The Trouble with Developing Countries?
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India.
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Introduction.
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The original article 'The Trouble with Developing Countries' was written in response to a number of e-mails from Organisations in Developing Countries about their problems.  The main article covers general problems relevant to many of these counties and these sub-articles are concerned with the more specific problems we have been asked about.  A sample of their e-mails are include at the beginning which are an abridged version of their comments and/or questions followed by our reply.  [See... Global Road Safety Report: pdf.]
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Abridged E-mail.
If I can use one word to describe your article on "The Trouble with Developing Countries?" it would be 'wonderful'.  Really a tremendous labour, efforts and time would have gone into producing this excellent report.  I wish people who matter get to see it and act on it.
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I can visualise and relate each point, that you have brought up, to ground realities in my own country [India.]  I just have one point to mention out of my own experience.  On most occasions it is not the paucity of funds but the lack of will that hampers safety on roads.
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I would just like to recount one issue and would be thankful to receive your comments.
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The Indian Motor Vehicles Act of 1988 legislated by the federal Indian government makes it mandatory for the driver as well as rider of a two-wheeler [scooter, mopeds, motorcycles] to wear a helmet.  However, the actual implementation of the act was left to the discretion of the individual state governments [India is a federal union of 29 states.]
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Till date [i.e. even after 15 years of the passage of the bill by the parliament of India] less than 50percent of the states have implemented the rule.  Every time there is an attempt by a state government to implement the rule there is a hue and cry raised by the public at large and the decision is deferred.
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This is in spite of the fact that we lead the world with maximum number of fatalities in road crashes [over 85000 in 2002.]  The majority of the victims in crashes involving 2-wheelers die due to head injuries, which can be averted to a large extent by use of helmets.
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The maximum percentage of the fatalities in these crashes are from the age group 19-40, which is the most productive age group in any society.
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A substantial portion of our health budget every year goes into providing trauma care and emergency services to these unfortunate victims of these road crashes.  A developing economy like ours can ill-afford it.  Much more funds would be available for primary and preventive health care if even 50% of these accidents could be prevented.
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The reason the leaders in the government give to non-implementation is that their political fortunes would be marred in the polls.
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There are pressure groups of neurosurgeons, NGOs, Consumer activists and professional bodies like ours but their efforts do not make any impact.
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How would you solve this problem?  It does not require money but only sheer will.
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This is only one of the many similar issues that we encounter in India where money is not the problem but political will.  We would be really thankful if you could let us have your views on the same.
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Regards, Anoop Khanna, Assistant Manager [PR] I.P.A. India Organisation.
www.ipaindia.org 
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Reply.
There are many different factors to be taken into consideration and as we don't know how your system works it is very difficult for us to comment in specific terms, so we shall just make a few general observations.
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You are absolutely right, the biggest single problem that almost any country faces is overcoming Political apathy.  I guess you have to deal with the reality of the situation... that in a democracy Politicians don't always base decisions on their merits but on their political implications and don't want to pass laws that will make them unpopular.  [More on this later.]
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You also have an additional problem if the people who use bikes don't want to wear the helmets, but why is that?  Is it a 'image' thing? [doesn't look good,] is it a cost thing? [buying a helmet is expensive,] is it because they are to hot?  We have experience of travelling in quite a few developing countries and the one thing we've noticed is: not only do they not where crash helmets but, you could see anything up to five people on one single bike, [usually a combination of adults and children,] which looks incredibly dangerous.  Are there laws about this? are they enforced? would a bike owner need to buy 3,4,5, helmets?  Would it deny them a cheap mode of transport for the whole family?  
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So, basically, you have two problems, Politicians and the 'End Users'.  You need to identify in detail why people are resisting the implementation of this law, [there might be quite a few different reasons,] and then develop a strategy to tackle each point of resistance, for example...
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Politicians.  You say that less than fifty percent of States have implemented this law.  That means that nearly fifty percent have implemented the law.  I would imagine that all States would face similar problems and opposition in trying to implement the law, so... why have some succeeded? what problems did they encounter? how did they overcome the opposition? what strategies did they adopt?
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Next, we think you need to do a little bit of research, [if it hasn't been done already.]  For those States that have implemented the laws, how did this affect... the numbers killed? numbers injured? the health service? what was the total saving to the State?  You can then project these figures for your own State.  Once you have come up with a credible set of figures, you then have a 'club' to beat your Politicians with.  One way or another the cost of these accidents has to be paid by the people who live in that State/Country, either through insurance premiums: through higher taxes: or by poorer services. 
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Now, when Politicians say they have not passed the law because it would make them unpopular, you can confront them with the 'price of their popularity'.  Is your popularity worth 500 lives? [a year, every year] is it worth 5000 people being seriously injured?  If you confront them with these types of question it is unlikely they will say "yes, it is worth it".  And in a similar way, you can say to 'taxpayers', 'this Government is costing every household $xxxx per annum': valuable resources unnecessarily wasted.  Point out that, 'This is a Government that is far more interested in holding on to power than improving the lives of the voters', etc. etc. 
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If you can get existing Politicians to support you, great! but, if you can't persuade them in private to support you, let them know you will be passing the information on to opposition Politicians, and the sort of tactics to expect in the future.  [You'd probably want to get some expert advice before developing a Political strategy like this: in some countries antagonising Politicians can be bad for your health!]  If decisions are made on a basis of popularity, then you have to make them unpopular! make life uncomfortable for them!
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People are always happy to vote for 'lower taxes' and 'better services', and the only way that you can achieve both of these is through a more efficient use of resources: and the easiest way to do that, is by not squander the resources you already have.  So, don't emphasise the specific 'law' you want passed, just emphasise the amount of resources that they have been wasting.  Convince them that this is a problem that is not going to 'go away', it will stay with them until they deal with the problem.
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'End Users'.  Some important issues: is Insurance for bikes compulsory in your country? if not who pays for the damage done to property and people? if someone is taken to hospital, who pays the medical bills? the State? the individual? insurance of some kind?  Someone, somewhere always has to pay the bill for these things!  Looking at your website - you obviously have a very strong representation of high ranking Insurance people on your Board, so what pressure can you bring to bare through the Insurance industry?  For instance: on Insurance forms, do they ask the question, 'do you wear a crash helmet'? if the answer is, 'No' does this mean that cover is refused? or premiums are 2, 3 times higher? [with the proviso, that if you answer 'Yes', pay the lower premium, and then have a accident while not wearing a helmet, the insurance is invalidated.]
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In western countries people often see this as an issue of 'freedom of choice', they do not want the 'nanny' State telling them what to do, but as soon as they have an accident they expect the 'nanny' State to come along and pick up the pieces, which may involve looking after them for the rest of their lives.  If the State has to pick up the bill, then the State has a right to tell you to, 'take reasonable precautions'.
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How does this work in your country?  If a man, [say, with children,] had a serious head injury and could no longer work, who would look after him? his immediate family? his extended family? his village/community? the State? an insurance company.  Whatever happens, a heavy burden falls on someone!  Can you use this line of argument against those who say they don't want to where a helmet?  Ask them, 1.Why not?  2.'If you have a serious accident who will look after you'?  3.'Do you think it is o.k. to become such a terrible burden on your family/community/country just so you can look good? save a few rupees'? or whatever the excuse!  So, perhaps you should emphasise this point, 'anyone who does not wear a helmet is selfish, putting their own small pleasure in front of their responsibility to their family/community/country'. 
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Can the Insurance industry put direct pressure on the manufacturers of bikes.  Basically, say to them that when they sell a bike, they must sell them with 2 crash helmets included in the price.  Otherwise, they will set the insurance premiums for their bikes 20, 30%?? higher, which would mean their bikes become less competitive on cost.
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If the helmet has an 'image problem' then you need to work on that, promote them, make them more stylish, riders should want to own a really nice helmet, just as much as they want other consumer goods.
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We think this is the basic approach you need to take.  But, as you rightly observe, you need 'will power' and if that doesn't come from Politicians, then it has to come from somewhere else.  We are sorry we can't be more specific, but as we say...  Identify the problems and then explore various ways of counter-acting them.  Without doubt it would be far better if you could get the 'law' passed, otherwise it's going to be a long uphill struggle.  [See blinkx Video for more Information and News stories on this subject.]
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Sept 2006.  A road safety manual for decision-makers and practitioners focusing on the issue of helmets has been published this week and launched in Bangkok, Thailand. The manual has been produced by WHO under the auspices of the UN road safety collaboration, in collaboration with the Global Road Safety Partnership, the FIA Foundation for the Automobile and Society, and the World Bank, as one of a series of documents that aim to provide practical advice on implementing the recommendations of the World Report. To download a copy of the manual see grsroadsafety.org or WHO International.
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