The RTrT Partnership: Reducing Traffic-related TraumA - A community-based prevention and first-response programme intervention for Malawi and beyond.

Injuries resulting from road traffic collisions are a major and growing cause of preventable death in sub-Saharan Africa. Road traffic collisions in low and middle income African countries account for approximately 169,000 deaths and about 6 million healthy years of life lost due to disabilities people are left with. Road traffic collisions also impact on people's ability to work and on community wellbeing. As working aged men are three times more likely than women to be involved in a road traffic collision low and middle income countries lose up to 3% of their earning potential. As a result improving outcomes from road traffic collisions will contribute to the delivery of four of the United National Sustainable Development Goals: no poverty; health and well-being; sustaining cities and communities and partnership working.

Malawi has one of the highest rates of road traffic related death, lowest rates of vehicle ownership, and lowest income levels per person in the world. Consequently the Malawian Government have identified road traffic related trauma as a major barrier to improving the health and finances of the nation. However it faces considerable challenges in making improvements. Malawi has no formal prehospital care system, no universal emergency telephone number, and almost no ambulance service. Care of injured people is haphazard and often provided by passers-by who have very little or no training in basic first aid. As a result people who have survivable injuries often die. This has led to doctors from the largest Malawian hospitals recently publishing a Call to Action that highlighted the need to improve trauma care. All of trauma care would benefit from further research and development. However the Call to Action says that research to improve pre-hospital trauma care should be a specific priority. So pre-hospital trauma care is the Partnership's specific focus. This proposal was developed following a 9 day study visit to Malawi by Dr's Duncan and Uny in September 2017, at the invitation of Dr's Chokotho and Mulwafu. During this visit local challenges of road traffic related trauma were discussed with a wide range of different organisations, academics and community members. There was a broad consensus that the first step should be the development of community based programme intervention that is made up of different, but linked, interventions to prevent and respond to collisions. Tackling prevention and response together is likely to lead to bigger improvements in communities than dealing with either separately.

Our Road Traffic Related Trauma (RTrT) Partnership brings together experts in applied health science, public health, global health, arts and humanities, pre-hospital and emergency healthcare delivery, community engagement, and local community members. We will use a variety of methods from the different disciplines we represent. These are likely to include creative ways of gathering, sharing and discussing different people's views and ideas on the challenge of road collision, including the use of visual methods and theatre to engage and communicate within the research team, wider stakeholders and the public. Working in Malawi and at a distance between meetings we will develop an intervention to improve community prevention and first-response within local communities highly affected by road traffic collisions. Towards the end of the project we will will look at ways our work can be transferred to other sub-Saharan countries. We will then apply for funding to implement and test our interventions.

We will share our work locally, nationally and internationally. We will ensure that our findings are shared with with academics, Government policy makers, organisations involved in road traffic and trauma care, and local community members. Where appropriate these outputs will be developed with local residents and translated into key local languages.

In the long-term our interdisciplinary Partnership will deliver innovative inter-sectoral solutions to the problem of road traffic related trauma (RTrT) in Malawi and across sub-Saharan Africa. These solutions are likely to lead to:- 1) improved health outcomes, as people who are involved in RTrT will be more likely to receive timely lifesaving interventions; 2) safer communities, through a reduction in the frequency of road traffic collisions; 3) improved economic productivity, by reducing the number of people unable to work due to trauma resulting from a road traffic collision which usually affect the economically productive age group; and 4) less resources used in the hospitals due to reduction in the burden of RTrT. Within the period of this project there will be academic, civil, policy, and public impacts.

Academically our Partnership will result in an increased focus on generating solutions to the problem of RTrT in Malawi and across sub-Saharan Africa. This will be achieved through a series of Labs and working groups that will take an interdisciplinary and inter-sectoral approach to developing a community-based programme intervention to prevent and respond to RTrT. The increased focus on RTrT in Malawi will lead to members of the Partnership considering potential future projects to improve other aspects of the Malawian trauma care pathway, and the applicability of our interventions across other sub-Saharan African countries. Our academic outputs will raise the profile and importance of addressing RTrT in Malawi and across sub-Saharan Africa.

Malawian civil society will directly benefit from the our exchange of knowledge, as several key services (e.g. Malawian Road Traffic Police, Malawian Red Cross, Malawi Fire Service, Malawian Road Traffic Authority) will be brought together to participate in Partnership activities. The study visit of co-applicants ED & IU to Malawi in September 2017, combined with the existing relationships that co-applicants LC & WM have with these key civil society services ensures their engagement and active participation in our Partnership. During the Partnership these organisations will learn about the challenges of preventing or responding to RTrT from the differing perspectives of each other's organisations and learn about arts and applied healthcare approaches to improving outcomes. It is anticipated that this innovate inter-sectoral approach to RTrT will result in the identification of quick wins that do not require further evaluation and can be implemented without delay.

The Partnership will impact on policy through the development of briefings that will be co-produced and shared with the Malawian Ministry of Health, The World Bank, The World Health Organisation and others. These briefings will provide clear summaries of the findings and recommendations of the Partnership in order to inform these key decision making bodies about the importance, challenges and potential solutions to the problem of RTrT, to stimulate discussion, and to encourage further action to be taken.

There will be a series of impacts on members of the Malawian public. These include:- increased awareness of the challenges; potential solutions; quick wins that each person can do to prevent collisions; guidance on how best to respond if they do happen; and key prevention and response messages to share with their family and friends. These impacts will be achieved through members of the public becoming involved in the activities of the Partnership as well as through attending a two day creative and interactive exhibition to communicate the work of the Partnership. We are aware that attendance at the exhibition will only be feasible for individuals living the Southern region of Malawi. We will therefore communicate the same messages through local and national media.