43208 IEG Working Paper 2008/2 The Health Benefits of Transport Projects: A Review of the World Bank Transport Sector Lending Portfolio Background Paper for the IEG Evaluation of World Bank Support for Health, Nutrition, and Population Peter Freeman Kavita Mathur This paper is available upon request from IEG-World Bank. 2008 The World Bank Washington, D.C. ENHANCING DEVELOPMENT EFFECTIVENESS THROUGH EXCELLENCE AND INDEPENDENCE IN EVALUATION The Independent Evaluation Group is an independent unit within the World Bank Group; it reports directly to the Bank's Board of Executive Directors. IEG assesses what works, and what does not; how a borrower plans to run and maintain a project; and the lasting contribution of the Bank to a country's overall development. The goals of evaluation are to learn from experience, to provide an objective basis for assessing the results of the Bank's work, and to provide accountability in the achievement of its objectives. It also improves Bank work by identifying and disseminating the lessons learned from experience and by framing recommendations drawn from evaluation findings. IEG Working Papers are an informal series to disseminate the findings of work in progress to encourage the exchange of ideas about development effectiveness through evaluation. The findings, interpretations, and conclusions expressed here are those of the author(s) and do not necessarily reflect the views of the Board of Executive Directors of the World Bank or the governments they represent. The World Bank cannot guarantee the accuracy of the data included in this work. The boundaries, colors, denominations, and other information shown on any map in this work do not imply on the part of the World Bank any judgment of the legal status of any territory or the endorsement or acceptance of such boundaries. ISBN No. 13: 978-1-60244-087-6 ISBN No. 10: 1-60244-087-5 Contact: Knowledge Programs and Evaluation Capacity Development Group (IEGKE) e-mail: eline@worldbank.org Telephone: 202-458-4497 Facsimile: 202-522-3125 http:/www.worldbank.org/ieg The Health Benefits of Transport Projects: A Review of the World Bank Transport Sector Lending Portfolio Peter Freeman and Kavita Mathur Independent Evaluation Group, World Bank Sector, Thematic and Global Evaluations Unit Background paper for the IEG evaluation of World Bank support for health, nutrition, and population February 12, 2008 This paper was prepared as background for the forthcoming IEG evaluation of the World Bank's support for health, nutrition, and population (HNP). It builds on information from the IEG evaluation of the World Bank's support for the transport sector. The authors would like to thank Martha Ainsworth, task manager of the IEG evaluation of HNP, for very useful comments and organizing principles, and also Chris Bennett, Julie Babinard, Anthony Bliss, Eva Jarawan, Gayle Martin, Son Nam Nguyen, and Jocelyne do Sacramento for their comments. The findings, interpretations, and conclusions expressed in this paper are entirely those of the authors and do not represent the views of the World Bank, its Executive Directors, or the countries they represent. Table of Contents Executive Summary...........................................................................................................iii 1. Introduction................................................................................................................. 1 2. The Health Impacts of Transport Projects .................................................................. 2 Transport Safety...................................................................................................... 3 Pollution.................................................................................................................. 6 Facilitating Disease Transmission ......................................................................... 6 Sedentary Lifestyles ................................................................................................ 7 3. The Evolution of World Bank Sectoral Policies on Transport and Health................. 7 Transport safety ...................................................................................................... 7 Air pollution and harmful emissions....................................................................... 9 Transport and the prevention of HIV/AIDS ......................................................... 10 4. Methodology............................................................................................................. 10 5. Findings..................................................................................................................... 12 A. Approved projects......................................................................................... 13 Anticipated health benefits ................................................................................... 13 Explicit objectives to improve health outcomes................................................... 13 Project components with plausible health benefits............................................... 15 Inclusion of health benefits and costs in the economic analysis........................... 18 Health indicators................................................................................................... 19 B. Closed Projects.............................................................................................. 21 Implementation of health components.................................................................. 21 Inclusion of health benefits in ex post economic analysis.................................... 22 Collection of health indicators.............................................................................. 22 Changes in health outcomes.................................................................................. 23 6. Conclusions............................................................................................................... 26 References......................................................................................................................... 29 Annex 1. List of Projects Reviewed ................................................................................. 32 Annex 2a. TSB Projects with a health focus (FY97-06), by region ................................. 38 Annex 2b. TSB Projects with a health focus (FY97-06), by income ............................... 38 Annex 3. Achievement of health outcomes and objectives.............................................. 39 Boxes Box 5-1: Reducing Harmful Emissions............................................................................ 24 Figures Figure 5.1: Trend in the share of projects with explicit health objectives, by country income and region............................................................................................................. 15 Figure 5.2: Trend in the share of projects with health components, by country income and region ................................................................................................................................ 17 Tables Table 2.1: Potential health risks of transport projects and policies to mitigate them........ 3 Table 4.1: Transport Projects Included in the Portfolio Review ..................................... 11 i Table 5.1: TSB-managed transport projects and commitments approved in FY97-06, by region ................................................................................................................................ 12 Table 5.2 : TSB-managed projects and commitments approved in FY97-06, by country income group .................................................................................................................... 13 Table 5.3: TSB-managed projects approved in FY97-06 justified by health benefits...... 13 Table 5.4: TSB-managed projects with explicit objectives to improve health outcomes (FY97-FY06) .................................................................................................................... 14 Table 5.5: Health Related Components Supported by TSB Projects approved, FY97-0616 Table 5.6: TSB-managed Projects with a Health Focus (FY97-FY06)............................ 18 Table 5.7: Among TSB Projects with a health focus, inclusion of health benefits in ex ante economic analysis ..................................................................................................... 19 Table 5.8: TSB-managed Projects Proposing to Collect Health Outcome Indicators (FY97-06) ......................................................................................................................... 20 Table 5.9: TSB Projects Proposing to Collect Health Output Indicators (FY97-06) ....... 20 Table 5.10: Planned and implemented health-related components in closed TSB projects (approved in FY97-06) ..................................................................................................... 22 Table 5.11: Health outcome indicators ­ planned and collected ..................................... 23 Table 5.12: Improvements in transport safety among completed projects...................... 25 ii EXECUTIVE SUMMARY The transport sector plays a crucial, overarching role in the global economy: it facilitates access to jobs, education, health care, markets as well as for social and leisure activities. Yet, transport also has detrimental impacts on the environment and on human health, and this can result in conflicts in the formulation and application of transport policy. While traffic injuries, fatalities, and annoyance from transport-related noise have long been identified as negative externalities, there has been increasing evidence in the past decade of direct effects of transport-induced air pollutants on mortality and respiratory disease. The adverse impacts of transport on health are worse in developing countries than in industrial countries, as resources are more limited, regulatory controls are often inadequate and poorly enforced, the transport fleet tends to be older and technically more inefficient, the population is generally less educated, and transport- related law enforcement is frequently inadequate This paper reviews the contribution of the World Bank's transport lending portfolio to health outcomes, as background for the Independent Evaluation Group's (IEG) evaluation of the Bank's support for health, nutrition and population (HNP). Over the past decade (FY97-06), the World Bank committed nearly $28 billion to 229 new transport projects managed by the Transport Sector Board (TSB). Specifically, the paper reviews the extent to which these projects: cite potential health benefits or risks in design documents; include specific objectives with respect to improving health outcomes or mitigating health risks; propose environmental improvements that are likely to provide health benefits; target transport services and both health and behavioral outcomes to the poor; and plans to collect evidence on changes in health outcomes as a result of transport interventions. For completed projects, it assesses the extent to which expected health benefits or objectives have been achieved. Half of TSB-managed projects in the last decade have had a health focus, defined as those that cited anticipated health benefits or mitigating a health hazard, that had explicit health objectives for which they were accountable, or financed components or activities with plausible health benefits; this share rose from a third of projects in the first half of the period to two-thirds in the second half. The benefits cited most frequently were safety-related, primarily road safety; improvements in air quality and a reduction in harmful emissions and prevention of HIV transmission along transport corridors were cited in a minority. Transport projects in middle-income countries were more likely to have a health focus that those in low-income countries. A quarter of TSB projects planned to collect health outcome indicators, but very few planned to collect health output indicators that would help to establish attribution between the activities financed and health outcomes. iii Among the 105 projects approved from FY97-06 that had closed, a quarter (28) had explicit health objectives or financed components with potential health benefits. All of the planned road safety, waterway and port safety components were implemented, while more HIV/AIDS components were implemented than planned at project appraisal. Closed projects with explicit health objectives were more likely to plan to collect health indicators and to actually collect them than were projects with health components absent from these objectives. All fifteen TSB-managed projects that measured health outcomes had to do with transport safety (13 of them road safety), and in all but one case the indicators suggest an improvement in road safety. The attribution of these outcomes to the projects' outputs was not always clear, however, because of: inadequate documentation of outputs; failure to consider other factors that might have affected the accident rate; and lack of specificity of the data to the areas covered by the project interventions. Addressing these issues would help to assess with greater certainty the effectiveness of these safety efforts. The reason why a minority of road projects has explicit objectives to minimize health hazards remains unclear. Any road project that leads to faster travel speeds also has the potential to increase the severity of accidents that occur. It would be sensible for all road projects during appraisal to address this issue and to implement and monitor any mitigation measures. None of the small number of closed transport projects with HIV/AIDS components collected data on health outcomes, so the effectiveness of these activities is unknown. A recent update on the implementation of the Bank's Global HIV/AIDS Program of Action notes, however, that more than half of the projects in the active transport lending portfolio include HIV/AIDS activities, most of them `retro-fitted' after the projects were approved. Thus, these projects are unlikely to have an explicit HIV/AIDS objective for which they are accountable; it remains to be seen whether they will actually collect and report output and outcome data that would yield insights into their effectiveness. The experience in the rest of the transport portfolio suggests that health indicators are rarely collected in the absence of explicit health objectives. Finally, this review of project documents has not yet led to insights on the operational linkages between the transport and health sectors that may help to explain why some projects succeed in reporting and achieving improvements in health outcomes and others do not, or whether intersectoral collaboration in implementation has any impact on the effectiveness of these interventions. However, the next step would be to learn more about the reasons for the data patterns uncovered by follow-up interviews with transport staff, as the basis for recommending how the performance of health components of transport projects can be improved. iv List of Acronyms and Abbreviations AFR Africa region DALY Disability-adjusted life years EAP East Asia and the Pacific region ECA Eastern Europe and Central Asia region FY Fiscal Year GEF Global Environment Facility HNP Health, Nutrition and Population ICAO International Civil Aviation Organization ICR Implementation Completion and Results Report IEG Independent Evaluation Group LIC Low income countries LCR Latin America and Caribbean region LMIC Lower middle income countries MAP Multi-Country AIDS Program MNA Middle East and North Africa region OED Operations Evaluation Department (now IEG) PAD Project Appraisal Document PPAR Project Performance Assessment Report SAR South Asia region TSB Transport Sector Board UMIC Upper middle income countries WHO World Health Organization v 1. INTRODUCTION 1.1 The transport sector plays a crucial, overarching role in the global economy: it facilitates access to jobs, education, health care, markets as well as for social and leisure activities. Yet, transport also has detrimental impacts on the environment and on human health, and this can result in conflicts in the formulation and application of transport policy. While traffic injuries, fatalities, and annoyance from transport-related noise have long been identified as negative externalities, there has been increasing evidence in the past decade of direct effects of transport-induced air pollutants on mortality and respiratory disease1. 1.2 Poverty and poor health continue to be mutually reinforcing conditions and there are substantial grounds to demonstrate that the negative impacts of transport on health are worse in developing countries than in industrial countries. In developing countries where resources are more limited, regulatory controls are often inadequate and poorly enforced, the transport fleet tends to be older and technically more inefficient, the population is generally less educated, and transport-related law enforcement is frequently inadequate.2 Improving traffic safety is an evolutionary process linked to income. In this regard it is worth noting that in the case of road safety the trend from low to high income status seems to follow the same pathway as environmental improvements, in the form of an environmental `Kuznets curve'.3 Road crash fatalities per capita increase until around US$8,000 per capita, then begin to decline, presumably as awareness of the problem becomes sufficient for concerted management measures to be taken. 1.3 This paper reviews the contribution of the World Bank's transport lending portfolio to health outcomes, as background for the Independent Evaluation Group's (IEG) evaluation of the Bank's support for health, nutrition and population (HNP). Over the past decade (FY97-06), the World Bank committed nearly $28 billion to 229 new transport projects managed by the Transport Sector Board (TSB). Specifically, the paper reviews the extent to which these projects: cite potential health benefits or risks in design documents; include specific objectives with respect to improving health outcomes or mitigating health risks; propose environmental improvements that are likely to provide health benefits; target transport services and both health and behavioral outcomes to the poor; and plans to collect evidence on changes in health outcomes as a result of transport interventions. For completed projects, it assesses the extent to which expected health benefits or objectives have been achieved. 1.4 The paper is organized into six sections. Following this short introduction, an overview of transport-related health impacts is given, followed by a short overview of Bank sector strategies on health and transport. The fourth section describes the scope of the review and the methodology used, the fifth section presents the detailed findings for 1WHO 2000 2WHO 2004 3Kopits and Cropper, 2003 1 all approved projects as well as closed projects, and the last section summarizes the findings and concludes by raising issues for further study. 2. THE HEALTH IMPACTS OF TRANSPORT PROJECTS 2.1 Transport projects can produce important health benefits in terms of improved access to health care and emergency responses. In rural areas lack of access to all weather roads prevents some communities from easily reaching health care facilities. Transport is clearly essential for the distribution of drugs, blood and other medical supplies. Better transport can also play a critical role in terms of access to emergency obstetric care, which can have an important impact on reducing maternal and infant mortality. 2.2 Moreover, better access to markets can lead to greater income, and improved nutrition and health. However, better access to health care facilities is a necessary, but insufficient condition for better health outcomes. For example, it is possible to travel quickly to a health facility, only to receive bad care. In such a case better access due to improved roads may have no health benefits whatsoever. 2.3 Improved transport can also pose considerable health risks (see Table 2.1). These health risks include: transport accidents (both of vehicle users and pedestrians); air, water and noise pollution; facilitating the spread of communicable disease; and a more sedentary lifestyle as fewer people walk or bike to their destinations. 2.4 There are potential synergies arising from reducing potential health risks. Lower network speeds will produce lower road deaths and injuries, and also reduce emissions. More walking and cycling will also reduce emissions, but will require more attention to road safety risks to ensure that appropriate protective features are provided in the road network. Both policies will reduce energy consumption (a non-health related bonus). 2 Table 2.1: Potential health risks of transport projects and policies to mitigate them Policies and interventions to prevent or mitigate Potential health risks health risks Transport safety Accidents (all transport modes) Rectification of hazardous locations; traffic management improvements; public transport priority measures; behavior change measures such as attitudes to seat belt usage and alcohol use when driving; vehicle safety improvements. Security-related incidents Improvement of terminal security (ports, rail and bus stations, airports); reduction of risk of aviation and maritime accidents through upgrading navigational aids and improved enforcement of safety standards. Pollution Air pollution Reduction of emissions and particulates to provide cleaner air; establishment of policies to ameliorate air pollution such as standards for exhaust emissions. Noise pollution Reduction of noise pollution through noise barriers or compensation of affected citizens; establishment of policies to ameliorate noise pollution such as introducing standards for permissible engine noise. Water pollution Proper handling and prevention of ships' waste; Prevention of marine oil spills; Reduction in run-off from roads and streets into natural water systems. Spread of communicable diseases Awareness, behavior change communication, promotion of condoms along roadways and at border Disease transmission crossings to prevent HIV/AIDS transmission. Prevention of the spread of infectious diseases, like SARS and avian influenza, via air travel. Promotion of sedentary lifestyle Reduced physical activity, increasing Encourage more walking and cycling, less use of risks of heart ailments, cancer and motorized vehicles especially for short trips. Changes diabetes. in planning and land use to curb the use of private motor vehicles. TRANSPORT SAFETY 2.5 Accidents occur in all modes of transport, but the extent of road traffic accidents caused the World Health Organization (WHO) in 2004 to declare that road traffic injuries constitute a major public health and development crisis.4 Every year, 1.2 million people are known to die in road accidents worldwide (over 3,000/day) and as many as 50 million more are injured, with some suffering permanent disabilities. Projections indicate that these figures will increase by about 65 percent over the next 20 years unless there is a radical commitment to widening the reach of prevention. 5 The public, however, has become inured to these statistics, and the figures attract less mass media attention than other less frequent but more spectacular types of accident, such as aircraft crashes. 4WHO 2004 5Kopits and Cropper, 2003 3 2.6 A disturbing aspect of these data is that 80 percent of the deaths and 90 percent of losses because of road traffic injuries occur in low and middle-income countries. The 6 economic cost of road crashes and injuries is estimated to be 1 percent of gross national product in low income countries and 1.5 percent in middle income countries. This is $65 billion more than these countries receive in development assistance.7 One good reason to expect that the negative impacts on health will be worse in developing countries is that they are facing traffic conditions with far higher levels of vulnerability in terms of pedestrians and non-motorized road users. Compounding this vulnerability is the rapid rate of motorization that is predicted, far outstripping our historical experience so far. 2.7 Historically, motor vehicle "accidents" have been viewed as random events that are unpredictable and cannot be managed, but in recent years there has been a shift in perception as it has become increasingly recognized that the accident rate can be lowered through rational analysis and remedial action. Successes have been achieved in several industrialized countries including Australia, Canada, France, Japan, New Zealand, UK and the United States in reducing the fatality rate, but at the same time fatality rates in many developing countries experiencing rapid motorization, such as China, Colombia, India and Malaysia, have been increasing dramatically.8 The successful industrialized countries reported that improvements followed an integrated, multi-facetted approach to road safety issues. 2.8 While a decrease in deaths due to road traffic accidents of around 30 percent is forecast between 2000 and 2020 in high-income countries, this will be more than offset by a huge increase in traffic-related deaths expected in the rest of the world during the same period; if no action is taken, road traffic injuries could become the sixth leading cause of the global burden of disease and injury by 2015,9 measured in disability- adjusted life years (DALY). There are a number of interventions and policies (broadly listed in Table 2.1) that can be utilized to mitigate these health risks. 2.9 Elimination of hazardous locations. Typically the elimination of hazardous locations occurs when a road is rehabilitated or upgraded. The traffic authorities have knowledge of the most dangerous sections of road and minor infrastructure improvements are carried out to make the road safer. Often this involves improving sight distance, reducing the incidence of sharp curves, replacing unsafe structures and improving road signage. The idea is that the accident rate will improve. However, sometimes the higher vehicle speeds resulting from the improvements lead to increased severity of collisions, so it is not a foregone conclusion that such project components will lead to improved safety in all cases. 2.10 Improvements in road traffic management, bus priority, and risk behavior. This category covers a wide range of improvements, including installation and coordination of computer-controlled traffic signals, lane markings, warning signs and 6Losses are calculated in terms of annual disability-adjusted life years 7Jacobs, Aeron-Thomas, and Astrop 2000 8WHO mortality database 9In 1990, road traffic accidents were ranked 9th WHO 2004; in a later work, WHO 2005, Mathers and Loncar predict an upward ranking to 6thby 2015. The impact on men and on children is particularly severe. 4 studs, pedestrian crossings, sidewalks, underpasses, bicycle paths, street lights, traffic calming measures, and speed limits. 2.11 For public transport, priority bus-bays, segregated busways, and bus priority lanes are typical features. Schemes to promote public transport usage and reduce private vehicle usage also result in safety enhancement because public transportation is generally a safer means of travel. 2.12 Some interventions target human behavior and involve enforcement of regulations to ensure seat belts are worn, drunk-driving limits are respected, and helmets are worn by motorcyclists. The literature gives examples of the effect of such measures; for example in Malaysia, where legislation was introduced in 1973, it was estimated that the introduction of a helmet law led to a 30 percent reduction in motorcycle deaths.10 In Sweden and the United States research has shown that seat belt reminders with audible warnings are an effective means of increasing seat belt use. In Sweden it was estimated that the introduction of such systems contributed to a reduction in car occupant deaths of 20 percent.11 An international review of the effectiveness of random breath testing found that alcohol-related crashes reduced by about 20 percent.12 2.13 While the interventions described above have measurable outcomes, there are also a number of components with important outputs, but whose impact is less easily assessed. These components are aimed at strengthening the institutional capacity for road safety which could include training, the setting up of coordinating bodies, improving legislation pertaining to traffic laws, improving enforcement capability, streamlining road safety into road work design activities, and improving response to assist at the accident scene and to ensure injured persons receive urgent emergency treatment. Good data are also essential to measure performance and this entails the setting up of systems to record and analyze information about road accidents including data capturing, definitions,13 and analysis. WHO reports that only 75 countries fully complete the vital information returns pertaining to road traffic injuries, while a further 35 countries submit incomplete data; some countries have no workable systems at all.14 2.14 Other transport safety interventions Other transport modes experience much lower numbers of accidents. Some components of such projects relate to port and inland waterway safety, aviation safety and safety on public transport. In this review only one component was identified directly relating to the improvement of health facilities (in the Chile Santiago Urban Transport Project). 10Supramaniam and others 1984 11Larsson and others 2000 12Elder 2002 13Since not all fatalities occur at the scene of the accident and some people die of their injuries only some time later, rules need to be set about what to include in the accident data. There is growing acceptance that deaths occurring within 30 days of the accident are recorded as road fatalities, and that deaths at railway crossings are counted as road deaths. WHO 2004 14WHO 2004 5 2.15 Aviation safety has become an important and even controversial topic because certain developing country airlines with poor safety records have been banned from the airspace of industrial countries. In recent years there has been a trend to try to upgrade both aviation safety in developing countries (mainly through improved navigational aids) and transport security globally, especially at airports, following various terrorist incidents and threats. POLLUTION 2.16 Concern about transport-related pollution has also been growing, especially in the urban environment where road traffic congestion prevails. Air quality has also assumed new importance in the context of greenhouse gas emissions;15 road transport alone accounts for nearly a quarter of man-made gases believed to be contributing to climate change. Fine particles are emitted from vehicle exhaust systems as a product of combustion, especially from diesel engines. In developing countries this may be worsened because of poorly maintained or badly adjusted engines. Non-exhaust particulate matter also results from tire wear as well as dust from brake pads and shoes. The WHO estimates that suspended particulate matter leads to the premature death of over 500,000 people per year.16 2.17 Much of the growth in the world's population for the foreseeable future will take place in the cities and towns of the developing world and this has significant implications in respect of likely vehicle emissions. Already almost half of the world's population, or some 3.3 billion people, live in urban or peri-urban areas17 and 600 million additional people are expected to migrate from rural areas to cities in the next ten years. To put this in perspective, this urbanization trend is equivalent to 60 additional cities roughly the size of London or Moscow. The volume and spatial distribution of the emissions, as well as dispersal conditions, affect pollution levels. Urban planners also have a crucial role to play that can affect the degree of exposure of the population to pollution. 2.18 Other kinds of transport-related pollution focus mainly on aviation emissions, pollutants in water run-off from transport infrastructure, and the effects of noise, especially near airports and busy highways. In the maritime sector oil spills and disposal of waste from ships are important issues. FACILITATING DISEASE TRANSMISSION 2.19 Transport corridors can be a conduit for the transmission of diseases. HIV/AIDS in particular is known to be spread along major transport routes by transport workers, especially truck drivers, and their sexual partners. Transport construction sites can also be the foci for HIV/AIDS transmission. These risks are addressed through interventions that provide information, promote behavior change (fewer partners, safe sex, condom use), and provide STD treatment along transport routes and at construction sites. The outbreak of severe acute respiratory syndrome (SARS) in 2002-3 highlighted the potential role of 15Stern 2006 16WHO 2002 17Economist 2007 (49.2% of world's population is urbanized); UN Population Fund Report 2007 6 air transport in international disease transmission. The potential for occurrence of a pandemic caused by avian influenza, for example, is being closely monitored by the United Nations System Influenza Coordination Group, while standards aimed at preventing disease transmission via aircraft (as far as is practically possible) are enforced by the International Civil Aviation organization (ICAO). SEDENTARY LIFESTYLES 2.20 Linked to the growth of cities and increasing use of motorized transport, is the increased likelihood of sedentary lifestyles by urban dwellers. Reduced physical activity is estimated to be responsible for some 1.9 million deaths globally every year as a result of disease such as heart ailments, cancer and diabetes.18 3. THE EVOLUTION OF WORLD BANK SECTORAL POLICIES ON TRANSPORT AND HEALTH 3.1 Strategies emanating from both the transport and the health sectors have highlighted policies to improve the health benefits or mitigate the health risks with respect to transport interventions. They focus on three main concerns ­ transport safety, harmful emissions, and the spread of HIV/AIDS. Transport safety 3.2 Two transport sector strategy documents have helped shape the Bank's approach to transport in relation to health issues during the review period of this study. The first, entitled Sustainable Transport (1996)19, advocated substantial changes in the role of government in transport, reducing its function as a supplier, but increasing its function as a regulator. It viewed sustainability in a comprehensive sense, covering economic, financial, environmental and social sustainability. The second, called Cities on the Move (2002)20, focused specifically on urban transportation. 3.3 Sustainable Transport accorded a higher priority to moving people rather than vehicles, ensuring greater safety in transport, and minimizing adverse effects on health. It recommended benchmarked safety programs and the adoption of cleaner fuels as well as encouraging a more systematic estimation of the impact of transport programs on safety and air pollution. Moreover, it highlighted three road-related areas where the Bank could improve its advice and reduce the accident rate, namely; the separation of motor vehicles from pedestrians and non-motorized traffic such as bicycles; improvements in driver behavior through better education, regulation, and enforcement; and the introduction of geometric road designs that would take into account the large number of vulnerable road users in developing countries. 18WHO 2002 19World Bank 1996a 20World Bank 2002 7 3.4 Cities on the Move estimated that up to 15 million people are injured annually in urban road accidents in developing countries. It recommended that a key first step to improving traffic safety was the development of a national road accident data collection and analysis capability, supported by institutional arrangements to ensure that such data were transmitted to those who needed them for policy purposes. It endorsed the viewpoint that accident frequency and severity can be reduced by improved road design and traffic management measures. Furthermore, it recognized that poor people tend to be the most vulnerable to the effects of air pollution and that our understanding of the environmental impacts of urban transport is deficient. 3.5 Both strategy papers focus mainly on the road mode of transport when referring to health issues21 and both flag road safety and air pollution as areas to receive greater attention. In practice, improving air quality received much less attention, possibly because this area requires specialist knowledge beyond road design and traffic management, which are the comfort zones for most task managers in the transport sector. Nevertheless, some indirect amelioration of poor air quality is likely to have been achieved through better urban planning, installation of centralized traffic management systems, and the development of less polluting vehicle fuels. 3.6 The building of countrywide data systems is included as part of this strategy. An early example of this approach was the Road Improvement and Traffic Safety Project in Turkey.22 The road safety objective of this project was substantially achieved, but its full potential was not realized because follow up was impacted by the financial crisis affecting Turkey at the time.23 Nevertheless, between 1996 and 2000 the number of accidents declined from 3,635 to 921 annually and the number of fatal injury accidents nationally also declined, although a number of exogenous factors could have also contributed to this result. Recently a stand-alone road safety project has been launched in Vietnam, which experiences problems worsened by a high percentage of two-wheeled traffic.24 3.7 Following publication of the Bank's Cities on the Move, a road safety specialist was appointed in the transport anchor and collaborative work with the World Health Organization (WHO) was launched. 3.8 Further impetus to the road safety theme was given by the publication of the World Report on Road Traffic Injury Prevention--jointly issued by WHO and the World Bank in 200425--which highlighted the growing public health burden of road deaths and injuries in low and middle income countries, and represented a collaborative effort from 21There is an active project, however, on air transport safety and security for West and Central Africa. 22World Bank 1996b 23OED 2005b 24World Bank 2005b.The outcome of this project is expected to yield many lessons and thus is being closely monitored. It comprises three components: institutional and capacity building, road safety demonstration and awareness program, and a road safety monitoring and evaluation program. Since its inception the project has doubled in scale with an infusion of funds from the Japanese Bank for International Cooperation. 25WHO 2004 8 staff in both the health and transport sectors. In a follow up note26 the Bank summarizes the findings and provides guidelines to assist with the implementation of its recommendations. These guidelines require both countries and donor agencies to substantially scale-up and refocus their activities, with a strong emphasis on managing results. The first step should be a country capacity review to build a multisectoral framework for dialogue between counterparts in different ministries, between Bank staff working in different sectors, and between Bank staff and their client agencies. Air pollution and harmful emissions 3.9 Reducing Air Pollution from Urban Transport, published by the Bank in 200427, was triggered by the growing concern about air pollution from road transport. It was not a product solely of the TSB, but rather of the Thematic Group on Air Quality and was duly approved by the then Environment, Transport, Energy and Mining Sector Boards. It proposed a framework for selecting and implementing policies, drawing lessons from international experience, and was especially directed towards cities in developing countries. It placed a special emphasis on how to coordinate policies across several sectors closely linked to the mitigation of air pollution from road transport--and how to reconcile the sometimes conflicting objectives and demands of these sectors to achieve environmental improvements. This document was clearly a seminal reference work in this field; it is unclear as to the extent it has been used by the Bank and its clients since publication, although it is often cited in the literature.28 3.10 A Decade of Action in Transport, an IEG evaluation issued in 200729 recommended that safety, energy efficiency and climate change receive much more attention in the future and this proposal is also incorporated in the Bank's draft updated transport sector strategy30.The absence of international coordination by an accountable agency with a clear leadership role is also addressed. This updated transport sector strategy31 focuses on the need for more complex projects including more projects on road safety, more attention to urban traffic congestion and air pollution reduction, and more effective public transport systems. Recently, a World Bank Global Road Safety Facility has been established to generate increased funding to reduce accident rates in developing countries. It is working with the Harvard Initiative for Global Health to improve the estimates of health losses from road deaths and injuries, with a view to arriving at comparable country by country data. Recently, a first consultative meeting was held at the World Road Congress in Paris in September, 2007. 26Bliss 2004 27Gwilliam and others 2004 28The Bank has been actively participating in the ICAO discussions on aviation emissions, with the objective of gathering all available information on the environmental impacts and its relevance to developing countries. Thus far this has not translated into project support, however. 29IEG 2007 30World Bank external consultation draft 2006 31Currently in preparation 9 Transport and the prevention of HIV/AIDS 3.11 The Bank's health sector considers transport a priority sector for HIV/AIDS interventions, both because of the risk of contracting and spreading HIV at construction sites and because people engaged in transport (truckers, taxi-drivers, railway and port workers, for example) travel a great deal away from their families and are at high risk of contracting and spreading HIV along transport routes.32 The Africa region strategy, Intensifying Action Against HIV/AIDS in Africa (1999), committed to "mainstreaming" HIV/AIDS in all sectors, including transport. It also advocating "retrofitting" HIV/AIDS activities into ongoing projects in priority sectors like transport. The 2005 Global HIV/AIDS Program of Action commits to including HIV/AIDS in all construction contracts with World Bank funding and to adding HIV/AIDS activities to all new transport projects in India and Africa and all existing projects in Africa during mid-term review.33 3.12 In December 2003, following greater awareness of the link between transport and the spread of HIV/AIDS the Abidjan-Lagos transport corridor project34 was launched with the objective of increasing access along the corridor to HIV/AIDS prevention, basic treatment, support and care services for underserved, vulnerable groups--including transport sector workers and their clients. This project was discussed in a paper published in 200535, which also listed other transport corridors with similar initiatives. 4. METHODOLOGY 4.1 This review systematically assesses the objectives or outcomes of Bank-supported transport projects with respect to any identified and anticipated health benefits and health risks that require prevention or mitigation. The transport projects reviewed include all active and closed projects approved over a ten year period between fiscal years 1997- 2006 (FY97-06). Only those projects managed by the transport sector board have been included and for the purposes of the review this covers projects with financial commitments under the sector codes TA (roads and highways), TP (ports, waterways and shipping), TV (aviation), TW (railways) and TZ (general transportation ­ which includes urban transport). Supplemental credits and projects approved under emergency procedures are excluded. Transport projects managed by other sector boards were excluded because the resources needed to track down the relatively small number of such projects were not warranted.36 An omission in this regard was transport projects related 32The priority of the transport sector is amply demonstrated by its emphasis in the HNP lending portfolio. Among the 54 freestanding AIDS projects or projects with AIDS components approved between FY97-06 and managed by the HNP sector, all but five identified transport workers as a high-risk group. In most projects in the Africa region Multi-Country AIDS Program (MAP), the transport sector is a prioritized sector for multisectoral involvement. (Source: Portfolio Review, IEG evaluation of HNP) 33World Bank 2005a, p. 39 34Managed by the HNP board 35Brushett and Osika 2005 36In the Transport Sector Review (IEG 2007), only 16 percent of all transport projects were managed under sector boards other than the TSB. 10 to improvements of air quality that fell either under the environment sector board or were funded through the Global Environmental Facility (GEF). 4.2 In total, 229 projects were reviewed: 126 projects approved from FY97-01 and 103 projects approved between FY02-06. One hundred and twenty four projects remain active while 105 have already closed (Table 3-1)37. A list of the projects reviewed is given in Annex 1. Table 4.1: Transport Projects Included in the Portfolio Review Fiscal Year of Approval Active Closed Total 1997-2001 28 98 126 2002-2006 96 7 103 Total 124 105 229 4.3 The review assesses the design of transport projects on specific questions or themes in order to determine the extent to which health outcomes played a role in the rationale for the design and implementation of the projects approved over the past ten years. The Staff Appraisal Report or Project Appraisal Document (PAD) was reviewed for each project to answer the following questions: (a) Were potential health benefits cited as a justification or a benefit of the project? Were potential health risks mentioned, in terms of the need to prevent or mitigate them? (b) Did the project include explicit objectives with respect to improvements in health outcomes in general and, if so, what were they? (c) Did the project finance any health components? If so, what kinds of activities and how much was committed to them? (This includes components to set up new institutions). (d) Did the project propose to collect health indicators in general and/or among the poor and, if so, what indicators were supposed to be collected? (e) Did the project specifically target behavior change interventions (in objectives or components) to improve health and, if so, what type of behavior change? 4.4 For completed projects, the following was recorded based on the Implementation Completion Reports (ICR) and the IEG Project Performance Assessment Reports (PPARs): a) Were specific planned health components implemented including transport safety improvements, (especially road and aviation safety), the containing of the spread of infectious diseases along transport corridors, and the reduction of harmful vehicle emissions causing respiratory problems? 37The cut-off date for data download is from Business Warehouse is June 25, 2007. 11 b) Did the project actually collect data on health outcomes (even if not planned)? If so, did health outcomes improve and can they be linked to the project's activities? c) For projects that had an explicit health objective, was it achieved? 5. FINDINGS 5.1 Approved World Bank commitments in the transport portfolio managed by the TSB between FY97-06 totaled US$27.02 billion, as shown in Table 5.1. For the period in question, 76 percent of transport projects were classified as road or road-related, rising from 75 percent in FY97-01 to 79 percent in FY02-0638. Thus it is hardly surprising that road safety features so prominently in transport-related health components. Table 5.1: TSB-managed transport projects and commitments approved in FY97-06, by region FY97-01 FY02-06 Total: FY97-06 Projects Commitments Projects Commitments Projects Commitments Region Nbr (%) US$m (%) Nbr (%) US$m (%) Nbr (%) US$m (%) EAP 35 28 4,813 35 24 23 3,262 25 59 26 8,075 30 SAR 14 11 2,928 21 15 15 3,653 28 29 13 6,581 24 LCR 21 17 2,763 20 19 18 2,017 15 40 17 4,780 18 AFR 18 14 1,290 9 23 22 2,253 17 41 18 3,543 13 ECA 32 25 1,902 14 15 15 1,363 10 47 21 3,266 12 MNA 6 5 192 1 7 7 584 4 13 6 775 3 Total 126 100 13,889 100 103 100 13,131 100 229 100 27,020 100 Source: World Bank data 5.2 Over the past decade, TSB-managed transport commitments in the Africa (AFR) and South Asia (SAR) regions have risen dramatically, while they have declined in other large regions. The Africa region is in fact the only region with a significant increase in the number of transport projects approved; there was a significant drop in the number approved in the East Asia and Pacific (EAP) and Eastern Europe and Central Asia (ECA) regions, while the number remained more or less unchanged elsewhere. The highest commitments in the last five years were in the SAR and EAP regions at 28 and 25 percent, respectively, followed by AFR with 17 percent. EAP and AFR had the greatest share of projects (23 and 22 percent, respectively) followed by the Latin America and Caribbean (LCR) region (18 percent). 5.3 Moreover, from Table 5.2 it can be seen that transport lending has been predominantly to low-income (LIC) and lower-middle income (LMIC) countries and that over time the percentage of commitments to upper-middle income (UMIC) countries has declined to just 12 percent. 38In practice, the percentage of roads may be as high as 80 percent because urban roads and streets are classified under general transport. 12 Table 5.2 : TSB-managed projects and commitments approved in FY97-06, by country income group Country FY97-01 FY02-06 Total: FY97-06 income Projects Commitments Projects Commitments Projects Commitments group Nbr (%) US$m (%) Nbr (%) US$m (%) Nbr (%) US$m (%) LIC 47 37 5,085 37 42 41 6,215 47 89 39 11,300 42 LMIC 55 44 5,890 42 48 47 5,344 41 103 45 11,234 42 UMIC 24 19 2,913 21 13 13 1,573 12 37 16 4,487 17 Total 126 100 13,889 100 103 100 13,131 100 229 100 27,020 100 Source: World Bank data A. APPROVED PROJECTS Anticipated health benefits 5.4 About a quarter of all TSB projects (28 percent) approved from FY97-06 justified themselves (at least partially) by health benefits or by mitigating or preventing a health hazard (Table 5.3). The share of projects justified by health benefits or reduction in health risks has risen over time, from 26 to 31 percent. The cited benefits for the most recent five-year period also show greater diversity. Overwhelmingly, the benefits cited most frequently were safety-related, and of these the majority indicated an expected improvement in road safety, with a few related to improved safety in other transport modes. The remaining projects were either focused on improvements in air quality due to a reduction in harmful vehicle emissions, or on the prevention of the transmission of HIV/AIDS along road transport corridors by truck drivers. Table 5.3: TSB-managed projects approved in FY97-06 justified by health benefits Project justified by health FY97-01 FY02-06 Total, FY97-06 benefits/mitigation of health Number of Number of Number of risks? Projects (%) Projects (%) Projects (%) Yes 33 26.2 32 31.1 65 28.4 Of which: Improved Road Safety 30 23.8 27 26.2 57 24.9 HIV/AIDS Prevention 2 1.6 6 5.8 8 3.5 Air Quality 2 1.6 4 3.9 6 2.6 Public Transport Safety 0 0.0 1 1.0 1 0.4 Waterway Safety 1 0.8 0 0.0 1 0.4 No 93 73.8 71 68.9 164 71.6 Total Projects 126 103 229 Note: The number of justifications exceeds the number of projects because in some cases more than one benefit is cited. Explicit objectives to improve health outcomes 5.5 Just under a quarter of TSB-managed projects in the review period had explicit objectives to improve health outcomes (Table 5.4). Again, the number of road safety projects predominates. There was no statistically significant difference between the 13 period FY97-01 (23.0 percent) and FY02-06 (25.2 percent), showing that the incidence of health objectives has been roughly unchanged. 39 Table 5.4: TSB-managed projects with explicit objectives to improve health outcomes (FY97-FY06) FY97-01 FY02-06 Total, FY97-06 Explicit objectives to improve health Number of Number of Number of outcomes/mitigate health risks? Projects (%) Projects (%) Projects (%) Yes 29 23.0 26 25.2 55 24.0 Of which: Improve road safety, of which 27 21.4 18 17.5 45 19.7 Reduce the rate of accidents, injury, and death associated with 1 0.8 5 4.9 6 2.6 road transport Improvement of safety at selected accident "black spots" 0 0.0 2 1.9 2 0.9 Development of institutional capacity for road safetya 3 2.4 5 4.9 8 3.5 Establishing a safer public transport system 0 0.0 1 1.0 1 0.4 Improve aviation safety 0 0.0 2 1.9 2 0.9 Improve waterway safety 1 0.8 0 0.0 1 0.4 HIV/AIDS prevention 0 0.0 1 1.0 1 0.4 Enhance social inclusion through improved access to health facilitiesb 0 0.0 1 1.0 1 0.4 Improve air quality. 0 0.0 1 1.0 1 0.4 No 97 77.0 77 74.8 174 76.0 Total Projects 126 103 229 Note: The number of objectives exceeds the number of projects because in some cases more than one objective is cited. a. Of these projects, four had objectives exclusively focused on improved management or institutional capacity of the road safety program, with no explicit objective of improving road safety b. Chile Santiago Urban Transport Project 5.6 The share of projects citing health benefits and the share with explicit health objectives is not much different ­ 28 vs. 24 percent, respectively, over the whole period (Tables 5.3 and 5.4). However, certain types of benefits are less likely to appear as explicit objectives and others more so. For example, while appraisal reports for 8 projects referred to the benefits of HIV/AIDS prevention, only in one case did this become a formal objective. Similarly, in only one instance does air quality become an explicit objective, although mentioned as a benefit in appraisal documents for 6 projects. Conversely, aviation safety does not feature in the benefits table based on appraisal information, yet a formal objective appears in a project. 5.7 The likelihood that TSB projects have a health objective rises with country income (Annex 2). Projects in UMIC were much more likely to have a health objective (41 percent) than in LMIC or LIC (24 and 17 percent, respectively). While the share of 39The objective of improving access to health care is not included in the table, as virtually any road would be expected to contribute to improved physical access to health and a host of other services; better access may or may not improve health outcomes. There were only three such projects with explicit objectives of improving access to health care: Chile Santiago Urban Transport Adjustment (2006), Albania Road Maintenance Project (2002), and Guinea National Rural Infrastructure (2005). 14 projects with health objectives in LMIC and LIC remained constant over the decade, there was a marked increase in the share of UMIC with health objectives (Figure 5.1). Figure 5.1: Trend in the share of projects with explicit health objectives, by country income and region 70 62 60 FY97-01 FY02-06 50 46 s ect 40 oj 40 37 pr of 30 29 cent 27 25 26 Per 21 22 20 19 19 15 10 10 7 7 0 LIC LMIC UMIC SAR EAP AFR LCR ECA Country income Region* Note: MNA had no projects with explicit health objectives. Source: Annex 2 5.8 TSB projects in East Asia and the Pacific region are the most likely to have a health objective (37 percent)40, and in SAR and MNA the least likely (7 and 0 percent, respectively, Annex 2).41 The share of TSB projects with explicit health objectives has risen over time in ECA and LCR (Figure 5.1). It would thus appear that road safety, despite its importance, is accorded less priority in some regions. Project components with plausible health benefits 5.9 While only about a quarter of TSB-managed transport projects have an explicit health objective, nearly half (46 percent) have components or activities with potential health benefits (Table 5.5). The share with health components has increased over time ­ from 36 percent in the first half of the decade to 59 percent more recently. 5.10 In fact, forty-two percent of TSB projects had transport safety components, including activities such as improving management of traffic or road safety,42 improving 40Within EAP projects in China predominate, with 53 percent of the projects and 70 percent of financial commitments. Substantially more Chinese projects also have health objectives, 77 percent compared with 23 percent for the rest of EAP. 41This explains in part why 40 percent of all TSB projects with health objectives are in EAP. 42These components could include training, setting up coordinating bodies, improving traffic legislation, improving enforcement capability, streamlining road safety into road work design, and improving response to assist at the accident scene and to ensure injured persons receive emergency treatment. 15 hazardous sections, improving accident data collection or analysis.43 All but a handful of projects with these safety components were for road safety; a few projects had components related to port and inland waterway safety, aviation safety and safety on public transport. None of the safety components explicitly mentioned behavior change. The share of projects with transport safety components has risen dramatically over the 10-year period, from 33 percent in FY97-01 to 52 percent in FY02-06. The total value of the road safety components is in the order of $414 million. Table 5.5: Health Related Components Supported by TSB Projects approved, FY97-06 FY97-01 FY02-06 Total Did the project finance Number of Number of Number of any health components? Projects (%) Projects (%) Projects (%) Yes 45 35.7 61 59.2 106 46.3 Of which Any safety component 42 33.3 53 51.5 95 41.5 ·Traffic management 37 29.4 35 34.0 72 31.4 · Road safety management 33 26.2 35 34.0 68 29.7 · Improvement of hazardous sections 21 16.7 21 20.4 42 18.3 · Accident data collection/analysis 15 11.9 16 15.5 31 13.5 · Port safety 1 0.8 1 1.0 2 0.9 · Aviation safety 0 0.0 2 1.9 2 0.9 · Railway safety 0 0.0 1 1.0 1 0.4 · Inland waterway security 1 0.8 0 0.0 1 0.4 HIV/AIDS prevention 4 3.2 15 14.6 19 8.3 Air quality 7 5.6 2 1.9 9 3.9 Rehabilitation of health centersa 0 0.0 1 1.0 1 0.4 No 81 64.3 42 40.8 123 53.7 Total Projects 126 103 229 a. No components were identified that involved building health facilities, but three components mentioned the improvement of emergency services and response time. 5.11 About 8 percent of all projects had components for HIV/AIDS prevention, substantially higher than the share with explicit objectives on HIV/AIDS. Components in this category include assistance with the formulation of an appropriate policy, the distribution of condoms and AIDS prevention material to transport workers, counseling assistance to roadside populations and road workers including at border crossings on the prevention of HIV/AIDS, and identification of health centers where HIV/AIDS related health services can be strengthened. The share of projects with HIV/AIDS components has increased over time, from only 3 percent of projects in the first half of the decade to 15 percent in the second half. In fact, this may be an undercount, as Table 5.5 is based only on review of appraisal documents and excludes components that were added after 43 This includes setting up of systems to record and analyze information about road accidents including data capturing, definitions, and analysis. Since not all fatalities occur at the scene of an accident and some people die of their injuries some time later, rules need to be set about what to include in the accident data. 16 appraisal.44 About two-thirds of the 19 projects with HIV/AIDS prevention components are in Sub-Saharan Africa. The HIV/AIDS prevention components over the 10-year period amounted to about $8 million in commitments. 5.12 Only 4 percent of TSB-managed projects had components to improve air quality. They involved the development of a motor vehicle emission control strategy, the implementation and supervision of an urban air quality management strategy, and equipment and training for vehicle inspections.45 5.13 There has been a leap in the share of TSB projects with health components in countries of all income levels and all regions, except MNA (Figure 5.2). The greatest increase has been among LICs and LMICs, and in three regions ­ LCR (from 19 to 68 percent), ECA (from 31 to 60 percent), and AFR (from 44 to 74 percent). 46 Figure 5.2: Trend in the share of projects with health components, by country income and region 90 FY97-01 FY02-06 80 77 74 70 68 62 60 58 60 s ect 52 51 50 projfo 47 44 40 ent 40 rceP 32 33 31 30 29 20 19 17 14 10 0 LMIC LIC UMIC MNA SAR EAP ECA LCR AFR Country income Region 5.14 Altogether, half of all TSB projects in the past decade have had a health focus, defined as those that anticipated health benefits, had explicit health objectives, or including components with plausible health benefits (Table 5.6). The 44IEG's 2005 evaluation of the Bank's support for HIV/AIDS control identified16 transport projects approved between FY97-04 that had incorporated HIV/AIDS activities, of which 13 were in Sub-Saharan Africa (OED 2005, p. 115, 117). Among the 24 African countries that had approved MAP projects by mid- 2004, half also had projects managed by the transport sector that had HIV/AIDS components (Ibid, p. 157). 45This is an understatement of the number of projects with emissions components, as most are managed by other sectors. 46Over the 10-year period, nearly half of projects in low and middle-income countries have health components, but there are differences across regions. More than half of TSB projects in AFR (61 percent) and EAP (54 percent) have health components, compared with about 40 percent in ECA, LCR, and SAR, but only 15 percent in MNA. See Annex 2. 17 share with a health focus in the past five years (two-thirds), is nearly twice the share of projects in the first five years with a health focus (37 percent). This parallels the Bank's increased awareness, especially of road safety issues, resulting from the collaborative work with the WHO issued in 2004. Table 5.6: TSB-managed Projects with a Health Focus (FY97-FY06) FY97-01 FY02-06 Total Number of Number of Number of Projects (%) Projects (%) Projects (%) Projects with a health focus 47 37 69 67 116 51 Safety 44 35 59 57 103 45 HIV/AIDS Prevention 4 3 15 15 19 8 Air quality improvement 7 6 5 5 12 5 Projects without a health focus 79 63 34 33 113 49 Total projects 126 103 229 Inclusion of health benefits and costs in the economic analysis 5.15 The health benefits of transport projects were usually not reflected in the project's ex ante economic analysis. About 17 percent of the 116 projects with a health focus included health benefits in the calculation of economic benefits (Table 5.7), and all were road-safety related. The benefits were mainly defined in terms of a reduction in injuries, death, and property damage due to a reduction in accidents. Three-quarters of the projects with a health focus that did not include health benefits in the economic analysis did not explain why they were excluded. None of the 126 transport projects without safety components factored in any adverse health outcomes in their economic analysis. 18 Table 5.7: Among TSB Projects with a health focus, inclusion of health benefits in ex ante economic analysis Did project have an economic FY97-01 FY02-06 Total analysis (ERR, NPV, CE analysis)? No. (%) No. (%) No. (%) Yes, of which: 46 98 67 97 113 97 Projects that included health benefits 9 19 11 16 20 17 in ERR/NPV/CE analysis Assumptions on health benefits are 7 15 5 7 12 10 explicit Health benefits defined as: Cost savings due to reduction in 8 17 11 16 19 16 accidents - Imputed value of life 4 9 1 1 5 4 - Cost of injury 3 6 1 1 4 3 - Reduction in property damage 1 2 1 1 2 2 Reduction in accidents 5 11 0 0 5 4 Reduction in number of deaths 1 2 0 0 1 1 Projects that excluded health benefits 37 79 56 81 93 80 in ERR calculation Reasons for excluding health benefits: Reasons not discussed 24 51 42 61 66 57 Lack of data 12 26 11 16 23 20 Safety impacts uncertain 6 13 3 4 9 8 Benefits from the component cannot 1 2 1 1 2 2 be calculated because subprojects have not been identified No economic analysis. 1 2 2 3 3 3 Total TSB Projects with health focus 47 69 116 Health indicators 5.16 About a quarter of the TSB projects proposed to collect health outcome indicators (Table 5.8), roughly the same share as had health objectives. The road safety outcome indicators included the number of accidents, injuries, and fatalities, and accident, injury, and fatality rates. Other indicators included access time to health care facilities, HIV/AIDS awareness, and emission control. No projects proposed to collect health indicators specifically among the poor. 19 Table 5.8: TSB-managed Projects Proposing to Collect Health Outcome Indicators (FY97-06) FY97-01 FY02-06 Total FY 97-06 Proposes to collect health Number of Number of Number of outcome indicators Projects (%) Projects (%) Projects (%) Yes 29 23.0 31 30.1 60 26.2 Number of accidents 10 7.9 9 8.7 19 8.3 Severity of accidents 1 0.8 3 2.9 4 1.7 Number of fatalities 9 7.1 9 8.7 18 7.9 Number of injuries 3 2.4 0 0.0 3 1.3 Accident rate 5 4.0 6 5.8 11 4.8 Fatality rate 11 8.7 10 9.7 21 9.2 Injury rate 1 0.8 2 1.9 3 1.3 Number of fines for drunk driving, speeding. 0 0.0 1 1.0 1 0.4 HIV/AIDS awareness 0 0.0 2 1.9 2 0.9 Travel time to health facilities 0 0.0 2 1.9 2 0.9 Use of health services (# clinic visits by groups, gender) 0 0.0 1 1.0 1 0.4 Access of transport officials to HIV/AIDS treatments 0 0.0 1 1.0 1 0.4 Use of condoms 0 0.0 1 1.0 1 0.4 No 97 77.0 72 69.9 169 73.8 Total Number of Projects 126 103 229 5.17 Even fewer projects ­ only one in 20, or 5 percent ­ planned to collect health output indicators (Table 5.9). This is significant, because without information on project outputs related to transport safety or health activities, it is difficult to confidently attribute any change in health status or accident rates to the interventions of the project. Table 5.9: TSB Projects Proposing to Collect Health Output Indicators (FY97-06) FY97-01 FY02-06 Total FY 97-06 Proposes to collect health output Number of Number of Number of indicators Projects (%) Projects (%) Projects (%) Yes 5 4.0 6 6.0 11 4.8 Number of road safety campaigns 1 0.8 0 0.0 1 0.4 No. of traffic signs/signals installed; no. of road safety hazard sites treated; 4 3.2 3 2.9 7 3.1 line markings. Number HIV/AIDS awareness 0 0.0 2 1.9 2 0.9 campaigns Greenhouse gas emissions 0 0.0 1 1.0 1 0.4 No 121 96.0 97 94.2 218 95.2 Total projects 126 103 229 20 B. CLOSED PROJECTS 5.18 Among the 105 completed projects (as of June 25, 2007), only 28 (27 percent) had a health focus ­ that is, had explicit health objectives and/or components with potential health benefits.47 The list of these projects, their health objectives, benefits, components, and indicators, and evidence of changes in health outcomes, are provided in Annex 3. All except one were approved in the first five years of the period under review (FY97-01). Implementation of health components 5.19 All 28 completed projects with a health focus had health components ­ although for three projects, health components were added after approval.48 Most health-related components involved road safety, including improvement of hazardous sections (accident black spots improvement), implementation of traffic measures (lane markings, crash barriers, reflective studs, traffic signs/lights), improving road safety management, or setting up functioning accident data systems (Table 5.10). Safety components for other modes were comparatively rare. In most cases the roads under improvement were rehabilitated roads, but in a few instances (mainly in China) the roads were newly constructed highways. In most cases of new construction the reduction in the accident rate in comparison to the rate on the original "old" road was significant. Only in the case of the National Highway III project in Hubei Province was this questioned when it was noted that while the absolute number of accidents had declined, the fatality rate had actually increased, suggesting that there was a higher likelihood of death associated with higher speeds. 5.20 In a few cases there was an attempt to adopt a comprehensive approach to road safety improvement. For example, in Latvia a new Road Traffic Law was promulgated and a company was set up to deal with the issuing of drivers licenses and the testing of vehicles. In Lithuania, there were traffic safety campaigns, an improved accident reporting system was established, and road safety education for school children was introduced into the curriculum. On the other hand, in Zambia a Road Safety Action Plan could not be pursued because of lack of capacity and in Togo an Office of Road Safety was established, but did not become operational because of budgetary constraints. 5.21 All of the planned physical road safety components, as well as waterway and port safety components were at least partially implemented. However, components relating to traffic management, road safety management and accident data collection were less likely to be implemented, with the lowest implementation rate (only 25 percent) for components to improve air quality. 5.22 In contrast, more HIV/AIDS components were implemented than had been planned. Projects in Ethiopia, Malawi, and Niger implemented HIV/AIDS prevention 47Closed projects with Implementation Completion Reports (ICR) available for assessment 48An HIV/AIDS component was added to the Ethiopia Road Sector Development Program Support Project and the Niger Transport Infrastructure Rehabilitation Project after approval. (The latter already had a road safety component.) Road safety was added to the India Andhra Pradesh State Highway Project. 21 components. In Malawi, the National Roads Administration held a sensitization workshop for the senior management in the transport sector. The Implementation Completion Report (ICR) notes that HIV/AIDS activities are now part of tender documents for major development partner funded projects, but it does not specify which activities. The Ethiopia Road Sector Development Program Support Project initiated an HIV/AIDS strategy for the transport sector. The target groups were the staff of the Ethiopian Roads Administration, contractors, consultants and local communities at the project sites. The Niger Transport Infrastructure Rehabilitation Project implemented an information, education and communications program to reduce the risk of HIV/AIDS along transport corridors and among transport workers. Table 5.10: Planned and implemented health-related components in closed TSB projects (approved in FY97-06) Number of projects with Number of projects Actual/ planned health that implemented Planned Type of health component components health componentsa (%) Any safety componentb 23 23 100 Improvement of hazardous sections 12 12 100 Traffic management 20 15 75 Road safety management 18 16 89 Accident data collection/analysis 9 7 78 Inland waterway safety 1 1 100 Port safety 1 1 100 Air quality component 4 1 25 HIV/AIDS components 1 3 300 Total ­ Any health component 26 28 a. Includes components that were fully or partially implemented. In many cases, the lack of reported output indicators for the health components made it difficult to assess the extent to which they were fully implemented. b. Among the projects approved in FY97-06, none with planned railway or aviation safety components had been completed. Inclusion of health benefits in ex post economic analysis 5.23 Of the twenty projects that included health benefits in their ex ante economic analysis at the time of appraisal, only four have closed for which ICRs have been prepared. Only one of these projects, the China Anhui Provincial Highway Project (approved in FY99) included health benefits in the economic analysis. While the ICR for one project (Romania Second Roads, approved in FY97) gave no reason for the omission of health benefits in its ex post economic analysis, the ICRs for the other two (Latvia Highways and Lithuania Highways Projects, both FY97) explained that the actual net present values and economic rates of return for the road safety component cannot be calculated yet because there has not been enough time to observe the results of the black spot improvements in terms of reduced accidents. Collection of health indicators 5.24 Projects with explicit health objectives were far more likely to plan to collect health outcome data and to actually collect it, than were projects with health 22 components absent these objectives. Of the eighteen projects with explicit objectives to improve health outcomes, twelve (two-thirds) intended to collect health outcome data (Table 5.11). Ten of those that planned to collect health outcome data actually collected it, as did three other projects that had not planned to collect it. Among the ten additional projects with health components in the absence of explicit health objectives, only two planned to collect health outcome data and only one project actually did so. Another project which did not plan to collect data on health outcomes actually did collect it. All of these projects collected health outcome data related to road safety improvements such as the accident rate/fatality rate. None of the projects with HIV/AIDS components collected data on HIV/AIDS outcomes (including proxy indicators, like behavior change).49 Table 5.11: Health outcome indicators ­ planned and collected Planned to collect Actually collected Type of health focus health outcomes health outcomes Total Number % Number % Number % Projects w/explicit health objective 12 67 13 72 18 100 Projects w/health component, 2 20 2 20 10 100 no objective Total 14 50 15 53 28 100 Source: Annex 3. Changes in health outcomes 5.25 All fifteen TSB-managed projects that measured health outcomes had to do with transport safety ­ 13 with road safety, one with the safety of inland waterways, and one with the safety of public transport. The 13 road safety projects were concentrated in two regions ­ East Asia (five projects, all of them in China) and Eastern Europe (five projects). In addition, there were two projects that measured health outcomes in South Asia (Bangladesh, India) and only one project in the Africa Region (Zambia). Thus, the vast majority of projects reporting changes in health outcomes are in middle-income countries.50 5.26 In all but Zambia, the indicators suggest an improvement in road safety, although it is not clear whether all of these improvements are statistically significant (Table 5.12). Although it was not an explicit objective, the Zambia Road Sector Investment Program aimed to reduce road accidents by 20 percent. However, the number of accidents and fatalities actually increased, despite the establishment of a Road 49This lack of data on the outcomes of HIV/AIDS components in transport projects mirrors the experience of transport components in HIV/AIDS projects. Among five recently completed HIV/AIDS projects managed by the health sector with activities aimed at transport workers or Ministry of Transport civil service, none reported baseline or end-point data on risk behavior or condom use among transport workers. In none of the ICRs of closed projects was information provided on the impact of the transport sector interventions. The only achievements reported tend to be process indicators or planning activities (Portfolio Review, IEG evaluation of HNP). A recent review of Bank-supported HIV/AIDS interventions in the Africa transport sector came to the same conclusion ­ that M&E were largely absent (do Sacramento) 50As noted earlier, projects in middle-income countries were more likely to have an explicit health objective and those with objectives are more likely to collect data on outcomes. 23 Transport and Safety Agency (RTSA), responsible for road safety, traffic management, and motor vehicle licensing.51 5.27 Accidents were also reduced in inland waterways in Vietnam and in public transit in urban Senegal.52 No TSB-managed projects approved in FY97-06 that had closed documented improvements in HIV/AIDS outcomes or in air quality. A groundbreaking TSB-managed project in Mexico approved prior to the period under review showed a reduction of transport emissions (Box 5-1). Box 5-1: Reducing Harmful Emissions The $220 million Mexico Transport Air Quality Management Project (FY93-99) aimed to reduce high vehicle emissions in the Mexico City Metropolitan Area and was the first Bank operation anywhere to integrate transport and air quality. The project involved revising emissions standards, stricter vehicle inspections, replacement of old vehicles, gasoline vapor recovery, an alternate fuel pilot, preparation of a Transport and Air Quality Management Strategy, procurement of scientific equipment for better air quality measurement, and technical assistance for improved monitoring and environmental audits. In-depth field work by IEG found that despite an increasing number of vehicles and traffic, there was a significant decrease in the ambient concentration of pollutants from vehicle operations and emissions. Over the project period, there were reductions in lead (by 98 percent), ozone (by 48 percent), and carbon monoxide (by 27 percent). The decline in ozone levels reduced the number of "pollution emergency days", from 103 days/year in 1993 to 13 in 2001, and contributed to fewer respiratory illnesses and other acute syndromes due to poor air quality. Source: OED 2003. 51The ICR suggests that the Road Safety Action Plan was developed, but its actions were not effective due to a lack of capacity. The project procured traffic patrol vehicles, road safety education, publicity materials, speed traps, and first aid kits. 52The decline in accidents by 4 percent in Senegal may not have been statistically significant, however. 24 Table 5.12: Improvements in transport safety among completed projects Country Indicator Baseline Year Final Year Target Year Road safety results Armenia Road fatalities/10,000 (P040818) vehicles 12.1 1999 10.5 2004 11.0 2004 Bangladesh Road fatalities/10,000 (P037294) vehicles 76 1998 60 2005 50 2005 China Accidents (Xinjiang) w/fatalities/10,000 vehicles 25 1999 21 2003 19 2005 (P003643) China (Hunan) Accidents (P003654) w/fatalities/10,000 18 1999 5 2003 10 2005 registered vehicles (Guangdong) Accidents w/fatalities/10,000 20 1999 12 2003 10 2005 registered vehicles China (Hubei) Accidents (P036949) w/fatalities/10,000 vehicles 40 1998 12 2003 25 2005 China (Anhui) Accidents per 100 million (P050036) vehicles along National 124 1998 56 2005 None Highway G206 China Pedestrian and bicycle 15% (Liaoning) accidents 6,498a 1998 2,948a 2004 reduction (P041890) Pedestrian and bicycle 15% fatalities 897a 1998 698a 2004 reduction India Fatalities per 10,000 (P000755) vehicles 52 1999 39 2003 None Latvia Fatalities per 10,000 20% (P008532) vehicles 19.9 1995 8.4 2000 reduction Lithuania Fatalities per 10,000 20% (P008551) vehicles 7.5 1996 6.6 1999 reduction Poland Reduction in road crashes 66,586 1997 51,069 2004 None (P008593) Reduction in road fatalities 7,310 1997 5,712 2004 None Romania Fatalities per 10,000 9.2 1997 5.8 2003 None (P039250) vehicles Seriously injured people 7,451 1997 5,538 2003 None Zambia Annual road accidents 8,200 1998 9,588 2005 7,000 2005 (P003236) Annual fatalities 870 1998 1,046 2005 750 2005 Inland waterway safety Vietnam Accidents per 100 vessels 0.0034 2000 0.0023 2005 None (P004843) Safety of public transport Senegal Number of accidents by 20% (P044383) public transport in sub- 2318 1995 2225b 2000 reduction urban areas by 2000 Notes: a. According to the ICR, these data are not specific to the areas where the project was implemented, so attribution is questionable. b. The number of accidents involving public transport declined by 4 percent. Source: Annex 3. 25 5.28 While reported health outcomes almost universally improved in these projects, the attribution of outcomes to the projects' outputs was not always clear. In most cases it is plausible that the project interventions and the safety improvements were directly linked, but attribution was often weak due to: (a) inadequate documentation of outputs; (b) failure to consider other factors that might have affected accident reductions (for example, fuel prices, which can affect the amount of driving and the miles traveled); and (c) a lack of specificity of the data to the areas covered by the project interventions.53 On the other hand, to the extent that the projects improved the reporting of transport accidents, injuries, and fatalities, these statistics may in fact understate the impact of improved safety measures. 6. CONCLUSIONS 6.1 The distribution of TSB projects varies according to region and country income level, but only fifteen projects among the 28 closed projects with a health focus actually measured health outcomes. Health objectives are most likely in EAP, but least likely in MNA. In general the likelihood that a project will include a health objective rises with country income and projects with specific health objectives are more likely to identify health outcome data needs and to actually collect such data. There have been more transport projects with health components in recent years; the emphasis of the updated Bank transport sector strategy and joint initiatives with the WHO and others may have influenced this trend. 6.2 This review of health benefits in the transport lending portfolio over the past decade shows that in the majority of the cases the focus has been on improvements in road safety, as measured by a reduction in the fatality or injury rates. Among the 55 projects with health-related objectives, 82 percent had objectives to improve road safety, while only 7 percent had objectives to improve safety of other modes of transport and only 2 percent each had HIV/AIDS prevention or air quality improvement objectives. 6.3 Clearly, any road project that leads to faster travel speeds also has the potential to increase the severity of accidents that occur. Consequently, it would be sensible for all road projects during appraisal to address this issue and that any mitigation measures proposed should be implemented and monitored. This appears to be a major weakness in Bank evaluation procedures and tools--a point recognized by the Transport Anchor. 6.4 Many road safety interventions supported by the Bank were limited in scope to a reduction in the accident rate on specific stretches of infrastructure under improvement and likely to have only localized benefits54. This is because road safety was often an add- 53Lack of specificity was an issue in China Liaoning Urban Transport Project (P041890). According to the ICR there was a reduction in accidents in all three cities (Fushun, Anshan, and Shenyang) but it was not location specific and therefore not completely attributable to the project. 54Some exceptions include certain projects in China where a more comprehensive approach was used. 26 on component to a road construction or rehabilitation project and not designed to improve overall road safety.55 6.5 Although a reduction in road traffic accidents is used as an indicator to demonstrate the result of road safety countermeasures, there is an attribution problem, since such improvements can also be due to other factors. The attribution of outcomes to the projects' outputs is not always clear. The lack of reported output and outcome indicators for the health components of closed TSB-managed projects makes it difficult to assess the extent to which they are fully implemented. Measuring the benefits remains a problem, because of the inadequacy of proper accident reporting systems in many countries. The quality and reliability of data vary between surveillance systems in different countries and even between systems in the same country.56 Where basic data are not available, community surveys have sometimes been conducted as a proxy (e.g., Ghana, Pakistan, and Uganda). The updated transport sector strategy (close to finalization) acknowledges the need for better monitoring and evaluation. 6.6 Not one of the completed transport projects with HIV/AIDS components have reported on HIV/AIDS outcomes or proxies for them. Thus it is not possible to say whether any of the HIV/AIDS activities or interventions included in transport projects was effective. A recent update on the implementation of the World Bank's Global HIV/AIDS Program of Action57 notes that more than half of the projects in the current transport lending portfolio now incorporate HIV/AIDS activities, yet the update provides no evidence of their effectiveness in improving health outcomes, including healthier behavior.58 Most of these HIV/AIDS components were `retro-fitted' into projects after they were approved, thus HIV/AIDS related outcomes are not included as an explicit objective. As seen in the case of road safety projects, projects without an explicit health (or in this case HIV) objective are far less likely to collect health outcome data. 6.7 The portfolio review has pointed to a number of interesting patterns, but the reasons behind them and how performance can be improved remain unclear. The next step would be to learn more on the "why" and "how" by follow-up interviews with transport staff, as the basis for recommending how the performance of health components of transport projects can be improved. Among the remaining questions: 55 In the Malawi Road Rehabilitation and Maintenance Project, for example, road safety and HIV/AIDS activities were added on during implementation. 56 WHO 2004 Only 75 countries fully capture the necessary data, while a further 35 submit incomplete data. Some of the poorest countries have no workable recording systems. 57 World Bank Human Development Network, 2007 According to Annex 3, p. 56, twenty-five of the 39 projects in the current transport sector portfolio includes HIV activities. 58 OED's 2005 evaluation of the Bank's HIV/AIDS support found that among 16 ongoing transport projects with HIV/AIDS components, only one mentioned AIDS in its development objectives, four reported the status of AIDS activities in supervision reports, and five had AIDS indicators. When activities are "retro- fitted" into an ongoing project, there is often little documentation of the objectives or performance when the project closes. The activities are rarely large enough to become a formal component. Supervision resources are often too tight to be able to enlist a technical expert for these small and specialized activities for which the sector itself has little expertise. 27 · Why, if there are so many projects with transport safety and HIV/AIDS components, do so few of them: (a) have explicit objectives on transport safety and HIV/AIDS; and (b) propose to collect data to document whether safety/health improves or risks are mitigated? · Among TSB projects with explicit health objectives, what accounts for the fact that some succeed in reporting health outcomes and others do not? Are there important operational linkages between the transport and health sectors that are key? Are the statistics being collected from within the transport sector, or in collaboration with health or local government? · On the issue of improving attribution of outcomes to the project, (a) Why do so few projects propose to collect health outputs? (b) What additional information can be taken into consideration to improve attribution? · Why do so many fewer TSB projects in low-income countries have health components and objectives? 28 REFERENCES Babinard, J. and P. Roberts. 2006. "Maternal and Child Mortality Development Goals: What can the Transport Sector Do?" Transport Sector Board Paper, No. TP-12. World Bank, Washington, D.C. Bliss, A. 2004. "Implementing the Recommendations of the World Report on Road Traffic Injury Prevention". Transport Note, No. TRN-1. World Bank, Washington, D.C. Brushett, S. and J. Osika. 2005. Lessons Learned to Date from HIV/AIDS Transport Corridor Projects. World Bank, Washington, D.C. Economist. 2007. Pocket World in Figures. London: Profile Books, Ltd. Elder, R.W. and others. 2002. "Effectiveness of Sobriety Checkpoints for Reducing Alcohol-involved Crashes". Traffic Injury Prevention 3:266-274 Ezzati, M. 2003. Complexity and Rigor in Assessing the Health Dimensions of Sectoral Policies and Programs. Bulletin of the World Health Organization 81(6): 458-459. Global Road Safety Partnership. 2007. Annual Report of the Global Road Safety Partnership. Geneva. Gwilliam, K., M. Kojima and T. Johnson. 2004. Reducing Air Pollution from Urban Transport. Washington D.C., World Bank Independent Evaluation Group (IEG). 2007. A Decade of Action in Transport: An Evaluation of World Bank Assistance to the Transport Sector, 1995-2005. Washington D.C., World Bank Jacobs, G., A. Aeron-Thomas, and A. Astrop. 2000. Estimating Global Road Fatalities. Report No. 445, TRL Ltd. Crowthorne, UK. Jacobs, G. and A. Aeron-Thomas. 2000. Africa Road Safety Review Final Report Washington, D.C.: TRL Ltd for US Department of Transportation, Federal Highway Administration. Kayi, C. 2007. "An Analysis of Road Traffic Accidents Using GIS: the Case of Nairobi". Published thesis, University of Trier, Hamburg Kjellstrom, T., L. van Kerkoff, G. Bammer, and A. McMichael. 2003. "Comparative Assessment of Transport Risks--how it can contribute to Health Impact Assessment of Transport Policies". Bulletin of the World Health Organization No. 81, 451-458 29 Kopits, E and M. Cropper. 2003 "Traffic Fatalities and Economic Growth". Policy Research Working Paper No. 3035 World Bank, Washington D.C. Larsson, J., and G. Nilsson. 2000. Seat-belt Reminders: Beneficial for Society? Linkoping, Swedish National Road and Transport Research Institute, VTI Report 62- 2000. Mathers, C. and D. Loncar. 2005. "Updated Projections of Global Mortality and Burden of Disease". Geneva: WHO. Operations Evaluation Department (OED). 2005a. Committing to Results: Improving the Effectiveness of HIV/AIDS Assistance. Washington, D.C.: World Bank OED. 2005b. "Turkey: Road Improvement and Traffic Safety Project (Loan 4048-TR)" Project Performance Assessment Report. Report no. 31520 World Bank, Washington, D.C. OED. 2003. "Mexico: Transport Air Quality Management Project (Loan 3543-ME)" Project Performance Assessment Report. Report No.: 26202 World Bank, Washington, D.C. OED. 1999. Investing in Health: Development Effectiveness in the Health, Nutrition, and Population Sector. Washington, D.C.: World Bank. Stern, N. 2006. The Economics of Climate Change. London: Her Majesty's Treasury http://www.hm-treasury.gov.uk Supramanian, V., V. Belle and J. Sung. 1984. "Fatal Motorcycle Accidents and Helmet Laws in Peninsular Malaysia". Accident Analysis and Prevention 16:157-162. United Nations Centre for Human Settlements (UN Habitat). 2001. Cities in a Globalizing World: Global Report on Human Settlements. London: Earthscan United Nations Population Fund 2007 State of World Population 2007: Unleashing the Potential for Urban Growth, New York World Bank Human Development Network. 2007. "Progress in Implementing the World Bank's Global HIV/AIDS Program of Action as of end FY07", October 12. World Bank. 2006. Safe, Clean and Affordable...Transport for Development: An Update of the World Bank's Transport Sector Priorities for the Period 2007-2015 Transport Sector Board External Consultation Draft. Washington, D.C. World Bank. 2005a. Global HIV/AIDS Program of Action. Washington, D.C. 30 World Bank. 2005b "Project Appraisal Document for a Road Safety Project, Socialist Republic of Vietnam", Report No. 32337-VN, Washington, D.C. World Bank. 2002. Cities on the Move: A World Bank Urban Transport Strategy Review. Washington D.C. World Bank. 1999. Intensifying Action against HIV/AIDS in Africa: Responding to a Development Crisis. Africa Region Washington, D.C. World Bank. 1996a. Sustainable Transport: Priorities for Policy Reform. Washington, D.C. World Bank. 1996b. "Project Appraisal Document, Turkey: Road Improvement and Traffic Safety Project", Report No 15011-TU, Washington, D.C. World Health Organization (WHO) 2007. The Health and Environment Linkages Initiative http://www.who.int/heli/risks/urban/urbanenv.html WHO Europe. 2005. Health Effects of Transport-Related Air Pollution. Geneva: WHO. WHO. 2005. Pre-hospital Trauma Care Systems. Geneva: WHO. WHO. 2004. World Report on Road Traffic Injury Prevention. Geneva: WHO. WHO. 2002. World Health Report Attributable Mortality by Risk Factor, Level of Development and Sex Statistical Annex Geneva WHO WHO. 2000. Transport, Environment and Health. Geneva: WHO. 31 ANNEX 1. LIST OF PROJECTS REVIEWED Loan/Credit Project Appro- Closing Health Amount ID Project Name Country val FY Date Focus (US$M) P005980 Provincial Roads Argentina 1997 06/30/2006 300 P039584 Buenos Aires Urban Transport Argentina 1997 06/30/2010 200 P009518 Second Rural Roads & Markets Improvement Bangladesh 1997 03/31/2003 133 P000117 Transport Sector Investment Program Benin 1997 12/31/2001 40 P044393 Emergency Landmine Clearance Bosnia and 1997 12/31/1998 8 Herzegovina P006532 Federal Highway Decentralization Brazil 1997 12/17/2005 300 P034578 RGS Highway Management Brazil 1997 12/15/2005 70 P003643 Second Xinjiang Highway China 1997 12/31/2003 300 P003654 National Highway 2/Hunan-Guangdong China 1997 12/31/2004 400 P044457 Emergency Transport/Mine Clearance Croatia 1997 12/31/2001 102 P035722 National Highway Dominican 1997 10/31/2003 75 Republic P044651 Road Sector Engineering Eritrea 1997 06/30/2002 6 P009995 Andhra Pradesh State Highway India 1997 06/30/2004 350 P045600 Road Infrastructure Development India 1997 12/31/2001 52 P004026 Railway Efficiency Indonesia 1997 12/30/2004 105 P040521 Village Infrastructure II Indonesia 1997 07/31/2000 140 P004210 Third Highway Improvement Lao PDR 1997 06/30/2003 48 P008532 Highway Latvia 1997 12/31/2000 20 P038674 National Roads Lebanon 1997 09/30/2004 42 P008551 Highway Lithuania 1997 12/31/2000 19 P036061 Port Access & Management Poland 1997 06/30/2003 67 P039250 Roads 2 Romania 1997 06/30/2006 150 P044383 Urban Transport Reform TA Senegal 1997 06/30/2001 7 P034083 Urban Transport Turkmenistan 1997 12/31/2001 34 P039203 Forests Product Transport Uruguay 1997 04/30/2006 76 P004842 Second Highway Rehabilitation Vietnam 1997 06/30/2003 196 P039021 Rural Transport Vietnam 1997 12/31/2001 55 P040818 Durres Port Albania 1998 12/31/2004 17 P052590 National Highway Rehabilitation & Argentina 1998 12/31/2005 450 Maintenance P045484 Second Emergency Transport Reconstruction Bosnia and 1998 06/30/2000 39 Herzegovina P006559 Sao Paulo Integrated Urban Transport Project Brazil 1998 12/31/2004 45 P043421 Rio de Janeiro Mass Transit Project Brazil 1998 12/31/2007 186 P003614 Guangzhou City Transport China 1998 12/31/2007 200 P003619 Second Inland Waterways China 1998 12/31/2006 123 P036949 National Highway 3-Hubei China 1998 12/31/2004 250 P045788 Tri-Provincial Highway China 1998 06/30/2007 230 P001177 Transport Sector Adjustment Cote d'Ivoire 1998 06/30/2004 180 P057704 Port Sector Reform Egypt, Arab 1998 06/30/2000 2 Republic 32 Loan/Credit Project Appro- Closing Health Amount ID Project Name Country val FY Date Focus (US$M) P034154 Ports Rehabilitation Eritrea 1998 06/30/2007 30 P000755 Road Sector Development Program Support Ethiopia 1998 05/31/2005 309 P035737 Rural & Main Roads Guatemala 1998 06/30/2007 67 P003993 Sumatra Region Roads Indonesia 1998 12/31/2005 234 P010509 Multimodal Transit Nepal 1998 09/30/2003 24 P053705 Transport II Nicaragua 1998 06/24/2005 47 P035608 Transport Infrastructure Rehabilitation Niger 1998 05/30/2003 28 P008593 Roads 2 Poland 1998 09/10/2007 300 P002875 Road Transport Togo 1998 09/30/2002 50 P043700 Transport Sector Investment Tunisia 1998 12/31/2005 50 P049543 Road Sector & Institutional Support Uganda 1998 12/31/2007 30 P004843 Inland Waterways Vietnam 1998 03/31/2006 73 P003236 Road Sector Investment Program Support Zambia 1998 03/31/2005 70 P009524 Dhaka Urban Transport Bangladesh 1999 06/30/2005 177 P037294 Third Road Rehabilitation & Maintenance Bangladesh 1999 12/31/2005 273 P055230 Abapo-Camiri Highway Bolivia 1999 10/31/2005 88 P048869 Salvador Urban Transport Brazil 1999 12/31/2007 150 P004030 Road Rehabilitation Cambodia 1999 09/30/2006 45 P003653 Container Transport China 1999 06/30/2005 71 P041268 National Highway 4/Hubei-Hunan China 1999 12/31/2006 350 P041890 Liaoning Urban Transport China 1999 12/31/2005 150 P050036 Anhui Provincial Highway China 1999 08/31/2005 200 P051705 Fujian II Highway China 1999 06/30/2007 200 P039082 Toll Road Concession Colombia 1999 04/30/2001 137 P039161 Railway Modernization & Restructuring Croatia 1999 06/30/2005 101 P056514 Restructuring of the Transport Ministry Project Georgia 1999 06/30/2003 2 P008499 Road Transport Restructuring Kazakhstan 1999 12/31/2007 100 P042237 Provincial Infrastructure Lao PDR 1999 06/30/2007 28 P050589 Transport Macedonia 1999 09/30/2004 32 P001666 Road Maintenance & Rehabilitation Malawi 1999 06/30/2006 30 P045053 Rural Infrastructure LIL Nepal 1999 07/31/2003 5 P053706 Second Roads Rehabilitation Panama 1999 09/30/2003 85 P042722 Second Highway Rehabilitation & Russian 1999 12/31/2004 400 Maintenance Federation P052293 Infrastructure Asset Management Samoa 1999 03/31/2004 14 P002366 Second Transport Senegal 1999 12/31/2007 90 P002970 Roads Development APL Uganda 1999 06/30/2008 91 P049267 Second Transport Uruguay 1999 09/30/2003 65 P004833 Urban Transport Improvement Vietnam 1999 12/31/2005 43 P068853 Emergency Road Repair Albania 2000 12/31/2003 14 P044829 Transport Armenia 2000 12/31/2004 40 P059481 Rural Access Roads Bhutan 2000 06/30/2006 12 P070086 Trade and Transport Facilitation in Southeast Bulgaria 2000 09/30/2005 7 Europe P058843 Guangxi Highway China 2000 06/30/2007 200 P058844 Henan Provincial Hwy 3 China 2000 12/31/2006 150 33 Loan/Credit Project Appro- Closing Health Amount ID Project Name Country val FY Date Focus (US$M) P069930 Road Corridor Rehabilitation Djibouti 2000 08/31/2005 15 P035775 Transport Estonia 2000 12/31/2005 25 P040556 Roads Georgia 2000 12/31/2005 40 P009972 National Highways III India 2000 12/31/2007 516 P035776 Klaipeda Port Lithuania 2000 12/31/2008 35 P052208 Transport Sector Reform & Rehabilitation Madagascar 2000 07/31/2005 65 P042039 Railway & Ports Restructuring Mozambique 2000 06/30/2008 100 P045052 Road Maintenance and Development Nepal 2000 06/30/2007 55 P054238 Gazelle Restoration II Papua New 2000 12/31/2007 25 Guinea P039019 National Road Improvement APL1 Philippines 2000 03/31/2007 150 P065041 Trade and Transport Facilitation in Southeast Romania 2000 06/30/2004 17 Europe P055472 Urban Mobility Improvement APL Senegal 2000 12/31/2007 70 P050508 Urban Transport Uzbekistan 2000 03/31/2006 29 P059864 Rural Transport 2 Vietnam 2000 06/30/2006 104 P070078 Trade and Transport Facilitation in Southeast Albania 2001 03/31/2005 8 Europe P040716 Highway Azerbaijan 2001 10/31/2007 40 P040150 Roads and Municipal Drainage Belize 2001 09/30/2005 13 P070079 Trade and Transport Facilitation in Southeast Bosnia and 2001 09/30/2005 11 Europe Herzegovina P035672 National Transport Program Support SIL Chad 2001 01/31/2008 67 P045915 Urumqi Urban Transport China 2001 12/31/2007 100 P056199 3rd Inland Waterways China 2001 12/31/2007 100 P056596 Shijiazhuang Urban Transport China 2001 12/31/2008 100 P058845 Jiangxi II Hwy China 2001 12/31/2006 200 P070088 Trade and Transport Facilitation in Southeast Croatia 2001 03/31/2005 14 Europe P057538 Road Reconstruction and Improvement Honduras 2001 06/30/2007 67 P010566 Gujarat Highways India 2001 12/31/2007 381 P070421 Karnataka Highways India 2001 10/31/2007 360 P071244 Grand Trunk Road Improvement India 2001 12/31/2007 589 P050719 Urban Transport Kyrgyz 2001 11/30/2005 22 Republic P064821 Road Maintenance Lao PDR 2001 12/31/2004 25 P070089 Trade and Transport Facilitation in Southeast Macedonia 2001 12/31/2005 9 Europe P065779 Federal Highway Maintenance Mexico 2001 11/30/2006 218 P056200 Transport Development Mongolia 2001 12/31/2007 34 P068673 Road Rehab. and Maintenance III Nicaragua 2001 06/30/2007 75 P056213 Trade & Transport Pakistan 2001 06/30/2006 3 P044601 Second Rural Roads Peru 2001 11/30/2006 50 P057731 Metro Manila Urban Transport Integration Philippines 2001 03/31/2009 60 P008615 Seaway/Port Modernization Poland 2001 06/30/2007 39 P040795 Railway Restructuring Poland 2001 12/31/2005 101 P046061 Moscow Urban Transport Russian 2001 08/31/2007 60 Federation 34 Loan/Credit Project Appro- Closing Health Amount ID Project Name Country val FY Date Focus (US$M) P064082 Transport Sector Investment Tunisia 2001 06/30/2009 38 P042927 Mekong Transport & Flood Protection Vietnam 2001 12/31/2010 110 P070391 Rural Access Improvement Program Yemen, 2001 11/30/2006 45 Republic P003227 Railways Restructuring SIL Zambia 2001 06/30/2005 27 P066260 Road Maintenance Albania 2002 06/30/2007 17 P072458 Transport TA Algeria 2002 12/31/2007 9 P068968 Road Rehabilitation & Maintenance Bolivia 2002 12/31/2007 77 P071347 Road Management Safety Bosnia and 2002 06/30/2007 30 Herzegovina P051696 São Paulo Metro Line 4 Brazil 2002 06/30/2009 209 P055954 Goias State Highway Management Brazil 2002 12/31/2006 65 P060221 Fortaleza Metropolitan Transport Brazil 2002 03/30/2008 85 P058846 National Railway China 2002 12/31/2007 160 P070459 Inner Mongolia Highway China 2002 03/31/2008 100 P050623 Road Sector Development Program Ghana 2002 12/31/2007 220 P050668 Mumbai Urban Transport India 2002 06/30/2008 542 P069889 Mizoram Roads India 2002 12/31/2007 60 P072539 Kerala State Transport India 2002 12/31/2007 255 P040578 Eastern Indonesia Region Transport Indonesia 2002 06/30/2006 200 P034038 Urban Transport Development Lebanon 2002 06/30/2009 65 P001785 Roads and Bridges Management and Mozambique 2002 06/30/2007 162 Maintenance P004397 Road Maintenance & Rehabilitation Papua New 2002 12/31/2009 40 Guinea P074090 Trade and Transport Facilitation in Southeast Serbia 2002 03/31/2007 7 Europe P065436 Road Development Phase 2 APL Uganda 2002 06/30/2008 65 P078284 Emergency Transport Rehabilitation Afghanistan 2003 06/30/2007 108 P082472 National Emergency Employment Program for Afghanistan 2003 09/30/2007 39 Rural Access P071435 Rural Transport Improvement Bangladesh 2003 06/30/2009 190 P074030 Transport Sector SIM Burkina Faso 2003 09/30/2008 92 P054786 Railway Concession SIL Cameroon 2003 12/31/2008 21 P074490 Douala Infrastructure Cameroon 2003 12/31/2008 56 P058847 Third Xinjiang Highway China 2003 12/31/2007 150 P070441 Hubei Xiaogan Xiangfan Highway China 2003 12/31/2007 250 P076714 2nd Anhui Highway China 2003 06/30/2009 250 P044613 Road Sector Development Program Ethiopia 2003 06/30/2009 127 P055085 Second Rural and Main Roads Guatemala 2003 12/31/2007 47 P050649 Roads India 2003 03/31/2009 348 P067606 Roads India 2003 12/31/2008 488 P073689 Rural Transport APL 2 Madagascar 2003 06/30/2009 80 P073626 Trade and Transport Facilitation in Southeast Moldova 2003 09/30/2007 7 Europe P074963 Lagos Urban Transport Nigeria 2003 06/30/2009 100 P083906 Emergency Customs and Trade Facilitation Afghanistan 2004 12/31/2007 31 35 Loan/Credit Project Appro- Closing Health Amount ID Project Name Country val FY Date Focus (US$M) P088153 National Highway Asset Management Argentina 2004 12/31/2008 200 P060573 Tocantins Sustainable Regional Development Brazil 2004 12/31/2009 60 P064876 Road Sector Development SIM Burundi 2004 12/31/2009 51 P071207 Provincial & Rural Infrastructure Cambodia 2004 09/30/2007 20 P069852 Wuhan Urban Transport China 2004 06/30/2009 200 P075602 2nd National Railways (Zhe-Gan Line) China 2004 01/31/2008 200 P077137 4th Inland Waterways China 2004 01/31/2010 91 P081749 Hubei Shiman Highway China 2004 06/30/2009 200 P082466 Integrated Mass Transit Systems Colombia 2004 03/31/2009 250 P043195 Rijeka Gateway Croatia 2004 12/31/2010 157 P082914 Airports Development Egypt, Arab 2004 06/30/2009 335 Republic P086277 Secondary and Local Roads Georgia 2004 10/31/2009 20 P073776 Allahabad Bypass India 2004 06/30/2009 240 P074290 Second Eastern Indonesia Region Transport Indonesia 2004 06/30/2009 200 P081505 Amman Development Corridor Jordan 2004 06/30/2009 38 P082615 Northern Corridor Transport SIL Kenya 2004 12/31/2009 207 P083543 Road Maintenance APL2 Lao PDR 2004 03/31/2009 23 P082806 Transport Infrastructure Investment Madagascar 2004 06/30/2009 150 P079351 Transport Corridors Improvement (PACT) Mali 2004 12/31/2008 49 P082754 Rural Roads Morocco 2004 06/30/2010 37 P010556 Highways Rehabilitation Pakistan 2004 06/30/2009 200 P035740 Lima Transport Peru 2004 06/30/2009 45 P078170 Road Maintenance & Rehabilitation Poland 2004 06/30/2007 126 P075523 Infrastructure Asset Management APL2 Samoa 2004 06/30/2010 13 P075207 Transport Rehabilitation Serbia 2004 06/30/2011 55 P078387 Central Transport Corridor Tanzania 2004 12/31/2009 122 P075173 Highways Management Thailand 2004 06/30/2008 84 P059663 Road Network Improvement Vietnam 2004 12/31/2008 225 P071985 Road Rehabilitation Maintenance Zambia 2004 06/30/2010 50 P070628 Provincial Road Infrastructure Argentina 2005 06/30/2012 150 P087004 Road Sector Support Cape Verde 2005 08/31/2010 15 P076807 Infrastructure for Territorial Development Chile 2005 06/30/2010 50 P068752 Inner Mongolia Highway & Trade Corridor China 2005 06/30/2010 100 P082998 Second Road Sector Development Support Ethiopia 2005 06/30/2012 161 Program P065127 National Rural Infrastructure Guinea 2005 09/30/2008 30 P077856 Lucknow-Muzaffarpur National Highway India 2005 06/30/2010 620 P077977 Rural Roads India 2005 03/31/2010 400 P082618 Beira Railway SIL Mozambique 2005 06/30/2010 110 P083923 Rural Access Improvement & Decentralization Nepal 2005 12/31/2010 32 P088824 Road Maintenance & Rehabilitation 2 Poland 2005 12/31/2007 131 P083620 Transport Restructuring Romania 2005 07/31/2009 225 P077328 Rail Restructuring Turkey 2005 09/30/2009 185 P074079 Road Development APL 3 Uganda 2005 12/31/2009 108 P057481 Transport Infrastructure Maintenance & Rural Uruguay 2005 07/31/2011 70 36 Loan/Credit Project Appro- Closing Health Amount ID Project Name Country val FY Date Focus (US$M) Access P085080 Road Safety Vietnam 2005 12/31/2009 32 P079734 East Africa Trade and Transport Facilitation Africa 2006 09/30/2011 199 P083751 3A-West &Central African Air Transport TA Africa 2006 12/31/2009 34 P094488 Highway 2 Azerbaijan 2006 02/28/2011 200 P092990 Road Transport Project Brazil 2006 06/30/2010 501 P082412 Santiago Urban Transport Adjustment Chile 2006 12/31/2006 30 P086689 Santiago Urban Transport TA Chile 2006 12/31/2009 5 P070519 Fuzhou Nantai Island Peri-Urban Development China 2006 06/30/2011 100 P085333 5th Inland Waterways China 2006 06/30/2011 100 P093906 3rd Jiangxi Highway China 2006 12/31/2010 200 P099992 Liaoning Medium Cities Infrastructure China 2006 12/31/2011 218 P098850 Infrastructure Pre-Investment Facility Georgia 2006 09/30/2009 5 P095523 Transport and Territorial Development Haiti 2006 06/30/2013 16 P086775 Rural Infrastructure Honduras 2006 06/30/2010 47 P083499 Railways Reform Macedonia, 2006 10/31/2009 19 P094007 Rural Roads II Morocco 2006 06/30/2012 60 P083952 Fourth Roads Rehabilitation & Maintenance Nicaragua 2006 12/31/2011 60 P078813 Regional Transport Decentralization Peru 2006 06/30/2010 50 P096214 Road Maintenance & Rehabilitation 3 Poland 2006 09/15/2011 180 P078389 Infrastructure Development Sierra Leone 2006 09/30/2011 44 P086411 Road Sector Assistance Sri Lanka 2006 09/30/2011 100 P075407 Third Rural Transport Vietnam 2006 12/31/2011 106 P085231 Second Rural Access Yemen, 2006 11/30/2010 40 Republic Source: World Bank 37 o- o- with) nts 61 54 40 43 15 38 46 ne with) nts 46 46 49 46 (% Health comp (% health comp ne ) ) (% ject with 24 37 26 23 0 7 24 health ob -tives (% ject with health ob ives 17 24 41 24 FY97-06 FY97-06 with th 25 32 19 17 2 11 with th REGION heal nents 106 NCOMEI heal compo- nents 41 47 18 106 Total: No. compo- Total: No. BY th BY th No. with heal ves 10 22 12 9 0 2 55 No. objecti with 15 25 15 55 06),- heal ves objecti of st of st No. pro- jec 41 59 47 40 13 29 229 No. pro- jec 89 103 37 229 (FY97-06), (FY97 ) o- ) o- nts (% with 74 58 60 68 14 47 59 nts 62 52 77 59 health comp ne (% with Health comp ne FOCUS ) FOCUS ) (% ject with 26 25 40 37 0 7 25 38 health ob -tives (% ject with health ob ives 19 21 62 25 ALTH th op ALTH op No. with 17 14 9 13 1 7 61 Nbr 26 25 10 61 HE FY02-06 heal com -nents FY02-06 with Health com -nents HE A th No. 6 6 6 7 0 1 A 8 8 with heal object- tives 26 Nbr with ves 10 26 Health objecti WITH of st WITH of s 42 48 13 No. pro- 7 jec 23 24 15 19 15 103 Numb er 103 project ) o- ) o- nts (% with 44 51 31 19 17 29 36 nts 32 40 33 36 health comp ne (% with Health comp ne PROJECTS ) PROJECTS ) (% jec- 0 7 ject with health ob tives 22 46 19 10 23 (% with health ob ives 15 27 29 23 TSB th op Bank A.2 FY97-01 No. 8 with 18 10 4 1 4 45 15 22 8 45 heal com -nents TSB.B2 th op FY97-01 No. with heal com -nents rldo th th W No. 4 6 2 0 1 7 7 with heal object- tives 16 29 No. with 15 29 heal ves objecti ANNEX st No. of pro- ANNEX st Source: jec 18 35 32 21 6 14 126 No. of pro- jec 47 55 24 126 Region AFR EAP ECA LCR MNA SAR Total Region LIC LMIC UMIC Total taad .0 60 omrf (1999) e to at ed 10,000 at at Th yb ies lit omrf though eth 50 Road ies 1998 of of health lit ined per letionp 11sawt 10.5 10,000 Fata 10,000 ined in letionp 2005, Collect on outcomes? No. Yes. fata decl 12.1 vehicles appraisal to com (2004). targe per vehicles 2004. Yes. per vehicles decl 76 in short target project com (2005). er a on e and ts ? tede yb nte ng.i yd of fo en esi syoub en acklb stu patrol of del dec black up on component, akt provid for accid to ities Secretariat ent and , ent 41 reew were was to activit Safety An. cid trainyt enhan ac staff of safety activ eationcr comp aids safe et setting cem under we6dna1s ay anent darar road; 2001 of was signs the road highway the fic ecipsy althehroy What plaer Roads educational atedni safety and non-motorizedr new gationi annelshce and Qu. Road in rameworkf safety introduced re ador ent eedps targa roada theg the ectj traffic fo road cem of N-H-B and of elim road follow an nave ngi anc pro while with out and includin lanes the The. ousi patrol fully safet Th risp entr the the OBJECTIVES Were road implemented? Yes. com at from vyannailaIteht rmepa was edive National ed. A established stemys atunethy Armenia rec enfor useeth 33 were on institutional var repair Yes. Council was an improving data identif spots. Police liceoP not with equipment, campaigns. Yes. potss markings upgraded, and projects highway separate traffic completed did to AND d lthaeh ies data? rep clesi lit veh nde ect Road ies lit Fata 10,000 Inte coll outcome No Yes. fata 10,000 Yes. per vehicles. by d t an and nts are vei ec ofyt meu tesra latre proj 'sytr ili in improve The OUTCOMES doctc ident coun ntse liabre Armenia, 39 conditions acc rope. oje stme cture,u hance from pr Eu thee yment. fits? inv in ne safety with higherhcum in le and d be le, at infrastr en,yte to emplo Road ies than preserv alth lit ls safc HEALTH Justifie he No Yes. deplorab fata leve would considerab transport traffi transport generate No OF of at toev with eth and rt the k,r road inyt to po to and,tye . es ecti total saf y onstia implement ur alth accidents obj he netwo improve urate in sts,oc road ethe ciencyi eff pingloe acipac tif Roads loc improve onali iden and easm tions ove Improve .tyfe road To road nsem sportn creasin niae To devyb to Explicit impr outcomes Yes. sa Yes. inam design alicsy locae com reductions tra improve to operational Arm Yes. safety institut RHD hazardous to ph reduce thes nt 0.2 5.0 11.6 Health com- pone (US$ million) ACHIEVEMENT jectivesbo 3. it health 17 40 273 Loan/ cred amount (US$ million) YF explicit ANNEX ,y and,tc with sh ad Port Ro &noittalibi ncea oje approval ha Countr pr of Projects Albania Durres (P040818) 1998 Armenia Transport (P044829) 2000 Banglade Third Re Mainten (P037294) 1999 taad of the these yam . doubt; in may ed. no the th in e. wi rep clesi 1999 lasi in ed of cs in tyfe veah atth of tye esh iser duceder in 2003 sa ce lif veh health be saf parts worsen Collect on outcomes? However, quality statisti also some experts suggested road some Banglad have The.oN for of Number ies idents lit reduced 25 in appra wast 21 eviden presented ICR loss Yes. acc fata 10,000 was from to The targe 19/10,000 2005. . on on d for ts ? and e mic d . an in ontr for is w- ued en esi sea lope y.ic tedelp wer of and on set-up was activit the tabadeth econo an,ts t repo follo com dev tions ationic made which the A. saw the Losses ies to poly ec comp affictr ciden udia "Methods lic as ac was proposala to on was" fic ecipsy althehroy What ofs ancetsissa tyfe ove llew safetd ingd signalization identif sa ress safetyci cedures under ntse formulatingrof poyte cal impr roaa and velopmented spot measuring ficaftr of Pro ed ortper Economic to for Acc used safci an safet .y echniT. asytefas tersniyti cluin cid to Prog. traff leading improvement A of ent prior en acklB plem dueses Audit spots consider traff affi project. ingeb Tr is Were road implemented? recommendation stud Yes provided road im Elev improved, management Yes. improvement, methods los development procedures improving Safety completed black being on Measuring to It future plans. of to d lthaeh th data? wi rep cles.i veh nde ect Number ies idents lit Inte coll outcome No Yes. acc fata 10,000 by nt an to me t ot nts ge oft a'sin hum a Ch veah in meu na cos ma ofs magead portan of tinues and people of doctc the im The 40 term and ent con an roads ghwayih oje pr fits? fficartdna duceerl in ts, isy lopm affictr all accidentsci proportions on umbersn in ne wil iden safet deve as national veloped.ed and traff ousi in d be fety is es ser Sa accc productivity the in rapidly alth s. iviti and Road or,tces ed Justifie he Ye act traffi life vehicles. Yes. issue road grow high-speed, network frequency involved reach China. toev ad ro ghwayih ecti alth obj he ove Improve conditions. crease In .tyfe Explicit impr outcomes Yes. safety Yes. sa nt 1.2 3.5 Health com- pone (US$ million) it 40 300 Loan/ cred amount (US$ million) YF ,y and,tc Sector Project Xinjiang oje approval nin Countr pr of Be Transport Investment Program (P000117) 1997 China Second Highway (P003643) 1997 taad 40 in 1999 , ; 1999 es e 12 ed : st ,000 10. ,000 target iti lower target 2005. 10 ed in : 2003 st 10 ed in 2003 wer from to Hunan ies fromdesa 2005eth ter of ies in far for health lit per in5 fromdesa lit ter per 12 2005 10. Accidents talfa 10,000 the 1998 25 Collect on outcomes? Yes. Province Acciden involving fata decre 18 regis vehicles to below target Guangdong Province Acciden involving fata decre 20 regis vehicles to the was Yes. with per vehicles reduced in 2003, than appraisal of on sub- rsa is at and on ts ? of Its ad ysl rks. es en esi tyfe affictr nda edar design ad of spot s ana e onitorm ing wol held on sad rot ro activit medialer ent emtsys prep semin wa numbera nte giv Black: and, durne civi were A. procedur comp roal cludedin of cid safety of tion were safety was Unit ies tak fic ecipsy althehroy What Al: implementede operational. ouyrrac esehT blackspots, ecl oadr ram tyfe is toe acda llection, ons tivit tionc safety safety wer of velopmed col Sa co ac ad y. and, ta addition, Province prog wer ro, cs workshops ro plan, da In and measures an Province toril andde of safet ication tisti ofy implementation ures is.s alsunamytefas ialc ion Road tye ilotp ident provin held. cat A tasks auditsy ures construeth saf stud Were road implemented? Hunan components satisfac identif and easm acc analy road and were Guangdong eradi implemented. Yes. establish inam sta fetas and recommendation easm series the after A the safety of of to d lthaeh th th of am data? wi rep cles.i wi rep cles.i : (out veh veh of de nde Number ies ies tora spots progr tifi ect idents lit Number idents lit ghwayih letedp iden Inte coll outcome Yes. acc fata 10,000 Yes. acc fata 10,000 Output Indic Number black the safety com of by in is d n nts rate The. issue meu roadsa' worg as tose gh-iha in ing, and i,e network doctc hedcaer a. of lineced death toyel Chin rious Hub eas accidents ber proportio has fatality of lik if portant 41 Chin and involved in sea In the incr is oje imna num oft continuci ads ghwayih requencyf le have ns is ts Province,ie a.n te riesu inj thesah cles,i been serious uency ess pr fits? in ne isyt ro tyfe Chi los futureeth traff all The peop iden Hub in absolu and as, veh has more eqfr of er d be on d.e of proportio sad in safe alth velopmened as tionalan accc Roa the 1987 ineatr s. wheree estilia idents 10,000 high fat Justifie he Road the ector,s rapidly speed, develop numbers traffi serious Ye problem els while acc since per of suggesting with gnitudeam ele acc toev safetyeth safetyeth ecti alth obj he transport. transport. ove Improve Improve road road Explicit impr outcomes Yes. of Yes. of nt 0.3 n.a. Health com- pone (US$ million) it 400 250 Loan/ cred amount (US$ million) YF ay ay ,y and,tc Highw Highw oje approval Countr pr of China National 2/Hunan- Guangdong (P003654) 1997 China National 3-Hubei (P036949) 1998 taad sn to rep to all G206 from . . in in , eded ed of along stria l cle omrf 1998 2004 omrf as ce t The health idents illionm 1998 de Pe in in 698 ex halved in 2005 in s. bicy idents ined deaths ined to Collect on outcomes? Yes. number acc 100 vehicles Nationa Highway was (reduced 124 56 Ye and acc decl 6,498 2,948 and decl 897 waerehT estici ng)ay idents targe reduction acc three (Fushun, Anshan, Shen which the on the lks ts ? en esi ydemer the were seab ed . als, . of s the wa designs road on and studiese with ionat nda fety who exp sa was number le wasn in were siden tosya activit and Th work an s,r motorized constructed or whi stria (i) clists comp tion inytefas sign litya acepseth hiclesev an cations,loy inform rrie torized de stria roadw fic ecipsy althehroy traffic de What fica spots implemented.e municip improvements mental ands ffic were markings, bicy A mmittee were man d,esae mo pe, ple:ma approvedla the entiid acklb wer nned.apl spot ertteb he tra ban pet and In dthiw ast d.e co each ovements ad incr non- ally ex tha with off an nte road project. stria inde there ro to ific sever, impr ced safet audits ou for; Black ed tergovernin todele ascrci de signs Pe provid wasc sod shared for accid traff s. cated spec ngay street Were road implemented? worksites, of safety Yes. carri and polic on program follow-on Ye islands/medians Traffic were management establish However, shortcomings. available traffi allo nd,a reduced Shen for ngeahc were were to d lthaeh data? and hs.at spots). nde ect Reduced ies, lit deecl Inte coll outcome black No Yes. fata including pedestrian cybi by ks a nts yb s' re eb wor and . meu taken. nowear and orldw' doctc not Und.tear il will safety civ 42 isn China the blackspots) oje tio in has entdi hway issuese through identsccac pr fits? ac accidents acc hig of thes in ne te ad both affitr d be affic Tr problem measures rot of es alth proposed ys Justifie he appropria Yes. major most highes the component, addressed (improvement anal No toev the ansport.tr ciencyi ecti roadeth alth eff obj he of improve road ove To of Improve safety .mets Explicit impr outcomes Yes. safety Yes. operational and sy nt 3.1 n.a. Health com- pone (US$ million) it 200 150 Loan/ cred amount (US$ million) YF ,y and,tc Urban Provincial oje approval Countr pr of China Anhui Highway (P050036) 1999 China Liaoning Transport (P041890) 1999 taad is of isth not a and of atth to le t. ed but c, ise ce tab jec health not tion- Collect on outcomes? reduction 15%, was loca ecifips pro therefor eviden reduction attribu the on ; to y ts ? ofe d the and yte ofs to en esi inahC clesi fo saf nce junctions either flow nevE. ansi strianse e that in on veh on was activit concept torom no way fetaseth (issue lanes;a reew cles ped abse l and guide marked crossing and refug destrep comp for veig centereth waLy meant ed.it fic ecipsy althehroy old extr or focused Th.y centra program What rianst properly the an rianst dangerous m as also lim motorized foryitc ereht ed rovidep Safet for annelization which capa desep islands notdid edgeda en strianse vehirotom such MTy not fetase froe be ch design and tye atde cars desep roeth markedeth, creating nca an an Roadl safet way Anshan, ed,y addingyb in singa Fushun, for ped did equat ofs have in not lescy saf provid clists/ ad 2005),1y guidy Were road implemented? make (ii) junction emplo incre vehicles (iii) islands were protect bic where were crossings bicy between islands, conditions islands with an government Nationa Januar ccesus would to d lthaeh data? nde ect Inte coll outcome by nts meu doctc 43 oje pr fits? in ne d be alth Justifie he toev ecti alth obj he ove Explicit impr outcomes nt Health com- pone (US$ million) it Loan/ cred amount (US$ million) YF ,y and,tc oje approval Countr pr of taad ies lit ed llef in in4.8 Fata 19.9 to health 10,000 Collect on outcomes? Yes. per vehicles from 1995 2000. on ts ? of of Law e yc ador fic, In , a data ing en esi ad rds tye in on tionc made, issuing sides affic which ro nda Saf Tr of normativ for sta and trafefas and cludin activit routes both equ and responsible , cleshiev safetyci .taadyt comp were constru qualification for on Tr is tablis It securing of maintaining register safe fic ecipsy althehroy What provements drivers potss The major ad es sport qualification s,e ion adsor and on ad improved, im mark on on oth loped.e of for ers'iv ro ackbl cilitiesaf ible.sseccaeromy pment,i October technical emergen ethtadeh On affic Road basis traff the the hicleev gistrationer ing, ers' lations and statere gulations,er for driv regu ngi was Tran gistrationer ectp of dr has an safet icalsy 1997, dev and Roeth, licens ofy to hicleev color ate ofy insl ance lopinge and lit ph adwa vehicle eenb ica portingeR ident ro passed, affictr 1991 vehicle dev driving labi Were road implemented? The acc implemented. underpasses access the October, was road documents control, regulations, regulations, signs, vehicle marking have 25, Director Ministr Communications. for administering examinations of techn rveillus and vehicle base. conditions avai of to d lthaeh nte th nte data? cles.i for on cid wi cid veh ac on ac nde ect Number ies ties spots; spots. lit ted idents ted Inte coll outcome Yes. fata 10,000 Fatali trea black acc injured trea black by nts iatvaL with meu in vehicles doctc Europe, 44 oje pr fits? situationyte ints in ne saf d woreth 10,000rep ies be ad of ro littafa alth one 1995 Justifie he The is 19.9 in toev ad in ro ecti alth obj he ove Improve conditions a. Explicit impr outcomes Yes. safety Latvi nt 6.0 Health com- pone (US$ million) it 20 Loan/ cred amount (US$ million) YF ,y and,tc oje approval Countr pr of Latvia Highway (P008532) 1997 . taad clesi 6.6 road ined in eth eth, to 1999 ,069 ed of rep veh The ies 7.5 rcentep of ecld 51 For between and 66,586 to period health lit declined The 12 hes 2004. Collect on outcomes? Yes. number fata 10,000 has from (a drop) 1996 Yes. number cras from 1997 in same on of was and ts ? lice, eet sn r m, 00. made leb oadR en esi ci tionc eth higha eth en had ident for t fo , ation poci str sig .de is 20 tye le signs reew spots rum on of (c) activit that cc(a out. road delay aration were road of ngi and elev traff safetyci ad ildren Saf lev May ackbl and constru ciden ationc fetyas curriculu in traffeth but road of National comp ac for traff ro ch prep (b) edu road were Road high for out, ments of tivesia of fic ecipsy althehroy out esye What and portions program in tworken dentsci carriede plannd an in informyte ngi oft for gs, oject A broad ngi edi ent inity treatment en ts ac wer an of saf cludingin school pr and nationaleth (a) ons;tia ca ad train rdsa hoolcseth heldsaw leted);pmoce of at with carr ev(s of an designe ent ildren ad markin for improve safet loc adoption safet Th rola stem,ys en: ion ncee spots) hm ch rola lopmene in aken.t trainl stand ed dev road expandedeth under eciaps was tablis velopmedeth for wer (d) Road tiona inat Were road implemented? Yes. improvements nation incid black Coordination es reporting school nation campaigns, and design infrastructure, and Education includ but envisioned not Conference representation participation No police significant in markings network. Yes. undertak hazardous elim contracts install strips; es to d lthaeh data? iti tal nde Fa ect 10,000 Inte coll outcome Yes. per vehicles No by . d nts in la in in an meu iont ation 57,911 e causes ing; poor doctc situa ty oje terninybr fatalities wer population) accidents some fatalities maine l; 45 ,000 Th. eedps: pr fits? safed 094,1 10 ador 359,6 injuries ntse alcoho poo of of 1996 in ne roa d be isai ithw per gh;ihyrev with in ccida is serious The (2.9 ic number alth s. traff Justifie he Ye Lithuan standards, 1991 The Poland accidents 71,419 recorded of consumption and toev of ad in the the ro ecti the tiona sit alth situation; on management, nda with obj he Improve ove Improve conditions a.i tye tyfe (a) saf advise administr sad Explicit impr outcomes Yes. safety Lithuan Yes. road (b) operation, and roa coordination nt 5.0 12.7 Health com- pone (US$ million) it 19 300 Loan/ cred amount (US$ million) YF ,y and,tc 2 oje approval Countr pr of Lithuania Highway (P008551) 1997 landoP Roads (P008593) 1998 taad . e Th ed in for in clesi to in ed of ies fromdesa road tese 5,712 or l.a wer of rep of 538,5 to veh ies The ies 1997 2003. jurediny declin 7,451 to health lit targets lit hes fromdesa apprais lit in in Collect on outcomes? number fata decre 7,310 No reduction fata cras at Yes. number fata 10,000 decre 9.2 5.8 number seriousl people from 1997 2003. on and ts ? lra d an of alsi evi e tc.e, ai entm en esi )e( la eth lopede adoR rse Regional dev tye al , was process the ect skills, obil ions med spots ehTt. on and activit Nationeth Gene ads Private A equip s mater saf to jec of eff work. ofy ehold esci andytefasc the (NRSC), comp ande Rola signaling wa regions ad help ciatos fetyas were black with 2001; spots. m project ro ainingtr councils, reom Globa autom agen safety 2002-03 affitr fic ecipsy althehroy (GRSP) staky various 38 proeth What in tweeneb uncil Co licopci DKiA). eight The ole tye ofessional keat ke ntale roadg er ided underg Nation hedsil in saf ies,nap ofra ghuo of (GDs acklb training Progra wh would personnel pr sponsored to road Ministreth tab rship ad in es with com assreulah yeare ye und Th thr prove ate fety ro their rtne ad the campaigns ted rivind an safet Program Safety traffla the regulara which safety further Sad emthe 2000 In port Pa schools.eth wer rolt road ership itteem Governm ro, implementin ared in eatr Were road implemented? Safety coordination Road nation Director Motorway companies some Roa implemented (voivodships). comprehensive covering stemys tyfe con establish of regional improve enabl lead Yes. Trans Sa Com from insurance clubs for measures. decl education conducted and were police to to d lthaeh data? nde ect Inte coll outcome No by n the ehte nts nts,e alsr uctio meu ear acklb of of ces veah The. level longa ncis growing reve servi is constr doctc atth accident accidci motorization roads; low ent; the 46 oje poor; accidents cars surrounding without cem dicalem 1989/90 000, in trenda problems of trafffo 50,1 thw pr fits? of Polish iers); omfr keam poles and traffic in ne hostile time anges gro to d be ainingtr alth peytemos on barr enfor ees, and (tr walc ad ch of number and, cted rescue Ro riouesae cal lt. exceeding expe Justifie he drivers' of numerous spots road protective traffi period until arrive. Yes. becom politi annual now rapidly is difficu of toev affictr fitness t. ecti alth obj he the Police. ove Improve and eefleclhi Explicit impr outcomes National Yes. safety veeht nt 24.1 Health com- pone (US$ million) it 150 Loan/ cred amount (US$ million) YF ,y and,tc 2 oje approval Countr pr of Romania Roads (P039250) 1997 taad to . ts in et per public (by 1995, iden an ts clesi 1999 ed of The lylan aredp oft 318,2 targ 2000) In of duceer veh in ciden health idents ined in porteder rgi com targe Collect on outcomes? Yes. number acc involving transport decl ma 4% the 20% (Note: taltoa accc . The traffi were Dakar tropolitem to ac area) No. was the 10,000 10%yb 3% and l on s; ica not ts ? ofn s r of en esi had ided six in was pollution driver enes veah on prov, Mino the to wasytefaS Techn arters of activit Vehicles and ind bus awary comp plan area. construction tiveo offices fic ecipsy althehroy What hol. ns. implementatiod 6,000t fetas campaigns. deame Road intersections litan of the headqu because alcofo technical tio ssisteatc an action Autom thobt abou road wer ce and for A)T aket proje to ted media Offi d,e bu, an safet ce inspec safety ntse (CC erational The dangerous metropo op under s. eacr The ntereC Were road implemented? influen to control Ye development roada training and through adjustm most Dakar No. establish the Control completed been of to d lthaeh data? bystn r,a rep cles.i transport Dak . veh nde ect Reduction deic in et Number Inte coll outcome Yes. acni sub-urbaneth idents public in areas Thies Kaolack Yes. acc 10,000 by tye nts saf c life toe meu ad ro affitr an doctc in of hum damag 47 oje pr fits? stoceth ofsm and ter in ne in d be Improvements duceer alth idents productivity, Justifie he No Yes. will acc and vehicles. toev and the e in sport Dakar ad ecti alth mor ro reliable tran .aera obj he ssista of the an in ove To public Improve s. Explicit impr outcomes Ye provision affordable, safer services tropolitem .tyfe Yes. sa nt .an. 1.0 Health com- pone (US$ million) it 7 50 Loan/ cred amount (US$ million) YF port ,y and,tc ansport Tr Technical ecn ans (P002875) gal Tr oje approval ne Countr pr of Se Urban Reform Assista (P044383) 1997 Togo Road Project 1998 taad on of and ngi are The to ed er.ft evidence for tye no ICR taaD for (for1 idd saf atth of ed l and Highway ) that per of c eth health Collect on outcomes? eareht No provided The ect rstif idents decrease wast No. was the strengthen capacity road No. notes coll sections Nationa Highway the second Rehabilitation ojectsrP tear howeds acc not the number vehicles increased. However, ecifips numbers provided. targe reduce h on to ad ts ? taad suc tye edi ro ld) was en esi saf (o and ertaken. nts of on and did und me and carr nocleR of activit TA optionsez road nor comp safety signs were the been age component fic ecipsy althehroy crossing What aints. port improve not road ings analy and place, the vill tye . constry trans veah tyfe of toy at the saf on sad mark DNV taket stud an safet Roa The nodid a. works with1 road s. placement Bolsal The implemented Were road implemented? budgetar training collection Ye as pavements out. modernize pilot safety Route de No. not to d lthaeh to and data? ? 2,500: and atth osurc ction ntse nde ator roads vementap ect (outcome of gnsis Mer rds. Redu ies. nda accid lit Inte coll outcome No indicators) Output indic km have markings road meet sta Yes. in fata by of ,r mix nts meu andst nte clei doubled ctorsfa signed veh accid havioeb broad doctc have er 48 accidenci The poor the high oje nam d.el the propriate drivef ads. ro pr fits? in ne traff, Viet trip for inap segments, on d in unsa, importantly be 1990 juriesin road include alth most vehicles Justifie he No Since fatalities and responsible rate some condition but of out toev road ingy program. ad ro ecti alth obj he ngthene gementa carreth fetyas .tye ove Str man saf roada Improve Explicit impr outcomes Yes. sector through of Yes. traffic nt 5.3 1.0 Health com- pone (US$ million) it 65 196 Loan/ cred amount (US$ million) YF ,y and,tc II Highway oje approval uguay Countr pr of Ur Transport (P049267) 1999 Vietnam Second Rehabilitation (P004842) 1997 taad and 2005, ed of yb s from per vessels to in ies cline.ed health idents lit Accidents project 2000 Collect on outcomes? number acc fata 20%. Yes. on waterway dropped 0.0034 hundred in 0.0023 32%a No No No on of 1 de d ts ? t y ities and of en esi 66 tyiC omfr (anaC )mk section ptheda lattice to 30m. plann t. tha safet road ate eth on and ou roasah activ sector. staff RA),E( activit installation 72t. maine Minh ide of Nam work itiin poles, Th (40iaR to the suc d.e the the and, to 26 prov improvements ect comp or ou Chi Tien feedera atth of tceojrpeht tiona information for fic ecipsy althehroy improve What edir 266,sy Ha Gia oards. Ho to Mau and to widenedd ofht carried tes not es byn works allt pots"s tot nte develop HIV/AIDS proje weres Authority ultants car buo Ca an no km) were do tyfe ins ou Th bilitationa signb was froms to Hao wida peyteth also ned it strategy ads cons Luong on lack accid group an 830 sad Ro safet 498 626 edged ICRe "b et Reh works ce ion,at was Lach of Ganh dr and Th Kien 3m keatrednuer Roa carried An. unplan added. targ s. Were road implemented? Yes. navaids towers, masts, waterway to Cho total from were of Yes. safety However, eviden we Ye signaliz barriers were safety stemys Yes, were HIV/AIDS The Ethiopia contractors, per to d lthaeh data? rep per of km; km. nde Annual ect idents vessels. Injuries ties Inte coll outcome Yes. number acc 100 No Yes. vehicle Fatali vehicle No by nts ednilc te ,st goods meu des sharp night day will of ha doctc adequain and ted and cos thus, barge and 49 oje tyfeas en ing toeud make fore tion vingap ntse avaids),n( project obstacles. lem litai the the ccida users, pr fits? imp consumers of ad in ne d be rwayet ars aids ye herto navaids treacherous unsaf re ad.oryb rehab and, eratpoecli ro and Wa and .sy ande we veh alth s. centre at The imtl th Justifie he Ye in navigation bends Inadequate navigation navigation convo Yes. resurfacing components reduce trave benefiting producers transported No. No toev safetyeth ngiy inamowt routesya Mekong MinhihC mponents co ecti alth obj he ncea carrc the the Ho ove Enh affitr ofyitc health waterw with . with Explicit impr outcomes Yes. and capa inland connecting Delta City but No No No es nt n.a. Health com- pone (US$ million) objectiv n.a. n.a. n.a. thl it hea 73 65 75 309 Loan/ cred amount (US$ million) s YF expliciton ay ,y and,tc with e Waterway il tatS na Highw Support Sector oje approval public Countr pr of Vietnam Inland (P004843) 1998 Projects Braz Goias Highway Management (P055954) 2002 Dominic Re National (P035722) 1997 Ethiopia Road Development Program (P000755) 1998 taad eth 39 on 9 . roads ts in omrf to road toe from ed while ad cos 47%yb tea atthe idents The ies 1999 an­ edi dueb acc ed. health lit project ined in project . 2003 18 Collect on outcomes? Yes. fata six decl 52 in one increased to Ro.oN ident areyerehtar outcome on ect acc dropped ove period interm outcom could fewer No data HIV/AIDS coll on ts ? tly th t the ese ced S vesi RA) in safety and iving gh oject lort en esi dr Th nig to yif ec neeringi eth iat eth (N port US$1.3 lane cani redu ytfeas de.am were on project throu ackbl and con to activit projeth not of ildings roads eng road preth road of The. ident economic anstr Bu of and, and ngi signif iving. inityt dr during of HIV/AID entions ed and comp at MAP conducted km PAD) eenbe safety under and tion ntse safe ent Authority fic ecipsy althehroy improved safety and ghiha What es ia undingf activities and ad as which ad the andye interv significantly Strengthen ped ica em havt ad DSI opi ghtin pestyre mmission, information ads ro in tif ccida helpdect en unitim (RBD) 004,1 rriersabh ro collisions oth Co with adoR. improvement Ro Eth initial safety Ro all such cras studs,e the Safety lle during have . (not rvuse veloed iden timely road co enforc HIV/A an ented. to public ironm safet coml The road The on and ead-onh Road es Safety sea and ize cs entions turner tion icalsy ed env National ect Were road implemented? loca sites. provided illion.m Yes, PAD. Department audits implemented measures rking,am idents iviti plem linesab led of ph reflectiv improved comfort measures the driving acc Yes. act im Road the datab has spots inimm statisti interv rate through educa and road The coll to d lthaeh data? nde ect Inte coll outcome No No by nts meu doctc 50 oje pr fits? in ne d be alth Justifie he No No toev ecti alth obj he ove Explicit impr outcomes No No nt n.a. a.n. Health com- pone (US$ million) it 350 30 Loan/ cred amount (US$ million) YF and ,y and,tc Pradesh ghway ncea oje approval Hieta wi Countr pr of India Andhra St (P009995) 1997 Mala Road Rehabilitation Mainten (P001666) 1999 taad on ed nor,tye health neither saf HIV/AIDS Collect on outcomes? No No, road on outcomes. on t be e t as ts ? finale nca is.s was reew fo idors en esi iny and and on a senior Th edt yc stud activit ldeh was for create to poli HIV/AIDS nderetfo toear . ilopa fo Plan such, corr velopmened and intenam was analy theni(de ture tye tionac risketh comp sector. HIV/AIDS. for fu levels Action actions accidents workers. edu fic ecipsy althehroy ty campaigns, and part What the program reduce port workshop in incorporay and held w ojectsrp term supported ghih ad transport er neweth joram training,o safci lic were Clauses for improvement afftr Safe itialin ro unplannnA on safety ation, to an istics,atst eirth neareth along trans po gend, fors noera in in Als. on and safet es funded projecte tye withse ed cts Road up road ented ted Th saf base inform iviti zon A idents among Were road implemented? rela sensitization management transport poverty Workshops awarenes guidelines. act documents partner includ contra Yes. road key acc provided Yes. drawn dataa plem several implemented. PAD) communication im HIV/AIDS and to d lthaeh data? nde ect Inte coll outcome No No by ad ity nts rot easier eth meu tions activ affic.tr cani doctc provisioneth are: better loca ing cle from allow and 51 signif assets. oje be toeud to in vend bicy stsi tea pected mponent safety pr fits? will its in ne torom ex co road roadside separ road of d be ere Th nefeb shoulders to fitse for high Ben ansporttr alth wider ess also Justifie he Yes. safety of acc with and Yes. road improved protection toev ecti alth obj he ove Explicit impr outcomes No No nt 0.3 0.12 Health com- pone (US$ million) it 47 28 Loan/ cred amount (US$ million) YF e ,y and,tc II oje approval Countr pr of Nicaragua Transport (P053705) 1998 Niger Transport Infrastructur Rehabilitation (P035608) 1998 taad snt . the per ed and the of was ed project road tayb (2005) deci to 1998 muche 7,000 number eas than from 750. 1998 than et By health acd arey seda from in of of wer the estilia incr in much targ fat ar idents 20%t met. Collect on outcomes? Yes. closing roa per incre 9,588 8,200 and higher target Also of ye to1,046 870 were higher target The reducing acc leas not No on , ts ? ed due the ofy a eirht ns. e en esi on finedede traffic, iledp to fot eedps, an accepted wer procur ytefas ency Road als ticipation and, emth that activit Roada vehicle com ad the conditio Ag wer safety was effectedt lopede Council safety par cludingin ent of comp of A.y was no Support. ro, teriam dev fic ecipsy althehroy procuremen es the What ent fetyaS tionsc roadr motord fetas icl cies, forcem Borrowere Safety considers suggestt fo entm affictr provements fun an kits.dai ad Plan reew veh en en Th orgianeG no im lishm and Equip and roe capacity ag tion publicity and but, for of Road rstif included consultants involving does an safet Estab nca Acy actions nte and tion responsible enh its lacka trolapc The differ ecommendationsr ICR proposed Were road implemented? Yes. Transport (RTSA) as management, licensing. to Safet but to National (NRSC) traffi education, traps, No. comprehensive program of educa coordination. the consultants theoretical The the . to d lthaeh snt data? cing deci 20%t nde ect Redu acd easl Inte coll outcome Yes. roa atyb No by eth in is n nda nts th to in and dtene s is ain will Th meu bo cludein ct policing tce m desig tion costs ired ta;ad ii)( iii)( indir ction ath;ed ad doctc cause 52 costs i)(: imple road safetyci eth costs; redu remyetafs or.t between sec ro ituasy oje ntse as and parts); traff improvements ficf road ofk dination rganizations.o to ingyd fetas available pr fits? intangible chus of ontia nte v)i(;y andy not jurin reew of the ad on in ne accid tra, lac, ts ite in adequatein coor stuyb ro d be and Tangible.y hicleseveth to nistri eatmtr jurin toe du sts.oce sp ars of Road cost that adm of nc based In yet em eedps ling alth Justifie he Yes. tangible econom direc damage (replacement and dicalem tsn to lack sponsibleer costs output insura Yes. recen probla sought due markings, and the Improvements be prevai trends mponeoc toev alth he ecti alth d obj he anne ove pl Explicit impr outcomes No with No es nt n.a. Health com- pone (US$ million) objectiv n.a. thl it hea 70 40 Loan/ cred amount (US$ million) YF expliciton ,y and,tc Support with aib Sector ai (P040556) oje approval m Countr pr of Za Road Investment Program (P003236) 1998 Projects Georg Roads 2000 taad ed health Collect on outcomes? No on to ts ? . ed eht en esi eb on component, could prov, toe ousi du var activit ent comp implemented improvement, easily and ies. fic ecipsy althehroy What blackspotst not pots sical"y expect "ph irlyaf plem iers ilitb im was barr acciden Blackst ely would tot responsi an safet The pura one icul onali of diff Were road implemented? implemented. No. component Acciden was which implemented be institut lines to d lthaeh data? : of nde ect catorsid ident ted. Inte coll outcome No. Output in Number acc blackspots trea by nts ficaftr d , and a and meu and road an,e are road Georgia. improved doctc sisab monitor hing to for developingd unitiesm users 53 from drainag . oje legal improve blisat ram otsp pr fits? means in ne the and d be es;ytefasc an; come oadr prog nefiteb planting, licy po tye to acksbl saf Roadsid alth ident Justifie he proposing engineering coordinate traffi safety road Yes. non-motorized expected shoulders, acc toev ecti alth obj he ove Reportsn Explicit impr outcomes No tiolep nt 4.2 el Health com- pone (US$ million) Comn ailab tatio it 200 Avt Loan/ cred amount (US$ million) No = emenlp YF a..n Im: te: ,y and,tc urce sia No So ne Indonesia oje approval Countr pr of Indo East. Regional Transport (P040578) 2002 54