Titolo della tesi: Assessing the social costs of Road Traffic Crashes in Cameroon
EXECUTIVE SUMMARY
This thesis assessed the social costs of road traffic crashes (RTCs) in Cameroon and was motivated by the little attention that road safety has received from policy makers, and the World Health Organization’s (WHO) declaration of RTCs as the leading (yet preventable) cause of death for children and young adults in developing countries. Policy makers in developing countries are yet to give road safety the attention it deserves, going by widespread under-reporting of RTCs which underestimates the gravity of this problem. Most of the action points required for the reduction of RTCs necessitate an estimate of the actual numbers of RTC casualties and related costs to society, in order to rationalize and optimize allocation of scarce resources to road safety measures. Subsequently, this thesis sets out to assess the social costs of RTCs in Cameroon through three main objectives.
The first objective examined the current state of literature on RTC costing, to establish the coverage of contexts and relevant methods of costing. To achieve this, a meta-analysis of published literature was conducted on data gathered from scholarly search engines. Regression models and other qualitative analytical tools were used to obtain patterns in the data. The results point to a bias of literature, with studies covering social costs of RTCs in high Income Countries (HICs) making 55 % of the sample resulting from the search. Thirty-one (31) percent of the sample size comprised of studies conducted in Low- and Middle-Income Countries (LMICs), with only 12 % of the total studies focused on Sub-Saharan Africa (SSA) context. The latter justified undertaking the first systematic study to analyze social costs of RTCs in Cameroon.
Two main methods of estimating the social costs of RTCs have dominated literature from the results of meta-analysis: The Human Capital (HC) and The Willingness to Pay (WTP). The HC method emerged popular given that it was applied in 57 %of the studies in our sample; certainly, due to its simplicity in application and data requirements. Studies in HICs were the dominant users of the WTP approach, while all but one of the 30 studies conducted in LMICs used the HC approach. The average estimated RTCs costs expressed as a percentage of Gross Domestic Product (GDP) from studies using WTP was higher (2.43%) than that from studies that used the HC approach (1.68%), and so was the variation (standard deviation) of estimated costs in our sample of studies. Furthermore, we estimated a simple linear regression model with the estimated social costs of RTCs (as a percentage of GDP) from the studies in our meta-analysis sample. The results indicated that if one controls for other relevant predictors of the estimates of social costs of RTCs, then applying the WTP estimation in studies led to estimates of social cost of RTCs that are higher (by 1%) compared to those obtained in studies applying the HC estimation approach. The estimated social costs of RTCs in LMICs studies was also found to be on average lower relative to that in HICs, while holding all other factors constant.
From the literature and examination of the crash and casualty data in Cameroon, it was clear that there is huge under-reporting of RTCs, which is detrimental to its prevention. Under-reporting leads to under-estimation of fatalities and injuries: subsequently masking the amount of suffering caused by the problem in the society and the attendant costs. The study observed that both the Police and Gendarmerie data in Cameroon show persistent decline in RTCs in the last five years, a pattern which cannot be explained by any road safety policy action or intervention: this trend was more pronounced in the Gendarmerie than the Police data. The recently established National Health Observatory Data also exhibited under-reporting of casualty statistics especially fatalities, following a common trend observed in studies that assess under-reporting using primary investigation of RTC records. It has been established that the lack of reliable or comprehensive data can lead to wrong policy formulation, intervention or complete inaction. Even when the inclination to act exists, some countries do not have knowledge on the necessary data to be collected or the utility of existing data sources in creating a holistic picture in RTCs analysis. This deficiency can lead to countries missing the relevance of road safety investment and policies, and a misguided belief that their roads are safer than they truly are. This appears to be the case in Cameroon, raising the need to assess the rate of under-reporting of RTC statistics.
Subsequently, the second objective of the study sought to estimate the rates of under-reporting of RTCs in Cameroon, with the aim of obtaining a more complete picture of the magnitude of RTCs. Country-specific regression-based estimates of RTC fatalities reported by the WHO were exploited to obtain the most reasonable estimate of fatalities. The ratios of fatalities to injuries and crashes in the more reliable police crash data of 2016 were then utilized to adjust the number of crashes and injuries reported in the national health observatory data. Comparing the reported and adjusted data yielded indicative under-reporting rates of 73.5 % for fatalities and 47 % for injuries in the National Health Observatory casualty data. Fatal and injury crashes reported by the police were found to have an under-reporting rate of 63% and 98 %, respectively.
The obtained rates of under-reporting were then used to adjust the RTCs data that was used to estimate the social cost of RTCs in Cameroon in the third objective of this study. The HC method appeared to be popular in literature and easy to apply in the context of a developing country like Cameroon, and was adopted for this study. The current study makes a novel contribution to literature by incorporating a GDP-based benefit transfer estimate of WTP within the HC framework. This is an alternative approach to estimating the human costs component of RTCs costs without conducting the more expensive WTP preference surveys. The approach delivered a methodological middle-ground between HC and WTP approaches, and this is the first application in RTC costing studies in Africa. The results indicate that the estimated cost of RTCs in Cameroon for the year 2018 is XAF 805.4 Billion (USD 3.7 Billion based on the 2018 international exchange rate) and is equivalent to 3.7 % of GDP for the same year. This estimate is way above RTC cost estimates obtained by studies in SSA (Sudan and Ethiopia) using the HC approach. The estimate is also slightly an outlier of the range of estimates in LMICs literature that uses HC approach, but this is understandable since the said studies use arbitrary rules of thumb without contextualizing the obtained estimates. The estimated cost of RTCs in Cameroon represents a significant and material leakage from the economy. Based on the expenditure data from the Ministry of Finance in Cameroon, the total estimated RTC cost is equivalent to the expenditure on health and infrastructure sectors in 2018: this represents 12 % of the total expenditure on all the economic sectors in the same year.
By way of the results obtained in this thesis, we contribute to empirical literature by demonstrating the extent of under-reporting of RTC data. We are also making the first application of the GDP-based WTP estimates of human costs in social costing of RTC within the HC costing framework in Africa. The latter is superior to the hitherto popular rules or thumb for estimating human cost component of social costs, since it makes use of information that is specific to the context of the study. Based on the huge under-reporting of RTC data established, the study recommends institutional changes in the police and hospital crash data handling. First is the introduction of a road safety curriculum in police training and the recruitment of cadets with a background of medical training to handle crash scene medical-related data. Secondly, we recommend the establishment of a lead national road safety agency that will collate and maintain nationwide RTCs database. The latter will combine police, insurance, judiciary and national health observatory data, while maintaining the unique attributes and confidentiality of the various databases. It is also important to compute the exact overall vehicle fleet size and age in Cameroon, which remains unknown, for purposes of policy on fleet renewal. This is especially critical since we established that there is a positive correlation between older fleet and RTCs at both national and regional levels in the year 2017.
The third and most important recommendation is that the Government of Cameroon should increase investment in road safety interventions way above the current constant four percent of National Road Fund Levy allocation. Based on the estimates obtained in this study, this annual allocation, which is often not fully absorbed, can only meet 30 % of a very conservative road safety budget. The latter is conservative because it is based on RTCs costs estimates that are only 22 % of the cost estimates obtained in the current study. Cameroon is currently not honoring its commitment under the Accra Declaration on road safety to allocate 10 % of the budgets for public works (by Ministry of Public Works and Ministry of Urban Development) to road safety. This is compounded by the gross under-funding of the revised Road Safety Strategy of 2019. It is noted that the previous Road Safety Strategy action plan was not implemented because of under-funding and lack of coordination among key actors. The revised road safety strategy does not have specific RTCs reduction targets linked to the indicative budget, which would ensure accountability to taxpayers and decision-makers. We posit that establishing a lead national road safety agency will also improve utilization of available allocated resources for road safety, as well as enhance the administration and coordination of road safety activities and targets. Ultimately, these efforts culminate in sealing the economic leakages occasioned by RTCs and foster the achievement of the Sustainable Development Goals (SDGs) global targets of reducing deaths and injuries by 50 % by 2030.
Finally, we recommend that further studies be conducted on two areas. First, the rate of under-reporting of RTCs and injuries needs to be ascertained using the more accurate but expensive population-based surveys and systematic methods like capture-recapture techniques. Secondly and in furtherance of our current approach, it is crucial to incorporate more comprehensive field-based data in another RTC costing exercise: preferably before the preparation of the next national road safety strategy. This will ensure incorporation of more nationally representative data in costing of RTCs that can manifest the unique regional profiles in Cameroon.