The prevention of – and first response to – injuries in Nepal: a review of policies and legislation

Abstract

Background Injuries, the cause of an estimated 4.5 million deaths annually and many more disabilities worldwide each year, are the predictable outcome of particular circumstances. One of the most effective ways to prevent injuries is through policy and legislation. The aim of this research study was to identify and critically review all policy and legislation in Nepal that had the potential to prevent injuries. Methods We identified legislation and policy that met inclusion criteria through a stakeholder meeting, networks and contacts, and websites and electronic resources. Each included document was critically reviewed to identify areas of strength and opportunities for improvement. We compared the included documents against WHO’s recommendations of known effective interventions. Results Sixty-two documents met the inclusion criteria for this review. Of these, 24 (38.7%) were exclusively related to road injuries, 11 (17.7%) to occupational injuries, 6 (9.7%) to injuries in the home and 5 (8.1%) to injuries at school; 30 (48.4%) documents included text related to the first response to injuries. Of 127 strategic recommendations by WHO that provided an area for policy or legislative focus, 21 (16.5%) were considered adequately met by Nepali policy and legislation, 43 (33.9%) were considered partially met and 63 (49.6%) were not met. Conclusion We drew five conclusions from this critical policy review, which we have related to recommendations as follows: widening the scope of legislation and policy for injury prevention to emphasize injuries occurring at home or school; addressing the causes of injuries and promoting proven preventive measures; greater clarity on both individual and institutional roles and responsibilities; trustworthy data and quality evidence to inform decision-making; and financial investment and capacity-strengthening for injury prevention and first response. The current system of federal governance in Nepal has potential for strengthening injury prevention and first response at the central, provincial and local levels.

Identifying research priorities for road safety in Nepal: a Delphi study

“…In Nepal, a policy review identified that institutional arrangements and resource allocation for road safety were inadequate. 13 The lack of coordination of road safety sectors is a challenge globally 24 25 as well as in Nepal. Many of the participants in this study had the opportunity to meet and discuss road safety with those working in other sectors, for the first time.…”

“…However, the institutional structures necessary to implement these laws are still in development. 13 The research questions prioritised in this study emphasise the need for evidence to support both national development plans 8 and safer roads and transport in Nepal. 38 Existing road safety policies are mostly only partially implemented.…”

“…38 Existing road safety policies are mostly only partially implemented. 13 Policy gaps include policies to separate traffic and road users and those to address speed management.…”

Experience of living near a highway in Nepal: Community perceptions of road dangers in Makwanpur district

“…Local authorities failing to invest in road infrastructure and safety was another concern of our participants. This is there despite there being 21 legal documents and 14 policy documents relating to road traffic injuries or their prevention in Nepal as identified by a recent policy and legislation review study ( Pant et al, 2021 ). The National Transport Policy 2001, Nepal Road Safety Action Plan 2013–2020, and the current 20-year Master Plan for Strategic Road Networks (2002–2022) all include road crash reduction recommendations, but just like most of the policy documents, they include little consideration of the allocation of resources, leadership or robust monitoring and evaluation resulting in all these strategic approaches remaining on paper without implementation ( Pant et al, 2021 ).…”

“…This is there despite there being 21 legal documents and 14 policy documents relating to road traffic injuries or their prevention in Nepal as identified by a recent policy and legislation review study ( Pant et al, 2021 ). The National Transport Policy 2001, Nepal Road Safety Action Plan 2013–2020, and the current 20-year Master Plan for Strategic Road Networks (2002–2022) all include road crash reduction recommendations, but just like most of the policy documents, they include little consideration of the allocation of resources, leadership or robust monitoring and evaluation resulting in all these strategic approaches remaining on paper without implementation ( Pant et al, 2021 ). In low- and middle-income countries, it can be anticipated that with limited resources and lack of political will, issues such as road expansion and building safety infrastructure are not addressed quickly ( Kayani et al, 2012 ).…”