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ABSTRACT
Ghana carries a heavy burden of medical emergencies, trauma and injuries that have long become of public health concern. Overall, there is a huge injury burden not in an isolated occurrence but occurs daily or weekly resulting in severe disability and preventable deaths. Ghana through its National Development Planning Commission adopted the Sustainable Development Goals as part of its national policies. The Ministry of Health have inculcated some of the indicators of the SDGs especially Goal 3. This study seeks to examine the implementation of Goal 3.6 and its relevance to Road Traffic Accidents (RTA) in Ghana, its causes and the Ministry of Health (MoH) and other relevant stakeholders in preventing RTA.
The study adopts a descriptive approach to explore the efforts towards the implementation and achievement of Goal 3.6. The research employed qualitative methods using semi-structured interviews and conversations with institutional representatives guided by a questionnaire to enable achieve the study objectives. Key respondents were purposively selected to provide in-depth information and access to institutional data. We relied on both primary sources of data with the secondary data consisting of meetings reports, health summit conference presentations, institutional reports, policies and guidelines on the subject. The data was analyzed using thematic analysis for reporting. Although the study did not anticipate any harm to respondents, we observed ethical procedures by ensuring confidentiality, anonymity and informed consent for respondents.
The key findings from the study showed that Goal 3.6 is relevant to tackling RTA and the Ministry of Health has a major role in implementing it with the aid of its agencies and those from other sectors such as the Ministry of Interior through its Motor Transport and Traffic Department; Ministry of Transport’ Drivers and Vehicle Licensing Authority and National Road Safety Authority to enforce road traffic regulations and promote road safety; the Ministry of Roads and Highways to improve on road constructions and maintenance; the Ministry of Information’s National Media Commission to engage in active health promotion and preventive activities among others. This demonstrates the complexities of implementing and achieving Goal 3.6 with multi- sectoral coordination, poor resources and inadequate infrastructures. Preventing RTA require preventive actions and appropriate investment in institutions responsible for pre-hospital care.
The study concludes that the country might not achieve the target at the establish time due to the above challenges. Therefore, to make any gains there is the need to create a permanent or temporary working multi-sector committee to coordinate and implement activities relating to road traffic accidents. Also, law enforcement of road traffic rules and regulations must be strengthened, community engagement improved, skills of first responders built and improved, and media/press participant and advocacy increased to reduce the incident of RTA. This coupled with the policies guiding prevention of RTA and emergency services will impact on the implementation of Goal 3.6.
Background to the Study
The United Nations General Assembly (UNGA) met in 2015 to take a decision on how to address key challenges facing the world in its General Assembly Resolution 70/1 on the 25 September 2015, entitled “Transforming our world: the 2030 Agenda for Sustainable Development” (UNGA, 2015). The UNGA agreed on the Sustainable Development Goals (SDGs) which consist of 17 SDGs and 169 targets for member states to work towards achieving them by 2030. The United Nations Development Programme (UNDP) is the lead campaigner to promote the SDGs in member states (UNGA, 2015; UNDP, 2019).
Prior to the SDGs were the Millennium Development Goals (MDGs) that culminated in 2015 giving birth to the SDGs in the same year, and providing a continuation to improve and expand the goals to other areas. There are remarkable differences between the SDGs and MDGs. For instance, the mode of implementing the SDGs are based on internal national resource mobilization contrary to the MDGs that had an envelope of international aid for implementation. Also, unlike the SGDs, the MDGs excluded areas like injuries and deaths from road traffic accidents, mental health and wellbeing, disabilities and non-communicable diseases in general.
This study seeks to examine the Sustainable Development Goal 3.6 and its relevance to Road Traffic Accidents (RTA) in Ghana and its causes. We also intend to explore the role of the Ministry of Health (MoH), their preparedness in pre-hospital and hospital emergency services towards the management of casualties without excluding the roles of other relevant stakeholders in its prevention.
SDG 3.6 states that it seeks to ‘halve the number of global deaths and injuries from road traffic accidents by 2020’ (UN, 2019). There has been an increase in global deaths and injuries in the last few years, 2015, 2016 and 2017. In 2015, the number of road deaths increased in 21 countries compared to 2014. In 2016, the number of fatalities increased in 14 countries (IRTAD, 2017). Ghana carries a very heavy burden of medical emergencies, trauma and injuries that have long become of public health concern. Overall, there is a huge injury burden that occurs daily or weekly resulting in severe disability and preventable deaths.
The causes of the high rate of RTA in Ghana are multi-sectoral in nature with different actors and stakeholders. These actors and stakeholders include but not limited to Ministry of Interior-Motor Traffic and Transport Department (MTTD), Ministry of Roads and Highways, Ministry of Transport- Driver and Vehicle Licensing Authority (DVLA), Ghana Highways Authority, Ghana Police Service, National Ambulance Service (NAS), Ghana Red Cross Society (GRCS), National Disaster Management organization (NADMO), Ministry of Railway Development, The Media and Press, Ghana Standards Authority (GSA), Ministry of Aviation, Customs Exercise and Preventive Service (CEPS) St. John Ambulance, Local Government Service, Ghana Private Road. Transport Union (GPRTU), Ghana National Fire Service, National Road Safety Commission (NRSC), Ministry of Health (MoH) and the Government in general for road contracts.
The SDG 3.6 is therefore composed of multiple country specific stakeholders who are charged to address the needs identified in target 3.6. The achievement of this goal is dependent on internal mobilization of funds by the stakeholders charged to implement it coupled with high level political commitment.
Statement of the Research Problem
Ghana has an increased number of road traffic accidents which is of public health magnitude. There has been a gradual increase in casualties in Ghana in the past few years with many deaths. Statistics available records total vehicles involved in accidents in 2018 at 22,025, persons injured 13,677 total accidents cases reported 13,645, persons killed 2,341 (male 1,796, female 545)
commercial vehicles 8,431, private vehicles 9,691, motor cycles 3,903 (NRSA, 2018). These figures of 2018 are the reported cases, however, there could be many unreported cases which would have made the figures even higher (Harry, 2007; Afukaar, 2006). Statistics available at the Ghana Police Service –MTTD, has the following regional breakdown of road traffic accident deaths: Upper West 57deaths as the least, while Greater Accra recorded the higher number of deaths at 460. The rest are Upper East 65, Northern 184, Western 137, Volta 172, Central 221,
Brong Ahafo 241, Ashanti 399 and Eastern 405. With 2018 recording a total of 2,098 injured accident cases against a total of 1607 in 2017, signifies 30% increase. Equally, in 2016, the Ministry of Road and Highways has recorded deaths by age distribution to be below 18 years 10,622, age 18 to 35 years, 69,851 age 35 to 45 years, 33,558, age45 to 60 years,22,174, age 60
years above 8,814 and age not known 5,766 (NRSC, 2016; NRSC, 2017).
Unquantifiable is the burden and financial cost to a family with an accident patient. These include adjustment of work cycle to accommodate hospital visits, adjustment and restructuring of house space if disable, the enormous psychological effect for both patients and family, loss of work and productivity, if the bread winner for the family, then even catastrophic. Road traffic injuries (RTIs) keep people away from work and school and impoverish individuals, households, communities, and nations. The Ministry of Health has developed policies and guidelines for the referral and
management of accident victims. Also, it’s implementing agencies, especially, the National Ambulance Service, Health Institutions and National Health Insurance Authority, among others, through donor support are developing the necessary strategies towards pre-hospital emergency care, hospital emergency services and financing of emergency service.
The research problem is, therefore, to explore the causes of the high rate of injuries and deaths from road traffic accidents in Ghana and specifically, the role of the Ministry of Health, its Agencies and Donor Partners towards achieving the target. Also to briefly explore the roles of other relevant stakeholders towards achieving SDG 3.6.
Research ObjectivesTo examine SDG 3.6 and its relevance to RTA in GhanaTo explore the causes of RTA in GhanaTo examine the role of Ministry of HealthTo understand the roles of other stakeholders Research QuestionsWhat is the framework of SDG 3.6 in relation to RTA in Ghana?What are the causes of road traffic accidents in Ghana?What is the role of the Ministry of Health in combating these accidents?What are the roles and responsibilities of other relevant stakeholders in preventing RTA? Scope of the Study
This study is mainly about the role of the Ministry of Health and other key stakeholders in reducing the negative effects of road traffic accidents on victims. The role of these multiple actors such as the MoH and its implementing agencies in the private sector and donor partners in health are assessed. It also explores how the SDG Goal 3.6 is adopted but focuses on the MoH preparedness towards the achievement of Goal 3.6. For the purposes of this study, activities considered are between 1st January, 2015 to 29th June, 2018 as the timeline for the adoption of the SDGs in Ghana.
Significance of the Study
The Sustainable Development Goal is a widely adopted global agenda. One of the major health focus for the SDGs can be found under Goal 3 which is related to health service delivery and seeks to ensure healthy lives and promote well-being for all at all ages (WHO, 2016). However in Ghana, road traffic accidents are on the rise leading to high morbidity and mortality, especially among the youth and middle aged with a negative impact on economic development. National road safety has reported a total of 241,999 crashes involving 378,015 vehicles from 1991 to 2014. A total of 329,535 injuries with 47% of deaths. In 2015, 36% of OPD attendance was due to casualties (RTA) with fatality of 2199, seriously injured: 6,663 a fatality rate: 17% having an economic impact of 1.6% GDP. (Afukaar, 2016; GHS, 2017). This does not include domestic and Industrial Injuries.
SDG 3.6, seeks to ‘halve the number of global deaths and injuries from road traffic accidents by 2020, but as we approach the year 2020 and barely year away, this review is relevant to evaluate if Ghana could achieve the target despite alarming figures of RTAs. Assessing the activities of the
Ministry of Health and other key stakeholders will help to understand severity of the situation. Traditionally, most health interventions are geared towards communicable disease especial, Tuberculosis, Malaria, HIV and AIDS at the expense of non-communicable disease and road traffic accidents. Currently these later diseases are of public health concern and silent killers especially with increase in life expectancy.
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