depend on adoption of pro-poor policies and public investment aimed at agriculture and rural infrastructure. Things will remain exceedingly bleak as long as over 75 percent of Africa’s population is not implicated in the Africa rising saga.