Status of post-crash response systems and policy indicators in the WHO African region: a cross-sectional descriptive...

The WHO African region has the highest estimated road traffic fatality rate globally. Effective post-crash response and care are essential to mitigate the severity and fatality of injuries from road traffic crashes. Post-crash response can be conceptualised as a continuum of emergency care functions spanning the scene of injury, prehospital and facility-based care. This study describes the reported fatality-to-crash ratio and the status of post-crash response system and policy indicators in the WHO African region using the most recent data available. It identifies the gaps to inform the strengthening of post-crash response systems in the region.

We conducted a cross-sectional descriptive analysis using data from the Global Status Report on Road Safety 2018 and 2023 databases. Indicators were selected to reflect key components of the post-crash continuum, including prehospital services, facility-based emergency care and system-level enabling factors. We analysed the reported fatality-to-crash ratio and the availability of selected policy and system indicators related to post-crash response and care. Comparisons between 2018 and 2023 were conducted for a subset of comparable indicators. The analysis is descriptive and does not assess policy implementation or effectiveness.

Across the 40 countries reporting complete data, 238 851 crashes resulted in 340 170 injuries and 50 993 deaths, corresponding to a reported regional fatality-to-crash ratio of 21% with substantial variability observed across countries, including values exceeding 100%, which may reflect differences in reporting systems, under-reporting of non-fatal crashes and the occurrence of crashes involving multiple fatalities. Indicators showed limited reported availability of prehospital services, uneven access to emergency care facilities and shortages of trained personnel. Free psychological support and rehabilitation services were rarely available. Between 2018 and 2023, most comparable indicators showed declines in reported availability. However, interpretation of these findings is limited by substantial missing data for several indicators and potential inconsistencies in reporting across countries.

The findings suggest important gaps in post-crash response systems across the WHO African Region, particularly in prehospital care, emergency service capacity and rehabilitation. Strengthening emergency care systems and improving the quality and integration of injury data systems are important priorities for strengthening post-crash response in the region. Further research is needed to assess policy implementation and barriers to effective post-crash care.