7 MEDICAL EMERGENCY AND TRAFFIC ACCIDENT ...open_jicareport.jica.go.jp/pdf/11948668_03.pdfThe Study on National Road Traffic Safety Master Plan in the Socialist Republic of Vietnam

The Study on National Road Traffic Safety Master Plan in the Socialist Republic of Vietnam until 2020

Final Report

7 MEDICAL EMERGENCY AND TRAFFIC ACCIDENT VICTIM SUPPORT DEVELOPMENT STRATEGY

7.1 Planning Approach and Priority Issues

The planning approach and priority issues for the medical emergency sector are in coordination with the forecasted traffic accident capabilities by year 2020 as well as to address requirements on medical emergency of the health sector through the undertaking of goals and priority activities in accordance with the capabilities of the country.

1) Forecast to 2020

(i) Forecast 1: By year 2020, motorization in Vietnam will reach 35.62 million, with 2.62 million vehicles and 33 million motorcycles.1

(ii) Forecast 2: By year 2020, motorization in Vietnam will be 52.6 million.

With the continuing increase in rate of motorization, the country, particularly the health sector, is more and more faced with the challenge of reducing the number of traffic accidents as well as the number of fatalities.

2) Pre-hospital Care

(i) First aid and Information system:

(1) Delay in transfer of emergency information thus missing the “golden time” in trauma emergency.

(2) Provision of first aid on site is relatively low, mostly provided by the people in the communes.

(ii) Transportation system

Many of the traffic accident victims were transferred to hospitals through use of vehicles such as taxi or even by xe-om (motorcycle taxi) due to lack of ambulances. The World Health Organization (WHO) recommends that 15 ambulances is necessary per 1 million population. This means that Hanoi, which has at present 10 units of ambulances, should have 60 units of ambulances for its 4 million population. Ho Chi Minh City should have 120 units of ambulances for its 8 million population but has only 10 units of ambulances at present and Hue should have 20 units of ambulances instead of only 2 ambulances at present.

3) Hospital Care

(i) As Vietnam experiences continuing economic development, the health sector is expected to have more investments in its health facilities; hospitals in the central, provincial and district levels will be upgraded in terms of specialized facilities and equipment similar to other countries in Asia and will then have capability to provide much needed emergency services for traffic accident victims, especially during

1 Source: http://vietnamnet.vn/kinhte/thitruong/2005/10/502269/ based on information from the Ministry of

Transportation and development of the vehicle/motorcycle industry 2006-2015 and vision to 2020. Workshop 22 Jan 2008 - Hanoi

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Volume 2, Part I: National Road Traffic Safety Master Plan 2020 Chapter 7

mass casualty accidents (resulting in about 20 victims for district hospital and 50 victims for provincial hospitals).

(ii) The health sector also forecast that private hospital system will develop not only in the urban areas but also in the districts which are also developing economically. These private hospitals will be equipped with modern facilities and highly skilled health workers who can give appropriate and efficient emergency services to the traffic accident victims.

4) Training of Health Care Personnel

(i) The provincial and district hospitals have very enormous requirements in terms of human resources. Many hospitals do not have emergency specialist doctors; most of these hospitals rely on general practitioners who are sent to attend training courses in the central hospitals. There is therefore a lack doctors who have specialization, or has secondary or masteral degree, in emergency services.

(ii) Most of the present medical schools in Vietnam only offer general medicine and lacks specialization courses and training. Thus, during the first 5-10 years, doctors who are general practitioners still need to be trained or acquire specialization on emergency services through actual experience in the 115 centers, provincial or district hospitals.

5) Role of Community

(i) Data collected in the surveyed provinces show that nearly 70% of victims received first aid from the community while over 15% received first aid from health workers and 15% from others.

(ii) Given above data, it is therefore necessary to develop guidelines and provide training on first aid techniques such as (1) techniques to stop bleeding; (2) bandaging of different body parts (e.g. head, hand, feet, chest, etc.); (3) proper techniques in handling broken bones to avoid shock and injuries in blood vessels, nervous system; (4) proper transferring of victims, particularly for victims who sustained injuries in vertebral column; and (5) resuscitation of the victim (i.e. CPR). While these five basic emergency techniques are being applied in the medical sector of northern part of Vietnam since before 1972, it is therefore necessary now to make these techniques responsive to the need of traffic accident victims.

6) Disaster and Mass Casualty Accidents

(i) Traffic accidents involving passenger cars are continuously increasing such as the car collision with a train in ThuaThien Hue and passenger car accidents which occurred recently in Quang Tri, Nghe An, Khanh Hoa, Dac Lak, Binh Dinh which result in many victims being treated in hospitals. The triage area, ICU and operation wards can accommodate 20 victims at present. However, if the number of victims goes over 50, then it becomes difficult for the hospitals due to lack of manpower and medical equipment.

(ii) In general, the hospital system in Vietnam still has a very weak Mass Casualty Management (MCM) awareness and capability. Based on observations, the hospitals are still lacking in capabilities in the following: (1) search and rescue

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Final Report

operations; (2) triage services; (3) information guideline to manage flow of victims in hospitals; (4) information management particularly in assigning a spokesperson responsible in issuing official statements to the public so medical staff can concentrate on providing necessary first aid and medical treatment to the victims; and (5) hospital security.

7.2 Goal and Strategy

1) Overall Goal

To reduce by 50% the number of traffic accident fatalities in hospitals compared with 2007 data (i.e. lower fatality rate to 0.68/100,000 population from 1.36/100,000 population in 2007).

2) Specific Goals

(i) Upgrade Capacity (and Quality of Trauma Care) in Hospitals

All provincial hospitals must be upgraded both in manpower resources and medical equipment to have the capacity for treating severely injured TA victims. Provincial hospitals should be able to function as a “Trauma Center” of respective provinces.

District hospitals must also be strengthened to have the capacity to provide accurate evaluation and perform initial treatments to severely injured patients before they are transferred to provincial hospitals, if still necessary.

(ii) Improve Pre-hospital Care

(1) Setting up Emergency Medical Information System

Emergency medical information system will be established utilizing GPS and GIS by 2020, together with the expansion of communication infrastructure such as the mobile phone networks or receiving stations.

(2) Establish 115 Ambulance Transportation System

Nationwide 115 ambulance transportation systems will be established by 2020 covering more than 90% of the whole population. More than 80% of TA victims are expected to be transported to the hospitals within one hour.

(iii) Establish Training System on Trauma Care

All doctors of provincial and district hospitals taking care of trauma patients, as well as all 115 physicians must undergo training on trauma care.

All emergency medical system personnel, school children and people in the community must receive adequate information on first-aid.

Guidelines and training curricula must be prepared according to various levels of trainees and learners.

A training center must be established in 3 areas: north, central and south, to provide full-scale training.

(iv) Prepare for Mass Casualty Accident

Hospitals must be prepared for mass casualty accident by strengthening capacity

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in manpower, medical equipment, facility/space, drugs, etc. Provincial hospitals and district hospitals should have capacity to receive at least 50 victims and 20 victims, respectively.

(v) Improve Rehabilitation System

Rehabilitation must be started as soon as patent’s condition is stabilized. Various levels of rehabilitation facilities will be established in the province and the community.

(vi) Establish Reporting System

Establishing data reporting and recording system (Trauma Registry) is important to ensure accurate data on TA victims which are necessary for the Government to formulate policies on road traffic safety master plan as well as for academic organizations to share experiences with other countries.

7.3 Strategies for Medical Emergency Development Program

1) Development of Pre-hospital Care

(i) Strengthening Emergency Information System

(1) Timing is often the key in determining the quality of emergency care that can be provided, as well as the traffic accident victim’s chance of full functional recovery after treatment. And during emergency cases, it is said that the first hour is the most crucial.

(2) Information on how to provide first aid treatment and how to properly transfer the traffic accident victim in the nearest hospital is therefore very important. In addition, an effective information system is also key to successful development of pre-hospital care. The telephone system nowadays is relatively developed and widely available in most places nationwide. However, due to existing policy, the present reporting system does not easily allow the community to provide timely information to health facilities when traffic accident occurred. In order to make it more convenient for communities to report a traffic accident and request assistance from the hospitals, the health sector has the following recommendations:

• Consistent policy nationwide on a single, toll-free telephone code system for emergency (115). Once a call is placed, the system will automatically link the call to the nearest hospital (district hospitals), regardless of administrative boundary.

• Setting up a public telephone box along the national roads with proper guidelines and information to the community. These phone boxes will only have control button link with the police station and 115 system (or emergency units of nearest hospital). Information dissemination on the proper handling and use of this equipment to ensure a well maintained system for a long time.

• People’s committee of the provincial/district level have issued requests to the police and health sectors to ensure immediate rescue activities right

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Final Report

after information is received. An example is the railway accident in Lang Co - Hue in 2005 where all emergency systems of the two provinces of Danang and Thua Thien - Hue participated very actively upon receiving information about the accident.

• The Government needs to consider investing on GPS (Global Positioning System) to identify location of vehicles involved in traffic accidents and to be able to immediately deploy rescue and emergency operations.

• Application of modern information system in the command post of the 115 emergency system in big cities like Hanoi, Danang, Ho Chi Minh City, and Can Tho and utilization of the digital communication map in the central emergency command post such as those found in the cities of Bangkok, Singapore, Shanghai.

(ii) First Aid and Transportation

(1) Based on collected data, only 30.16% of traffic accident victims received first aid onsite. Most of the victims didn’t receive first aid and where transferred immediately to the hospitals. These situations however either increased the risk of fatality or more serious side effects for the victims. Therefore, first aid onsite is very important. It is necessary to apply the "4 ready in the field" principle which is command, manpower, facilities, and logistics in the application of medical emergency for traffic accident victims.

(2) It is a fact that only 37.55% of traffic accident victims were transferred to the hospital by ambulances; the rest were transported by other types of vehicles which were not properly equipped for a medical emergency, thus those victims didn’t receive first aid right after the accident occurred (while being transferred to hospitals). As already mentioned, this increases the risk of either fatality or more serious side effects for the victims. The following are therefore proposed: • District hospitals, especially those located in areas with high traffic accident

incidences need to have at least 2 ambulances which are not only properly equipped but also properly staffed with highly skilled medical emergency team which is very mobile and ready to rescue and provide emergency treatment to traffic accident victims.

• The health and medical facilities should have an effective plan to collaborate with the military stationed in the remote areas in providing rescue and first aid operations to the victims when a traffic accident occurs in their area. In case of mass casualty accident, there is a need to establish a “field combat hospital” which can provide first aid and treatment to the victims before gradually transferring them to the hospitals.

• Railway emergency medical stations which can provide first aid treatment in cases of accidents should be established especially along railway lines and stations which are far from residential and health facilities.

(3) Strengthening emergency capacity for health worker at the grassroot level: • Since health workers at the grassroot level make the first contact with the

traffic accident victims, they must be highly-skilled in providing first aid

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techniques such as tourniquet (to stop bleeding), bandaging, splinting broken bones, resuscitation or CPR, and transferring victim to the hospitals.

• Health workers must also be trained how to prepare the emergency equipment, medicines or drugs and how to swiftly mobilize the team for immediate deployment to traffic accident sites.

• This can be enhanced by regular drills or exercises of traffic accident situations in the area in order to effectively carry out a swift emergency response when traffic accident does occur.

• In addition, grassroot level health facilities should also establish close coordination mechanism with health facilities in the district and provincial levels to ensure assistance especially during mass casualty traffic accidents which result to overcapacity at the grassroot level health facilities and also when medical expertise is required for serious cases

(iii) Development of 115 System

(1) At present, the 115 emergency system in Vietnam is responsible for all medical emergencies caused by diseases, injuries and accidents, traffic accidents included. The rate however of traffic accident victims which have been transferred from accident sites to the hospitals were only around 10-15% of total. Many of these victims were in fact transferred to the hospitals through other transport facilities such as taxis and motorcycles, which, unfortunately, led to high likelihood of side effects or complications since first aid treatment was not available during the time of transfer of victim.

(2) Ministry of Health issued Decision No 01/2008/QD-BYT dated 21 January 2008 which promulgated the regulation on health emergency, active recuperation and poisoning control which prescribes the following for out-patient hospital emergency system (115 emergency system) as follows:

• Establishment of out-patient hospital emergency services (115 emergency canters) at provinces/cities level which shall be a unit belonging to the provincial health service. Provinces which have not yet set up 115 emergency centers will assign a 115 emergency mobile team from the provincial hospital. As well as in district hospitals, an out-patient hospital emergency mobile team (namely 115 emergency team) shall be assigned

• These 115 emergency centers must have fully-equipped ambulances (WHO recommends 15 ambulances per one million population), adequate space for treatment and work area, parking space to keep ambulances, information system, medical equipment, and highly skilled manpower which should be standard in the whole country.

• Other localities (township, small cities and districts) can provide emergency services outside of the hospitals and emergency centers, particularly for traffic accident victims. These facilities should also never refuse anyone seeking medical treatment. Hospitals must have a 24/7 personnel on duty manning the 115 emergency hotline and dispatch emergency services whenever information is received.

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• At major intersections on major national roads, railway stations, etc., ambulances will be on close standby or should closely coordinate with district hospitals to immediately respond in transferring traffic accident victims.

• To further enhance a unified emergency information system throughout the country so that information will flow directly to the nearest hospital and will not be passed around the switchboard of the local area. In addition, the use of mobile phones to report traffic accident information will be allowed. This will allow communities to immediately report traffic accident and thus request for emergency assistance for traffic accident victims.

(3) Social mobilization of private sector and community for 115 emergency services:

• In order to ease burden of government particularly in terms of state budgetary requirements, the Party and the Government’s social mobilization policy to involve the private sector in the provision of health and emergency services as well as to improve capacity of people in the community in dealing with emergency situations will enable the Government to re-allocate limited resources to other health care issues particularly for the poor and to develop high-tech centers.

• Based on experience in Nghe An, Quang Ninh and other localities, the quality of emergency transfers have improved due to appropriate fees collected for such premium service. This has in fact provided better chances also of survival and recovery for the traffic accident victims.

• Properly accredited private sectors involved in the provision of 115 emergency transport service under the management of the Ministry of Health provide better and quality service compared with illegally operating groups which do not have properly equipped vehicles and manpower which can increase chances of recovery, if not survival, of the traffic accident victims.

• Address the issue of the very high incidence of traffic accident victims (60%) being transported by non-medical transport faciltiies.

(4) Financial management of 115 emergency system:

• To implement a regulation wherein collection by 115 system from user fees will allocate 30% of collected fees to pay for staff directly involved in providing the emergency service (such as operator receiving information, first aid health worker, driver, etc.). This will in effect reduce the discrepancy of remuneration received by hospital and 115 system staff.

• To apply standard fees collected by the 115 system whihc should be equivalent to cost of transport by taxi plus related health service fees available in the localities. If the local goverment has a free of charge policy for emergency services (like Danang), the people's commitee will pay to the 115 emergency center.

• In the case of emergency service for traffic accident victims, priority is the

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provision of first aid followed by transfer of victim(s) to the hospital. In this case, fees will not be initially required. And if the traffic accident victim does not have a relative who can be responsible for the payment of fee, the insurance company or people's committee (local government) will pay to the 115 centre just like in Japan or Danang City.

(5) Encourage favorable policies for health workers in 115 emergency system:

• It is a fact that the 115 emergency system is constrained in attracting highly skilled staff, particularly specialist doctors, due to several reasons: significant discrepancy in pay and allowances as compared with those of the hospitals, very few chances to receive training to upgrade skill, and long work hours which includes weekends, holidays such as lunar festival (Tet).

• To standardize skills/level of specialization of manpower working at the 115 emergency centers such as staff must have completed specialized training on emergency; head of emergency wards at the provincial hospitals should have primary degree specializing in emergency.

• Link 115 system activities with the hospitals such as the case in Trung Vuong Emergency Hospital in Ho Chi Minh City. Doctors and nurses of 115 emergency centers who are off duty can participate in medical treatments in the hospitals and receive professional fees like a regular staff of the hospital. This model, which can be applied to the district 115 emergency mobile team, can provide a very good training ground to as well as augment earning capacity of the 115 medical staff.

• Medical staff of the 115 emergency centers are entitled to attend the post-graduate training courses on medical emergency. If this proves to be difficulty, they should attend the preliminary course specializing on emergency in order to have upgraded skills on emergency comparable to medical staff in the hospitals.

2) Training Health Workers for Emergency System

The manpower of the 115 system in general has very low level of skills in medical emergency. Most of the health workers employed by the 115 emergency systems do not have background on how to provide emergency services during a traffic accident such as rescue of victims and common first aid techniques on site. Thus, training on medical emergency should concentrate on the following items.

(i) Needs Identification

(1) To conduct study on actual situation of health emergency of the 115 system and emergency wards in the provincial/district hospitals. The estimated requirement of the whole emergency system is around 5,000 emergency doctors. At present, there are about 3,000 doctors all over the country who graduated from medical universities but are unemployed. Despite urgent requirement in the remote areas for doctors, they wouldn’t want to work there. The Government, through the Ministry of Health, can encourage these doctors to attend special training courses on medical emergency and become

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Final Report

"emergency doctors" who will work in the 115 emergency system or ICU of the provincial or district hospitals.

(2) Evaluation of training capacity in the medical colleges in the whole country; both lecturers and emergency equipment should be periodically updated with international standards to ensure that graduates of these medical colleges are adequately skilled to function well in a real hospital setting and will be capable of using modern equipment of the hospitals.

(3) Hospitals and 115 emergency centers can enter into contract agreements with medical training institutions in upgrading the knowledge and skills on emergency of their medical staff/health workers through conduct of short-term training courses paid for by the hospitals and the 115 emergency centers. In the same manner, the 115 emergency system must also be able to accommodate newly graduated students of these training institutions.

(ii) Standardization of Training Curriculum

(1) It is necessary to have adequate time to prepare a training curriculum for emergency which is approved by the MOET. If curriculum can be completed and approved within this year (2008), then training may commence for 2009-2010 training cycle. Otherwise, it should wait until 2010.

(2) While waiting for the completion of the official emergency training curriculum, the present training curriculum for existing staff of the 115 emergency units and emergency wards of the provincial/district hospitals must immediately be updated in time for the 2008-2009 training cycle.

(iii) Formulation of Emergency Training Centers in 3 Areas of the Country

(1) According to the regulation on health emergency, the 115 emergency centers are responsible for providing training on emergency techniques to the health emergency staff and members of the community in the provinces/cities.

(2) Organize three emergency training centers, one each from and affiliated with a medical university in Hanoi (for Northern provinces), Hue or Danang (for central coastal area) and Ho Chi Minh city or Can Tho (for southern provinces). These centers will be responsible for providing training in the post-graduate and masteral programs of medical emergency.

(3) For the period 2008-2010, prepare and implement a plan of cooperation with central level hospitals like Viet Duc or Cho Ray to provide special training to doctors who are general practitioners in the provincial hospitals to become emergency doctors.

(4) Development of training materials for refresher courses of provincial lecturers who will provide lectures to participants of short courses such as health workers in the district level or members of the community

(iv) Design, Printing and Dissemination of Training Curriculums

(1) Preparation of an overall plan on training and re-training on medical emergency for health workers in the whole country until the year 2020.

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(2) Design of training curriculums for different types of training such as official training, re-training, 1st or 2nd degree training, masteral or doctoral degree in medical emergency. These training curriculums shall be submitted to the MOET for approval.

(3) Preparation and printing of special documents, protocol and handbook on the 5 key first aid techniques (bandaging, tourniquet, fixing of broken bone, resuscitation or CPR, and transferring of victim) and dissemination to the community.

(v) Educating the Community and School Children

(1) First aid education to the community

• The community is referred here as the general population residing near traffic accident areas who can participate in the rescue and provision of first aid to the victim(s) immediately after the traffic accident has occurred. Thus, their awareness and capacity on first aid techniques (e.g. applying bandage and tourniquet, proper handling of broken bones, proper transfer of victims to nearest health facilities, CPR, etc.) should be enhanced.

• Regular reminders for the community members through the mass media (radio, television, newspaper) on first aid techniques, proper rescue and importance of immediate provision of first aid to the victim(s).

• Health workers are the key persons who can serve as mentors for the community to understand simple emergency techniques; they can identify local materials available in the community which can be used in providing first aid.

• Periodic announcements on important numbers of the nearest health facilities or the number linked to the 115 system which should be called during a traffic accident.

• Guidelines for the local authority and related sectors like police, military, youth union on how they should respond during mass casualty accident in the area.

(2) First aid education for the school children

• Close collaboration with the education/training sector which provides emergency education to the schools in the area. Education sector integrates emergency training to the official curriculum of the school system and invites health workers to give lectures in the schools in the area.

3) Disaster and Mass Casualty Accident

By the year 2020, the entire country is forecasted to have almost 50 million of motorized vehicles, of which over 1 million are passenger vehicles. This therefore increases as well the risk of mass casualty accidents. The health sector and local authorities at all levels should therefore be more concerned on the issue of mass casualty accident. In the recent years, traffic accidents with over 10 victims have occurred in different road types and in several instances. Some of these accidents

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Final Report

even occurred in locations which are far from health facilities which made the requirement for first aid and immediate transfer to the hospitals very critical. To address these issues, the following measures are necessary:

(i) Strengthening Emergency Capacity of the Hospitals

(1) Emergency system of the provincial/cities hospitals must be upgraded and should be equipped with adequate emergency specialists and doctors, medical equipment such as monitors, electro-cardiograph, X-rays, respirators and other facilities such as patient beds which can receive at least 20 traffic accident victims all at the same time.

(2) Provide appropriate and adequate space to triage victims at the consultancy ward; spaces for first aid, preparatory room prior to transfer of victim to operation wards when necessary, and for recovery and recuperation.

(3) Provide more operation wards which are reserved for emergency operations to victims who need immediate surgeries. Request other hospitals (military, police, and central hospitals) located in the province/cities to provide support during emergency operation.

(4) Ambulances of the hospitals must be used as 115 ambulances. Provincial/city hospital ambulances must be encouraged to transfer victims to different hospitals located within the province/city area, including military and police hospitals.

(5) Supplement emergency drugs to meet the emergency requirement of mass casualty accident victims. Also develop plan on how to encourage manpower support for medical emergency team in the hospitals especially during the time when many of the victims arrive almost the same time.

(6) Increase capacity of district hospitals to be able to receive 5 to 20 victims of mass casualty accident to reduce congestion of victims in the provincial hospitals. When necessary, provincial/central hospital will send mobile team support to the district hospitals.

(ii) Satellite hospitals

(1) Hospitals in the provinces/cities located in the focus regions such as North west, North East, north central coastal, South central coastal, highland, South east and Western South will establish an emergency satellite system by upgrading both expertise and medical equipment of the provincial hospitals located in the area. In addition, a provincial hospital will be upgraded into a regional hospital which will be responsible in receiving traffic accident victims from other provincial hospitals in the area.

(2) The Ministry of Health shall closely collaborate with the Ministry of Transport in creating emergency centers in designated rest stations along national roads. It is proposed that distance between rest stations are 200-300 km, with each station having restaurants, shops, rest rooms, emergency centers, and pharmacy, among others. There emergency services shall be equipped with ambulances to provide first aid to passing passengers as well as to traffic accident victim(s) in the area before transferring to the hospitals.

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(3) It is necessary to designate a location for this emergency center within the rest station, which will be equipped with emergency staff and has budgetary allocation for medical equipment and ambulances. During normal circumstances, this emergency center can provide health services to the community living in the area. Budget for these emergency centers may also be sourced from expected collection of service fees of business operators in the rest stations. The Ministry of Health or the Provincial Health Services shall be responsible for training of medical/health staff as well as preparation of list of required medicines, drugs and medical equipment.

(4) A “bidding mechanism” among the private sector interests may be conducted to award private operators of the proposed rest stations. In addition, to further attract the private sector to invest in this undertaking, incentives may be provided such as tax exemptions and free lease of land for a limited period of time (5 to 10 years) until private operator starts earning profit.

(iii) Provide Appropriate First Aid Techniques or Post-mortem to Accident Victims

(1) Strengthening capacity of the provincial hospitals to receive and provide first aid treatment to the victims of mass casualty accident (with over 50 victims) with available resources. When necessary, support mobile team will be requested from central and regional hospitals in the region.

(2) Training for leader and key staff of the local government and the local health unit on proper handling process during an emergency especially when many victims are received in the hospital all at the same time (e.g. triage, first aid, hospital security, recording/reporting system, press releases to the mass media, logistic management, etc.).

(3) Morgue should have capacity of accommodating 10 to 20 dead bodies up to at least one week to be able to conduct appropriate forensic medical investigation particularly when DNA testing is required to identify the fatalities.

(4) Conduct of annual drills/exercises. Budgetary allocation for these activities should be included during planning. In high risk areas where mass casualty accidents frequently occur, leaders of the local government, police, military, and insurance agencies should participate in these drills and exercises to ensure inter-sectoral close collaboration when a mass casualty accident occurs.

(iv) Organization of a Disaster Medical Assistance Team (DMAT)

A DMAT in all central and regional hospitals staffed with specialists equipped with modern medical equipment and ready to support the provincial and district hospitals when mass casual accident occurs.

7.4 Organization and Resource Development

It is necessary to prepare a master plan on medical emergency to respond to the ever increasing impacts of traffic accidents which may be supported by JICA and other international agencies.

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1) Accident and Injury Prevention Project

Ongoing project supported by WHO which focused on 7 provinces may be replicated to any other provinces, if not nationwide. This project will continue to receive support from WHO and other international agencies (SIDA).

Estimated cost is US$800,000 for the period 2009-2012.

2) Strengthening Medical Emergency System Project

This includes 3 subcomponents with total budget of US$2,000,000 recommended for JICA support:

(i) Strengthening Pre-hospital Care in the Pilot National Roads

• Selection of 3 national roads which have high risk of traffic accidents such as NH5 (Hanoi – Haiphong); NH51 (HCMC – Vung Tau) and NH1 (Nha Trang – Phu Yen) and related provinces/cities as pilot area.

• Installation of emergency telephone box system along these national roads; medical emergency units along the national roads and located in designated rest stations; ambulances and medical equipments for emergency.

• Development of training materials on common first aid techniques and conduct of training to the communities and school children. Estimated cost for this component is US$700,000 for the period 2009-2012

Estimated cost for this component is US$700,000 for the period 2009-2012.

(ii) Strengthening Human Resources for Medical Emergency

• Conduct of training needs assessment study in order to have proper training curriculums for the training centers.

• Establishment of 3 training centers, one in each region of the country such as Hanoi, Ho Chi Minh City and Hue (or Danang).

• Design and distribution of training and information materials on medical emergency.

• Conduct of training for medical doctors working in the 115 system and ICU of the provincial and district hospitals.


(iii) Strengthening Capacities of Medical Emergency during Mass Casualty Accident

• Strengthening capacity of the provincial hospitals to provide first aid during mass casualty accidents to at least 50 victims with existing resources, and when necessary, request for mobile team support from central hospitals located in the region.

• Training for leaders and key staff on the effective process of providing emergency medical services in cases where many victims are brought to the hospitals at the same time such as triage, first aid, hospital security, recording/reporting system, press release to the public and mass media, logistic management.

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• In the high risk areas where mass casualty accidents frequently occur, conduct of drills and exercises with the participation of the leader of the local government, police, military, and insurance agencies to ensure intersectoral collaboration when mass casualty accident occurs


7.5 Implementation Strategies

1) Period 2008-2010 (Preparatory Phase)

This period shall be for the preparation of all necessary conditions to implement the proposed strategies of health emergency for traffic accident. Thus, all strategies which can directly reduce fatality rate of victims such as upgraded hospitals, emergency centers on sites of accident and the number of ambulances to transfer victims to the hospitals are not yet expected to be in place.

(i) Goals

(1) Maintaining the number of fatalities caused by traffic accidents similar to that of 2007 since if fatality rate will not be contained from 2008 to 2010, this will become a very heavy burden on the health sector which already had a difficult time dealing with the 2007 fatality rate.

(2) Establishment of the initial emergency including 115 emergency system in 20 focus provinces belonging to the central government and 8 selected regions.

(3) By year 2010, there would have been 10 hospitals upgraded both in terms of specialists and medical equipment including ambulances.

(4) Completion of overall plan on human resources training for medical emergency until the year 2020.

(ii) Activities

(1) Conduct of pre-hospital care in the pilot national roads and provinces such as NH5 (Hanoi - Haiphong); NH51 (HCMC - Vung Tau) and NH1 (Nha Trang - Phu Yen) where there are high risk of traffic accidents.

(2) Consolidation and development of existing 115 emergency system; re-establishment of 115 emergency system in the selected provinces in 8 regions (each region select one pilot province).

(3) Strengthening of selected regional hospitals in the 8 regions to have the capacity to receive mass casualty accident victims of 50 or more victims and provide support to all other provincial hospitals located in the region.

(4) Conduct of survey on demand for manpower resources to formulate an overall plan on the appropriate training program for health emergency until the year 2020.

(5) Design of training curriculum on training emergency for health workers until the year 2020 and submission to the MOET for approval. Preparation, printing and distribution of these training documents to the focus provinces. Close collaboration with the Ministry in awareness campaign on common first aid to the schoolchildren of the education system.

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(6) Implementation of social mobilization for 115 emergency system and hospitals; encouragement of local private sector and foreign investments to the 115 emergency system and emergency hospitals.

(7) Improvement of the emergency information system on traffic accident victims in the hospitals

2) Period 2011-2012 (Start of Implementation Phase)

(i) Goals

(1) Reduction by 10% of number of fatalities in hospitals (based on 2007 data) resulting from traffic accidents per 100,000 population.

(2) Establishment of initial emergency system (including 115 emergency system) in 50% of the provinces of the country.

(3) Upgrading of additional 20 hospitals in the central and provincial levels, both in specialists and medical equipment (including ambulances), thus total number of upgraded hospitals will be 30 by end of this period, equivalent to 45% of provincial hospitals in the whole country.

(4) Establishment of 3 training centers on health emergency in the 3 regions: North, Central coastal and South of Vietnam.

(ii) Activities

(1) Establishment of emergency system and emergency hospitals in all provinces of the country with budget coming from the state, private sector and foreign investments.

(2) Strengthening capacity of the district hospitals in the focus area; each province shall select 50% of district hospitals as pilot which have capacity to receive up to 20 traffic accident victims per day and will have support from the provincial hospital level when needed.

(3) Start of the official and continuing training on health emergency based on requirement of the localities. Conduct of training on first aid to health workers at grassroot levels wherein these health workers will be the key persons to provide training to the community.

(4) Conduct of information dissemination and awareness campaign activities to the communities on common first aid techniques for traffic accident victims. Close collaboration with MOET in carrying out education program on first aid techniques in the entire school system of the country of which health workers in the grassroot levels will serve as lecturers.

(5) Consolidation of statistics, recording and reporting system on traffic accident victims of the whole country wherein data on health system will be integrated with the national statistical system to effectively manage and monitor the traffic safety master plan.

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3) Period 2013-2015

(i) Goals

(1) Reduction by 30% fatality rate of traffic accident victims per 100,000 population in the hospitals.

(2) Establishment of the emergency system (including 15 system) in all provinces and cities in the whole country.

(3) Upgrading of an additional 20 more provincial hospitals both in terms of specialists and medical equipment (including ambulances), bringing the total number of upgraded hospitals to 50 (or 80% of total number of hospitals in the country).

(4) Operation of training centers which successfully produces emergency doctors for the 115 emergency system and ICU in hospitals.

(ii) Activities

(1) Monitoring of effective health emergency system in the sites of traffic accident with participation of the community, related branches, local governments.

(2) Conduct of pre-hospital care in the whole country ensuring that 60% of traffic accident victims have been provided appropriate first aid and transferred to the hospitals by ambulances.

(3) All provincial hospitals have been upgraded and have capacity to give first aid to mass casualty accident victims (over 50 victims).

(4) Complete establishment of high technology medical centers in each of the 8 economic regions of the country; these centers will also function as support for all the provincial hospitals.

(5) Strengthening support of local private and international hospitals to the public hospitals in providing emergency treatment to the traffic accident victims. By the end of this period, there shall be no discrimination in selection by the community between public and private hospitals.

(6) Training centers for health emergency have adapted the full requirement on human resources of the 115 and emergency hospitals in the whole country.

4) Period 2016-2020

(i) Goals (Target completion by year 2020)

(1) 100% of the provincial hospitals have been upgraded; staffed with adequately skilled human resources and has appropriate medical equipment to provide first aid and emergency treatment to victims of mass casualty accidents of at least 50 victims. District hospitals have capacity to provide first aid and emergency treatment to up to 20 victims of traffic accidents. Fatality rate of victims at hospitals is reduced by 50% based on 2007 data (< 0.5/100,000 population).

(2) Fully developed and functional emergency network that provides early response and emergency treatment to the victims; community members are

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more proactive in providing first aid treatment and transfer of victims to the hospitals.

(3) 115 health emergency system coverage in all areas of the provinces/cities based on close collaboration with the public, private, and military hospitals. All district hospitals have out-patient emergency team equipped with medical equipment and ambulances to provide first aid and transfer the victims to the hospital.

(4) Emergency training system integrated in all medical schools to upgrade skills of the health workers employed by the 115 system and hospitals, as well as training to the community.

(5) Institutionalization and implementation of a national insurance system to ensure coverage for 100% of traffic accident victims.

(ii) Activities

(1) Maintaining the sustainable development of hospitals to ensure its effectiveness in providing first aid to victims in any kind of traffic accident. Enhancement of the social mobilization policy for timely emergency medical assistance of local private and international hospitals to the victims of the traffic accident.

(2) Continuing development of the 115 emergency system staffed with skilled health workers and equipped with modern medical equipment to ensure that at least 80% of traffic accident victims receive initial first aid in a timely manner. Establishment of monitoring centers in the big cities to ensure timely emergency assistance to the traffic accident victims as well as victims of other disasters.

(3) Conduct of emergency training at 3 regional centers of the country and effectively deploy these trained human resources to the health facilities and communities to act as trainers at the grassroot levels.

(4) Development of various insurance schemes to ensure 100% of traffic accident victims receives proper support and coverage from the insurance companies

(5) Strengthening of the information, reporting and recording system in the whole country to ensure an accurate data of traffic accident victims which are necessary for the central government and concerned branches to formulate appropriate policies on traffic safety master plan and share experiences to other countries.

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Final Report

8 INSTITUTION AND RESOURCE DEVELOPMENT STRATEGIES

8.1 Planning Approach and Priority Issues

Road traffic safety improvement in Vietnam has only recently been seriously considered, thus many issues have not been responded yet. Therefore, in order to ensure the sustainability of the traffic safety policy and to continue effective and efficient countermeasures, it is necessary to develop (1) institutional infrastructure, (2) human resource and (3) financial resource. The proposed Traffic Safety Audit System in the engineering sector for example, has very acceptable objectives, feasibility in terms of effectiveness and is highly agreeable for introduction to Vietnam transport sector. However, institutional framework such as organization and details of implementation, as well as the legal requirements and environment, have not been prepared yet. Moreover, human resource is not readily available and additional cost and time will be required for the audit implementation. This holds true not only in the traffic safety audit system, but as well as for other proposed measures in the other sectors. This Chapter will focus on the institutional issues in the intersectoral areas so as to (1) enhance comprehensive traffic safety measures and (2) ensure sustainability of traffic safety policy development.

Three institutional development programs shall be discussed in the succeeding subsections with the respective program components:

(i) Administrative Enhancement Program

• Enhancement of National Traffic Safety Committee

• Provincial/City Traffic Safety Committee

• Traffic Safety Department/Unit in the Transport Department

• Legalization of NTSC and Traffic Safety Plan

(ii) Research and Development Program

• Traffic Safety Center Development

• Traffic Safety Database Development

(iii) Resources Development Program

• Traffic Safety Foundation Development

• Vehicle Tax System and Other Fund Sources

• Traffic Safety Human Resource Development

The Administrative Enhancement Program is aimed at improving the function and capacity for the sustainable and comprehensive traffic safety policy development. Lack of the organizational capacity in the field of traffic safety can be observed not only in the central government, but also in the local government levels. From another perspective, the local governments may be burdened with more critical issues and problems as an implementation agency. However, in order to implement appropriate and effective traffic safety policy across the country, at the very least, a core, capable

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organization in the central government level is necessary which has a legal personality that will be significant in successfully coordinating with all concerned organizations involved in the traffic safety, for both planning and implementation stages.

The Research and Development Program will provide technical backstop and support for sustainable traffic safety development. The proposed Traffic Safety Center will be responsible for the periodic review of the Master Plan and Action Program based on a scientific approach. The proposed database will be the basis for this scientific evaluation and will also be an indispensable tool particularly for the modern computerized countermeasures.

The Resource Development Program will include development measures for human and financial resources. Due to the current constraint in these resources, it is important to develop strategies of generating the much needed resources from other areas, such as the private sector and road users/traffic participants. International organizations such as donor organizations like JICA, WB and ADB are expected to play significant roles as well for resource development.

8.2 Administrative Enhancement Program

1) Ideal Core Organization for Traffic Safety Development

One of the objectives of the program is to enhance the responsibility and function of National Traffic Safety Committee for sustainable traffic safety development in Vietnam. And critical to the success of the comprehensive traffic safety measures is for a core agency to ensure that the 4C (Communication, Cooperation, Coordination, and Corroboration) among the agencies and organizations involved in any traffic safety projects and activities are present.

Figure 8.2.1 illustrates a desirable and ideal core organization in the central government which will be responsible in promoting comprehensive traffic safety measures. To achieve its traffic safety development policy, A Kindhearted Traffic Society with no Traffic Accident, it shall require five main functions, as follows: policy development, planning/R&D, preparation of fund and human resource, implementation and monitoring of the safety measures, and finally, coordination among the concerned ministries and agencies. Another important function is to provide linkages with other sectors, such as local government agencies and NGO/private sector organizations, as well as international donors.

Given the abovementioned functions of this core organization, it is more fitting that the NTSC play this role, with further enhancement of its role and functions, as well as its legalization which will be discussed more in the succeeding sections.

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In most of the motorized countries, a National Traffic Safety Committee or an organization that has a similar function is established as a central coordination body. In Japan, the Central Traffic Safety Committee was formed in 1970, supported by the Traffic Safety Policies Act. At the same time, under this central committee, a local traffic safety committee is also established in each prefecture government. The central committee is chaired by the Prime Minister while the local committee is chaired by the governor of prefecture.

The main function of the central committee is as a deliberative organization for the strategies, focus areas and guidelines for traffic safety measures, particularly of the Five-Year Action Program. But when serious traffic accident happens sometimes, the committee convenes and discusses the immediate actions. Strategies, focus areas and guidelines adopted by the central committee are instructed to the local government through the local traffic safety committee. The local government prepares detailed action program based on the instruction from the central government. As an implementation body for the actual planning work, the Traffic Safety Task Force has been established both in the central and local governments and the task forces prepare the plan and submit to the committees. Figure 8.2.2 shows the basic organizational structure in Japan for the enhancement of the comprehensive traffic safety development policy.

Figure 8.2.2 Basic Organizational Framework for the Comprehensive Traffic Safety Development Policy in Japan

Source: JICA Study Team While some other countries provide more significant functions to the local government, the coordination mechanism among the relevant sectors is almost similar. Another important lesson from the developed countries is that many organizations and institutions from the government sector, institutional and private sectors are involved in traffic safety development for different issues, at different levels, with different approaches, but as a whole, contributing to the improvement

Central Traffic Safety Committee (Chaired by Prime Minister)

(Traffic Safety Master Plan, etc)

Prefecture Traffic Safety Council (General Director of Prefectural Police

Department, etc) (Traffic Safety Campaign, etc)

Central Traffic Safety Task Force (Lead by a State Minister)

(Coordination and promotion for the actual traffic safety measure developments)

Prefectural Traffic Safety Committee

(Chaired by Governor) (Prefectural Traffic Safety Action Program,

etc)

Local Traffic Safety Committee (Chaired by Mayor)

(Local Traffic Safety Action Program, etc)

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of the traffic safety environment in the countries. Needless to say, such multiple systems have been developed gradually in a long period of time and with a lot of efforts from various sectors, groups and people.

In Vietnam, however, the institutional environment for traffic safety development is still relatively young and in the development stage. The number of organizations and their functions are still very limited. In this current context, the National Traffic Safety Committee and the local traffic safety committees are required to play more multi-functional roles as the leading organization for comprehensive traffic safety development, including actual implementation of the traffic safety measures.

The main proposal for the NTSC strengthening program is the establishment of a National Traffic Safety Authority which will be capable of developing policies and strategies as well as support implementation under the supervision of the committee. The unit will be formulated based on the current organizations including Executive Office and TSPMU, and will conceptually be divided into six departments as shown in Figure 8.2.3.

In the proposed organization, the General Affairs Department will play the same role as that of the current Executive Office while the Department of Project Management will have similar functions with the current TSPMU. The Department of Comprehensive Traffic Safety Development will be responsible for the policy development and planning and a special task for traffic safety culture development, in collaboration with another proposed traffic safety center. The Department of Local Traffic Safety will provide assistance to the local traffic safety committee and agencies for their action program preparation and implementation support. The Traffic Safety Foundation and NGO desk will provide necessary information for their activities and provide legal support. The Department of Human Resource will develop training programs in cooperation with the education institute for different groups of stakeholders involved in the traffic safety development, not only for central government agencies but also for local government agencies.

This proposal is still on the conceptual framework stage and it will require further examination as well as consensus building among the relevant agencies and organizations. In addition, in order for the new system to be functional as planned, establishment of other organizations will be indispensable such as the Traffic Safety Center and Traffic Safety Foundation, among others.

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Figure 8.2.3 Proposed Organizational Framework for National Traffic Safety Committee in Vietnam

NTSC

National Traffic Safety Authority (EO+TSPMU)

Provincial Traffic Safety Committee

District Traffic Safety Committee

Proposed Function for National Traffic Safety Authority

Department Section Functions • Office of Committee Organize NTSC meetings General Affairs • Administration Account, Personnel, others • Planning and

Development Traffic safety policy and strategies Development of comprehensive traffic safety

program Development of Master Plan and Action

Program Preparation of the yearly evaluation reports

(Traffic safety white paper)

Department of Comprehensive Traffic Safety Development

• Traffic Safety Culture Development

Most of the safety countermeasures will be implemented by the respective line ministries such as MOT, MOPS, MOET, and MOH. But Traffic Culture Development shall be managed by the National Traffic Safety Center in cooperation with local governments.

The Center shall develop a training and development program and instructors.

Implementation of programs will be promoted to NGOs, private entities and other community groups.

Department of Project Management

(setup for specific projects) • VRSP • JBIC

Administration, coordination among the concerned agencies

Procurement Monitoring and supervision

• Northern Region • Central Region

Department of Local Traffic Safety

• South Region

Provide guidance and advices to Provincial Traffic Safety Committees

Provide financial support • Traffic Safety

Foundation • Relation Development

(preparatory office for the foundation) After establishment

Coordination of the foundation activities • NGO Desk Promotion of the NGO traffic safety activities

Provide guidance and support

Traffic Safety Foundation and NGO Desk

• Publication Traffic Safety Information Traffic Safety White Paper, etc

Department of Human Resource Development

Coordinate with educational institutions such as Universities, Police Academy and MOT Training Schools and implement training programs for Traffic Police, Inspectors and engineers.

Trainers’ training

Source: JICA Study Team

(ii) Provincial/City Traffic Safety Committee

While the NTSC will be involved more or less in policy making, the local traffic

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safety committees will however be expected to play a more comprehensive role: from the preparation of safety measures to their implementation based on their respective local conditions.

In Japan, the local traffic safety committees chaired by each Governor are responsible for preparing their respective traffic safety action program based on the National Traffic Safety Plan. Traffic safety measures in the local traffic safety plan will be implemented mainly with local budget; however, measures prepared based on the national plan will be provided subsidy from national budget.

Although significant role is expected in the local traffic safety committees, capabilities and resources in most local governments are very limited. This situation is not only true for Vietnam but also in Japan. With the current situation in Vietnam as discussed in Volume 2 of this report, establishment of the traffic safety committee is deferred from province to province or cities and not much activities are reported mainly due to the lack of funding, except for major cities such as Hanoi, HCMC and Haiphong.

It will be expected that local traffic safety committee will be enhanced in each province and city and will undertake responsibility of the traffic safety development. The first task of the committee would be to prepare local traffic safety action program based on the National Plan, which will be the first mutual collaboration between central agency and local governments.

In the local government level, fund and human resources will still be the significant issues, except in major urban areas such as HCMC and Hanoi, so that the target and basic strategies for the local traffic safety development are proposed as follows:

Target of the Master Plan: “By the year 2015, all Provincial Traffic Safety Committee and major City Traffic Safety Committee will be enhanced and Local Traffic Safety Action Program (2015-2020) will be prepared and implemented.”

Proposed strategies for the enhancement of Local Traffic Safety Committee are:

(1) Coordination with NTSC; major urban municipal governments shall enhance their own Traffic Safety Committee. And based on orientation of National Traffic Safety Strategies, respective safety committees shall prepare their action programs.

(2) Provinces which had or may have the chance to be involved in WB-VRSP and JBIC Traffic Safety Project will be prioritized in the implementation of the traffic safety measures in line with those ODA projects.

(3) Starting from major urban areas (Hanoi and HCMC) and any provinces where fund and human resources are available, activities of the proposed local traffic safety committees shall be put on track. The number of the total traffic accidents in the major urban areas shared a large portion of the national total; therefore, significant reduction on the number of fatalities will be expected.

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3) Traffic Safety Department/Unit in the Department of Transport

In the previous section, function of National Traffic Safety Committee was discussed for the comprehensive traffic safety developments. Even so, fundamentals of the comprehensive measures are still very much dependent upon the sectoral measures such as engineering, enforcement and education countermeasures. However, there is no specific department or section at present in charge of traffic safety in the concerned agencies. MOT is now in the process of establishing a Traffic Safety Department followed by VRA. This department and section are expected to be fully operational as soon as possible.

Other sectors, such as MOPS and MOET should establish more effective and specialized organizational setup for the traffic safety development, as discussed in the preceding chapters of the respective sectors. In the urban areas, Hanoi and HCMC should strengthen their capacity of implementing traffic safety programs and measures by establishing specific units in the Department of Transport.

The National Traffic Safety Committee and line ministries should prepare a series of guidelines for the local government organizations. Due to the lack of financial and human resources, it is very important to prioritize resources development at the local levels. In the meantime, however, the central government agencies should support the activities in the rural areas. Another strategy is for the central agencies to improve their capacity enough to extend their function beyond the central activities but also to cover some rural activities as well.

4) Legalization of the Traffic Safety Development Plan

(i) Comprehensive Traffic Safety Development Plan

One of the main themes of this master plan is the development strategy on how to introduce and disseminate the importance of the comprehensive traffic safety program. Since traffic safety measures will be implemented from different sectors by different agencies and organizations, cooperation and collaboration mechanisms for this comprehensive program will be a critical issue. As already discussed, the first step to promote implementation of the comprehensive traffic safety program is to institutionalize the comprehensive approach, to define the responsibilities of the organizations as well as sharing of cost among concerned agencies.

This comprehensive program has basically two areas: one is for accident prevention and another is for post-accident measures. Comprehensive approach for the accident prevention will consist of the 3Es (Engineering, Enforcement and Education), although each measure will not always involve the 3Es (sometimes only requires 2Es or just one E, for example, education component for schools and communities). More important issue however is who should take responsibility in the development and dissemination of the comprehensive approaches.

Comprehensive program for post-accident measures will discuss the medical emergency issues and treatment of traffic accident victim including accident and life insurance coverage.

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Final Report

Comprehensive traffic safety programs have been implemented as part of the ongoing Project for Traffic Safety Human Resource Development in Hanoi (TRAHUD), a JICA technical cooperation program. Pilot projects were implemented with the Hanoi Police Department, Hanoi Department of Transport (HDOT) and Hanoi Traffic Safety Committee Education sub-committee assigned as core counterpart agencies in cooperation with the JICA Project team. The core members coordinate and collaborate with the local Peoples’ Committee, local police office and volunteers, as well as mass media groups for the successful implementation of the comprehensive projects. The pilot projects were widely disseminated in Hanoi and has enhanced the level of safety awareness and consciousness of the people.

In the case of TRAHUD comprehensive traffic safety pilot projects, all key players are under the same umbrella of the Hanoi Peoples’ Committee; however, inter-urban or inter-regional trunk highways such as that of the National Highways may include organizations belonging to different structures and accounts.

National Highway No.5, which is the first high standard highway in Vietnam, was bluntly referred to as “dead road” when it opened to the public because of the large number of serious traffic accidents that occurred within a short period of time. Since then, many traffic accidents have occurred on the newly upgraded highways, which earned people’s perception that “new highway kills more people”. In order to change this perception and address the situation, during planning for highway development, traffic safety assessment should be evaluated carefully and if adverse impact is expected, traffic safety measures including enforcement and education activities should be made an integral part of the project. This will come in the form of a Traffic Safety Audit which would be the same procedure as that of the Environmental Impact Assessment.

For safety on existing roads, the first issue is how to identify black spots or sections. The Traffic Safety Standing Group is established in Hanoi and is chaired by the HDOT. The members are coming from police and district office, maintenance companies, etc. Responsibility of this group is to identify the black spots, analyze causes of accidents and develop countermeasures. However, available information is very limited thus it is necessary to introduce a new system to gather more relevant information (such as opening of hotline, etc).

Another chance to promote the comprehensive traffic safety program is with the activities during the national traffic safety month in September. This is a good opportunity for all organizations to focus on the same issues and also a good chance to enhance public participation. Each province or city may organize their respective safety month or safety week addressed to the general population or to road users in particular, taking this opportunity to bring their attention to the specific traffic safety issues.

Based on the above discussion, the following strategies are proposed to promote the comprehensive traffic safety policy:

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(1) Traffic Safety Master Plan (Strategies) and its Action Program shall indicate need and necessity of the comprehensive traffic safety policy as a fundamental policy (can be one of the clauses of the Traffic Safety Policies Act or Road Traffic Law).

(2) Implementation mechanism (implementation order) shall be prepared including responsibility of organization involved, particularly role of Traffic Safety Committee.

(3) For new road construction projects (highways and expressways), Traffic Safety Audit or Traffic Safety Impact Assessment Law shall be introduced and if found to have adverse impact on traffic safety, appropriate measures shall be integrated as component of the road project.

(4) Liaison council shall be established for periodical communication and coordination, and in the identification of target projects. Traffic safety standing group and activities in Hanoi may be disseminated to other municipalities.

(5) Provincial or City Traffic Safety Committee should play a central function in the promotion and implementation of the comprehensive traffic safety program.

(ii) Traffic Safety Policies Act

An important issue of traffic safety policy development is not only how to effectively implement the measures in each sector, but also how to develop the comprehensive measures, ensure their sustainability, as well as develop a smooth and effective dissemination mechanism. Many government agencies from central to local levels shall be further involved into traffic safety development, thus, the functions and responsibilities among these agencies and organizations and mechanism of policy development should be clarified and finally legalized.

In Japan, the Traffic Safety Policies Act was established to ensure the sustainability of the policy developments. The Act includes establishment of the traffic safety committee in the central and local revels and their functions, as well as policy guidelines for the 5-Year Action Program. Based on the Act, Japan has implemented a series of action program since 1970, and at present, the Eighth Five-Year Plan is ongoing.

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Table 8.2.1 Traffic Safety Policies Act in Japan Chapter 1: General (Clause 1-13)

− Objective − Definition − Responsibility of National Government − Responsibility of Local Government − Responsibility of the administrators for road and other transport facilities − Responsibility of vehicle and transport fleet manufactures − Responsibility of the users − Responsibility of Drivers − Responsibility of pedestrians, inhabitant − Budget and mandatory reporting to national diet

Chapter 2: Traffic Safety Committee (Clause 14-21) − Central Traffic Safety Committee, organization − Local Traffic Safety Committee, organization − Cooperation among the relevant agencies − Coordination between central and local traffic safety committees

Chapter 3: Traffic Safety Plan (Clause 22-28) − Development and declaration of the National Safety Master Plan − Admonishment of Prime Minister − Preparation of local action programs based on the National Safety Master

Plan Chapter 4: Fundamental Policy (Clause 29-38) Section 1: National Government Policy (Clause 39)

− Development of traffic environment − Safety driving and operation − Safety vehicle and fleet − Traffic order − Emergency − Compensation for loss − Research and development and others

Section 2: Local Government Policy − Traffic safety measures implemented by local governments

Chapter 5: Miscellaneous Provisions Source: JICA Study Team

8.3 Research and Development Program

Innovation in the research and development sector will be significant to develop appropriate plans in line with the socio-economic development and traffic conditions in Vietnam. Rapid expansion of the motorization in Vietnam is inducing various social distortions causing serious traffic accidents. Taking as an analogy, “new road kills more people”, causes of the traffic accidents would be more complicated. Therefore, current situations should be analyzed carefully in order to develop more suitable safety development plans. Another issue is to introduce state-of-the-art technology from developed countries for more effective measures given the present conditions of lack of human resources. However, modern technology would also require advanced knowledge and operation/maintenance cost.

In addition, a traffic safety database will be indispensable not only for scientific analysis for policy development, but also as support for the proposed high technology for driver- and vehicle-management system, enforcement activities, among others.

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Thus, based on the two issues discussed, the following are being proposed under this research and development program.

1) Traffic Safety Center Development

In order to ensure efficiency and effectiveness of the traffic safety policies and measures, many issues should be examined closely. While sectoral issues will be handled by each respective sector, an organization solely responsible for intersectoral issues shall be a very indispensable element in the development of comprehensive traffic safety policies and measures, as well as for the sustainable traffic safety development. This is the rationale for the proposed Road Traffic Safety Center (name of the organization will be decided on by NTSC). This subsection will focus discussion only on the main framework of the proposed organization.

The desirable framework for the proposed traffic safety center is as follows:

(i) Mother Body: National Traffic Safety Committee

(ii) Functions:

• Examination and analysis of traffic safety policies

• Preparation of Master Plan and Action Program in cooperation with relevant organizations and agencies

• Development of a traffic safety database and its analysis including accident-violation data, traffic data, road inventory data, etc.

• Traffic Safety Audit

• Monitoring and Evaluation of the traffic safety measures

• Publication of Traffic Safety White Paper

• Research and development for new traffic safety measures

• Traffic safety human resource development

• Others

(iii) Source of Funding

National budget and other fund sources such as insurance, license renewal fees, etc.

2) Traffic Safety Database Development

Data on traffic accidents and traffic violations are invaluable not only to examine traffic safety countermeasures, but also to examine various policies related to socio-economic activities including governmental and provincial budget considerations.

The data on traffic accidents and traffic violations provide a clear picture of the drivers’ personal histories, information indicated as “Drivers’ Status” which is the same as that in the driver’s license.

Therefore, to effectively and efficiently implement traffic safety countermeasures from the “Drivers’ Status” perspective, such as drivers’ education and licensing control, a systematic and integrated management of the traffic accident and violation data

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Final Report

together with that of the driver’s license database is necessary and should be made available to all concerned agencies.

Similarly, the data on “Vehicles’ Status” is also important in the examination of traffic safety countermeasures in terms of “Vehicle Status”. Figure 8.3.1 illustrates the two kinds of database representing “Vehicles’ Status”, that is, vehicle registration database and vehicle inspection database. Needless to say, for traffic safety countermeasures such as vehicles’ re-inspection and vehicle control to be efficiently implemented, these data should also be integrated with each other and readily available to concerned agencies.

Figure 8.3.1 Database on Driver’s Status and Vehicles’ Status


Furthermore, data “drivers’ status” and “vehicles’ status” should also be integrated and easily available for cross-referencing to ensure more effective traffic enforcement. For example, when enforcing parking violations, traffic enforcer can easily determine and confirm ownership of illegally parked vehicle based on the vehicle’s plate number.

Therefore, these two sets of database, while managed and operated by a particular related agency, should be made available without restrictions to agencies concerned with implementing traffic and transport system management.

In addition, it would be ideal if data on traffic facilities including road and traffic safety facilities, (herein referred to as “Roads’ Status”) should also be integrated with “Drivers’ Status” and “Vehicles’ Status” databases and available as well to all concerned organizations. As already discussed, traffic safety countermeasures shall be developed based on systematic evaluation of the three elements of road traffic society which are Person (Drivers’ Status), Vehicle (Vehicles’ Status) and Traffic Environment (Roads’ Status).

As mentioned also in this report, the 3E perspective (i.e., engineering, education and enforcement) shall also be considered to obtain the maximum benefit of proposed countermeasures through implementation of balanced countermeasures from all these perspectives.

Figure 8.3.2 shows the conceptual framework of comprehensive traffic safety database. In this figure, the comprehensive overall database consists essentially of the data representing “Drivers Status”, “Vehicles Status” and “Roads Status”. In particular, the

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database is consisted of data on traffic accidents, traffic violations, traffic operation, drivers’ licenses, vehicle registration records, vehicle inspection records, road construction, and maintenance record.

Figure 8.3.2 Conceptual Framework of Comprehensive Traffic Safety Database


The effects of countermeasures basically depend on strength of each component. However, a balance among these three components is ideal to obtain the optimum benefit from each proposed countermeasures of the 3Es perspective (Figure 8.3.3). This means that it is very important that when examining and developing countermeasures for a particular component (e.g. enforcement), careful consideration should also be given to the other components (i.e. education and engineering) to ensure implementation of practical and effective countermeasures.

Finally, in the development of the abovementioned database, it following should be clearly identified: what is the purpose, how will it be used, what kind of data is needed for input, what will be the output, etc. The system configuration may vary depending on purpose of usage.

Figure 8.3.3 Conceptual Framework to Obtain Optimum Benefit from 3Es Countermeasures


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8.4 Resources Development Program

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1) Traffic Safety Foundation Development Program

The Road Traffic Safety Center is being proposed as a one-stop center for traffic safety policy developments while the Vietnam Road Traffic Safety Foundation is being proposed to aim at promoting traffic safety education and campaign with non-governmental organizations, volunteers and private companies such as automobile companies.

A desirable framework of the proposed Vietnam Road Traffic Safety Foundation is as follows:

(vi) Proposed Organizational Structure:

To improve road user behavior and to develop an inherent safe culture in the Vietnamese society, the concerned core agencies that must be involved directly are the Central Ideology and Culture Department, Ministry of Information and Communication, MOET, in coordination with the MOT, Ministries of Justice, Public Health, MOPS, and private sector such as automobile companies, insurance companies and other safety advocates with fundamental support from the community and general public.

Figure 8.4.1 shows the proposed conceptual model of Organization Structure for the Traffic Safety Foundation.

(v) Source of Funding:

Support and sponsorship from automobile industry and other private sector.

(iv) Expected Membership: Private Companies, NGOs, Educational Institutions and Individuals, etc

(ii) Mother Body: Affiliation to National Traffic Safety Committee (although organizationally- and financially-independent)

(i) Mission: Development of Kindhearted Traffic Safety Culture in Vietnam

(iii) Functions:

• Others

• Collaboration with private sector for traffic safety

• Safe Driving Training

• Trainers’ Training

• Development of Education Programs and Materials

• Promotion of Traffic Safety Campaign


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Figure 8.4.1 Conceptual Model of the Proposed Traffic Safety Foundation


Chairperson

Vice-Chairperson Vice-Chairperson

Spec. Rep of WG

for Human Development and

welfare

Traffic Safety Culture

& Traffic Safety Education

Cooperation & Governance

Support Dept.

Coordination & Program Division (Strategic Partnership, Safety Management System &

Cooperation & networking)

Traffic Safety Culture Coordinating Division (TSE & TSC Policy and Planning development &

Communication)

- Administration Dept. - Finance Dept - Human Resources Dept. - Inform. System Dept. -Planning, Monitoring, Evaluating & Reporting Dept.

Communication Dept. (Proactive plan; messages, channel ; training,

skill, functionality) Central

Coordination

Health & Care Dept. (Improve quality of life and social welfare)

TS Policy & Preparedness Dept. (Campaign activity-based, exhibition,

conference, workshop)

Training & workshop development Unit

TS Education & circulation Unit

Management and Operational Support

Regional Coordination

City/District Coordination

Honorary & Institution

Representatives for Negotiation &

Compromise & Liaison & Funding-

i i

Public Relations; Protection of the Integrity; Legal: Hosted project

Spec. Rep. of WG for Accident Database

Development & Improvement; Risk

Management & Audit

Spec. Rep. of WG for Accident Investigation

Operation & Traffic Laws and enforcement

TSE & TSC for Organization Development Dept.

(Children; Youth; Parents, elderly, volunteers, public transport companies)

Community Relations and Publicity Dept.

Support Service Division (Supplementary Services)

Members of NTSC at Operational level

for Research & Development Cooperation Section supporting

traffic safety culture activities

Emergency Assistance Unit

Community Learning Center & Cultural House Relations

Unit

Vice-Chairperson


Final Report

However, it is understandable that due to the Government’s present economic and social constraints, to realize comprehensive implementation of traffic safety education and propaganda programs, as well as campaign activities, it is necessary for the Government and the private sector to work together in coming up with a workable arrangement to support the aforesaid traffic safety culture activities.

The Government shall also promote voluntary efforts and activities of private organizations with traffic safety improvement by assisting them in carrying out various projects and events in training programs for traffic safety instructors and also providing them with information necessary for their activities. In particular, there should be a promotion of those traffic safety education programs or publicity activities in private organizations for volunteer traffic aides. These efforts should be made to establish training and curricula to train traffic safety instructors.

In addition, it is recommended that the Government shall set aside a percentage of the violation fees, insurance premium from insurance companies, gasoline tax, or other transport tax for use in traffic safety education and propaganda activities.

It is also recommended that there should be some sort of incentives to those who make donations or social contributions to the activities. As in many countries, tax-exemption for the social contributions will encourage private sector to be involved in traffic safety education and promotional campaigns. In the case of Japan, traffic safety-related activities are being supported by more than 150 private organizations such as Bus Associations, Motor Vehicle Manufacturer Association, Railways Associations, etc. These private entities support not only in the financing aspect, but also in terms of materials, facilities, and long-term volunteers for traffic safety education in schools, communities and households. Therefore, introduction and examination of the possibility of such incentive system for traffic safety education and campaign activities in Vietnam should be considered.

2) Fund Resources for Traffic Safety Development

(i) Options to Increase Current Main Funding Sources

As discussed in the Progress Report, the two main funding sources for traffic safety are the state budget and fund allocation from collected fees/fines.

(1) Despite the Government’s other required sectoral expenditures to cover, state fund allocation for traffic safety is justified by at least two reasons:

• The huge economic losses as discussed above and negative social impact by traffic accidents: the expenditure for traffic safety has usually a high or very high Economic Internal Return Rate (EIRR) of about 15-30%. This means that, in general, investments into traffic safety improvement is economically justified.

• Economical Value-added by transport and by traffic safety. In Vietnam, as in many other countries, the newly constructed/improved road has numerous value-added. One clear example is the land price along the road which usually increases remarkably. Similarly, the traffic safety measures could have various economical value-added. For example, smooth, safe and

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sustainable transport is one condition to attract investors, domestic and foreign.

(2) In accordance with the current Decree No. 146/2007/ND-CP, the Government imposes fines for violations with a standard amount of fine for each violation type across all provinces/cities, rural and urban. As already mentioned, this is to ensure the unified implementation of this legal document in the whole country. However, city officials from Hanoi and HCMC have expressed that, given the higher living standards of people in their respective cities, the charges being fined to traffic violators may still not be prohibitive enough to effectively enforce the traffic rules and regulations. To address this issue, it is proposed that there will be an additional fee tentatively referred to as “surcharge for ensuring traffic safety order” charged for each traffic violation committed in the provinces/cities. The amount of this surcharge should be determined by the provincial people’s council based on the actual conditions in the respective localities which may vary by area. On the institutional aspect, it is possible for the Decree No. 24/2006/ND-CP dated 6 March 2006 of the Government to implement the Ordinance on Fee and Charge which stipulates that the Provincial People’s Council decides on other charges related to the Local State Administration Management (Article 1).

Other countries are using traffic fines to finance road safety. In Western Australia, one-third of the fines collected for red light and speeding violations caught on camera are paid into the Road Trauma Trust Fund. Seven states of the USA are using portions of traffic fines for law enforcement training. Surcharges are imposed on hazardous moving violations in two states: with Mississippi allocating the funds for emergency medical services and New Mexico donating the money to a Traffic Safety Education and Enforcement Fund. Vietnam is the only country known to allocate all of its traffic fines to road safety1 which can be seen as a model for various countries.

(ii) Road User Charges

The most common road user charges that can be used for financing road safety measures are as follows:

• Road safety surcharges on motor fuel used on roads

• Surcharges on weight-distance charges

• Surcharges on compulsory vehicle insurance fees

• Surcharges on vehicle licensing fees

• Surcharges on road tolls

• Others

(1) Road safety surcharges on motor fuel used in roads

Levies on motor fuels, like gasoline, diesel, ethanol blends, LPG, and CNG are typical sources to finance roads worldwide. Almost all governments finance

1 Aeron –Thomas, Downing, Jacobs, Fletcher, Selby, and Silcock 2002. Review of road safety management

practice – Final report, TRL ltd et others

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Final Report

their budgets partially through taxes on motor fuels. Expenditures for roads are normally paid from the budget. In general, there is no direct relationship between the amount of taxes received by governments and the amounts paid for construction, maintenance and operation of roads. The main advantages of financing road safety through fuel levies are that these charges cannot be evaded by road users and reflect the risk of accidents better than levies on vehicle licensing fees.

On the other hand, increasing fuel levies will put government into another dilemma, as this will increase fuel prices, generally opposed by road users. This is a similar problem governments face when they introduce road funds. Road users have to be convinced that paying additional fuel levies with actually save them money. For example, in a country with poor road conditions, additional money spent on road maintenance will actually save road users 2 to 3 times the amount of the additional fuel levy. But this implies that the additional fuel levy is exclusively spent on road maintenance in an effective and efficient manner. Similarly, road users might be willing to pay additional fuel levies for a Road Safety Fund as long as they are convinced that the benefits to them would be greater than the cost involved.

From 1994, in accordance with Decree No 186/CP dated 7 December 1994, a Transport Surcharge of VND300 per gasoline liter was stipulated. From 1 January 2001, this surcharge has been replaced by the so-called Fuel Surcharge with the Decree No. 78/2000/CP dated 26 December 2000. The Government collects this surcharge through the tax system. In 2007, with the fuel surcharge at VND500 per liter, the State budget has received VND4,457 billion (about USD 278 million). (Source: http://www.vnmedia.vn/newsdetail.asp?NewsId=120467&CatId=23).

The most pressing problem at present is the very high price of fuel worldwide. Thus, any proposal to increase this surcharge now is not rational. But it is advisable to propose that the fuel charge should consist of two parts. One part is fixed at current rate (500 VND/liter) in any case. The other part, about 100-150 VND/liter is not fixed, but is regulated by the fuel price. This part should be higher if the fuel price down, and vice versa, and may even be not collected if the fuel price is too high as it is now.

(a) Surcharges on weight-distance charges

Very few countries, like New Zealand or some states in the USA, are using weight-distance charges to collect road user charges from motor vehicles powered by diesel. This is to avoid the problem of the tax differential between diesel used for agricultural purposes and road vehicles. In New Zealand, these are paid into the National Land Transport Account and partially disbursed to finance road safety engineering as well as other road safety programs. Since weight-distance charges are recognized as genuine road user charges, it is much easier to justify a road safety levy.

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Unfortunately, weight-distance charges are difficult to administer and are susceptible to evasion. Therefore, they are not recommended for use in developing countries like Vietnam.

(b) Surcharges on compulsory vehicle insurance fees

A few countries help to finance road safety activities by adding a levy or surcharge to compulsory third party motor vehicle insurance premiums (e.g., Finland, Switzerland, Slovakia, and South Korea). Finland began this approach some 50 years ago, with a levy of 1.1% of insurance premiums. State mandated levies range from 1-10%. In some countries insurance companies agree to contribute a certain percentage of premiums on a voluntary basis like in Fiji. As long as all insurance companies comply, it does not affect their competitiveness.

Some state-owned insurers, who often enjoy monopoly power, actively invest in road safety. For example, the Transport Accident Corporation in Victoria (Australia) is required by law to invest in crash reduction and rehabilitation programs. Although the law does not specify the amount, the Corporation spent USD11.5 million in 2001. Likewise, the Canadian insurance company ICBC invested USD40 million in 2000. In South Africa, the Road Accident Fund allocates 2.5% of its income to finance road safety interventions and, in its early days, the Fund supported law enforcement and speed reduction campaigns (Global Road Safety Partnership 2006).

To finance road safety through surcharges on compulsory third party insurance premiums has the advantage of having a good relationship between road safety user charges and road accident costs as long as insurance premiums reflect the individual drivers risk profile. Also, it gives some additional incentive to drivers to drive safely. However, for this concept to be effective, it would be necessary that all motor vehicles using roads would have to be insured as proposed in Chapter 5. Unfortunately in Vietnam, it seems that numerous motor vehicles are not insured. While the levels of compliance with compulsory third party vehicle insurance are very high in high income countries, ranging from 90-99%, compliance levels are fairly low in Vietnam. Therefore, surcharges on motor vehicle insurance premiums are not an effective tool to finance road safety in countries with low compliance rates. As discussed in Chapter 5, higher levels of compliance may be achieved by:

- Requiring evidence of insurance before a vehicle can be registered;

- Requiring all vehicles to carry a windscreen decal that proves that they are insured; or

- Like the system being implemented in Victoria, Australia, collecting the insurance premiums as part of the annual licensing fees.

(c) Surcharges on vehicle licensing fees

Several states in the USA impose surcharges on top of vehicle licensing and registration fees to help fund the emergency medical services and trauma centers. For example, Virginia collects an additional fee of USD4 on

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Final Report

the annual motor vehicles registration fee to fund its Emergency Medical Services (EMS), referred to as “Four for Life”. It also imposes an additional USD3 fee on top of motorcycle registration fees for the Motorcycle Rider Safety Training Program (Global Road Safety Partnership 2006).

Botswana’s main source of funding for its National Road Safety Council is a safety surcharge on motor vehicle registration. This surcharge was increased by a factor of five to approximately USD1 some years ago. Papua New Guinea is also known to collect road safety funding through a surcharge on vehicle inspection stickers. Tanzania has reported considering a surcharge on motor vehicles to fund road safety (Global Road Safety Partnership 2006).

Unfortunately, licensing fees and inspection fees are frequently subject to evasion and abuse in many developing countries. Therefore, increasing fees may simply lead to even greater levels of avoidance. Surcharges on vehicle license fee are therefore not always an effective way to finance road safety in these countries.

(d) Surcharges on road tolls system

Many countries around the world are using the road toll system to finance at least part of their road infrastructure. Collection of toll fees is widely accepted as road user charges. Nevertheless, there are only few countries that are using levies on road tolls to finance road safety. In South Korea, for example, levies on the income of expressway authorities are used to partially finance the Road Traffic Safety Association.

As toll roads are becoming more and more popular in Vietnam, this may become a more feasible source of much needed resources.

(e) Other contributions from road users

Some countries are rather inventive when it comes to raising funds for road safety. New Zealand, for example, is using personalized licensing plates to finance the Road Safety Trust. In Korea, levies on tire manufacturers’ profits are used to partially finance road safety. Such other income from road users seems to be a good way of raising additional funds for road safety, though it can only contribute small amounts. In Vietnam, for example, many vehicle owners like to have the so-called “lucky registration number” which could be had at a higher price.

(iii) Contributions from the Private Sector

Many private businesses support road safety for their own direct benefit. They are road transport operator/management; insurance companies; manufacturers and distributor of vehicles; manufacturers and distributor of road safety equipment; and road safety engineering firms and consultants.

Other companies such as oil companies and car and truck manufacturers become benefactors to improve their corporate image or to brand their products as safe. They provide either funds or provide support in kind. These contributions tend to concentrate on road safety education and knowledge transfer; road safety

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campaigns; enforcement campaigns; and driver training and awareness.

Advertisement rights attached with some traffic safety facilities (e.g. pedestrian bridges, traffic safety promotional banner, etc.) could also be sold.

However, while contributions to road safety by private business cannot provide for all the funds necessary for road safety, its important role in financing and implementation of road safety measures may be further planned and developed. The issue is how to mobilize these contributions on a regular, long-term basis. The establishment of the so-called Road Traffic Safety Foundation is a sound possibility and will be discussed further in the Action Program.

(iv) International Donors

(1) Multinational and bilateral lending institutions and donors

Support from bilateral and multilateral donors has been of great importance to developing countries like Vietnam. These agencies contribute to road safety by providing loans, grants and technical assistance. Often these contributions form part of the road sector programs. In recent years, more attention has been given to improve road safety by assisting governments in supporting NTSC as well as financing various road safety measures such as those presented in Chapter 8 of the Progress Report.

(a) Global Road Safety Facility (GRSF)

While the above-mentioned resources dedicated to road safety have been rather limited in the past, the recent creation of the GRSF has created considerable hope for improving this situation.

The GRSF is administered by the World Bank and provides funds for road safety actions with a basic focus on capacity building and management. Founding donors were the FIA Foundation for the Automobile and Society; the Government of the Netherlands; the Swedish International Development Cooperation Agency (SIDA); and the World Bank Development Grant Facility. The goals of the facility for low and middle income countries are: (a) to strengthen global, regional and country capacity to support sustainable reductions in road deaths and injuries; (b) to increase road safety investment; (c) to accelerate safety knowledge transfer; (d) to promote innovative infrastructure solutions to improve the safety of mixed traffic environments. National agencies, as well as global and regional partners, can apply on a continuous basis.

(b) International Road Assessment Program (IRAP)

In view of the success of the EuroRAP, AusRAP, and UsRAP in Europe, Australia and the USA, respectively, an International Road Assessment Program (IRAP) was recently launched to assist interested developing countries and economies in transition to benefit from a similar standardized and internationally comparable road assessment. The RAPs were created to provide similar systematic and independent safety assessments of roads, as have been provided for road vehicles under the New Car Assessment Program (NCAP), in order to raise the overall safety standard of roads.

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Final Report

In assessing roads, IRAP takes into account driver behavior and vehicle safety. The assessments are carried out by collecting relevant road features (lane marking, roadside condition, pedestrian facilities, etc.) via video capture and drive-through inspections, which are then further analyzed to finally provide safety risk maps, star ratings, charts, tables and engineering toolkits. These outputs can help in prioritizing road improvement measures such as separate lanes of opposing traffic to reduce head-on crashes, roundabouts to ease the severity of side impacts at junctions or guardrails to prevent run-off crashes.

The first IRAP pilot project in Asia is currently being carried out in Malaysia where 3,000 kilometers of trunk roads, including the Asian Highway segments in the country, have been inspected with support from AusRAP and the Malaysian Automobile Association.

Similar pilot projects are under discussion/preparation for Asian Highway segments in Armenia and Georgia, as well as in Vietnam.

In summary, Table 8.4.1 lists typical advantages and disadvantages of different sources of financing of road safety.

(v) Funding Demand and Effective Usage of Road Traffic Safety

Having identified the main sources for financing road traffic safety, two questions remain: How much should be spent on road safety? How can the available financial resources be used effectively?

It is understandable that the answer for these questions depend on the concrete conditions. The following discussions are concluded from international experiences (World Bank, German Technical Cooperation – GTZ, ESCAP etc.) and could serve as reference in the case of Vietnam.

In developed countries, one can expect to spend between 10% and 15% of cost of road construction, rehabilitation, improvement, and maintenance of road safety engineering measures. And more or less one quarter to one half of this amount on enforcement, and about 3-4% of the total expenditures on roads on road safety campaigns.

Many developing countries are faced with much higher road accident rates than developed ones but they often have a lot of problems with higher priority over traffic safety. Therefore, funds for road safety should only be raised gradually and in line with the improvement of the institutional and human resource issues that permit an effective and efficient spending of road safety funds.

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Table 8.4.1 Typical Advantages and Disadvantages of Different Sources of Financing for Road Safety

Sources of Funding Advantages Disadvantages

Value-added to State budget from transport Large amount New concept and difficult

to evaluate

Surcharge for ensuring traffic safety in addition to funds collected from fines

Related directly to traffic safety and flexible enough for actual conditions of localities

Some requirements in institutional aspects

Surcharges on motor fuel Low level of evasion, low collection fee

Difficulty to raise fuel prices

Surcharges on weight-distance charges Accepted as user charge High level of evasion

Surcharges on vehicle insurance compulsory Best related to road safety High level of evasion

Surcharges on vehicle license fees Low collection fee High level of evasion

Surcharges on road tolls Low level of evasion, accepted as user charges

Toll roads form only a small part of the road network

Contribution by private sector

Can complement road safety financing and can make use of private sector management and efficiency

Can only provide limited amounts and may not be sustainable

Development loans and grants Can initiate effective road safety programs and financing schemes Not sustainable

Source: JICA Study Team (2008) and ESCAP document No. E/ESCAP/CMG(4/I)/7 dated 20 July 2007.

A good measure of the effectiveness and efficiency of road safety measures is to calculate their benefit cost ratios and to execute only those measures that have high benefit cost ratios. For example:

• In New Zealand, road safety measures are executed by Transit New Zealand if they have a benefit cost ratio higher than 4.

• Australia conducted Black Spot Improvement Programs in the 1990s with economic benefits of around USD5 for each USD1 spent (Australia Transport Council 2006).

• In many countries, it might not be easy to calculate reliable benefit cost ratios due to lack of data. In this case, it is recommended to make use of experience of other countries with similar conditions to fill the gap.

Following international experiences, road safety engineering measures, including road signs and markings which normally form part of the construction, rehabilitation, improvement and maintenance of roads, are financed through government budgets or road funds. In various countries, the amounts spent on these measures are relatively low, even in those countries that have road funds, since they often struggle to get enough funds for road maintenance which is considered to be of higher priority. Nevertheless, the funding situation is slowly improving giving more

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Final Report

room for financing road safety engineering measures. Since most of the road funds do not mention road safety improvements as their obligation, it might help to assign road funds a more explicit road in financing road safety engineering measures. Countries that do not have road funds may try to create them to improve overall financing of road maintenance and road safety. The goal should be to spend about 15% of the budget for national and local roads for road safety engineering measures in the long run.

Besides the physical engineering measures to improve the safety aspects of roads and road vehicles, road safety programs which need to be financed are road safety awareness campaigns, road safety education, and emergency medical services and trauma centers for road victims. Road safety programs on a national, regional and local level can be financed by a mix of road user charges and public and private sector funds. The target is estimated to spend the equivalent of between 3 and 5% of the total expenditures on roads for road safety programs. In terms of cost per vehicle or cost per liter of fuel, this would roughly come to USD0.9 to 1.4 per liter of motor fuel or USD14 to 30 per vehicle. On the average, a road safety surcharge on fuel of USD.01 or USD22 per vehicle should be enough to pay for road safety programs.

For road safety campaigns to be effective, a high degree of enforcement is necessary. Normally, enforcement of road safety-related rules and regulations is being conducted by the national police and, in some cases, by highway police that is part of the Ministry of Transport and/or Public Works as in Uruguay. In the case of New Zealand, the Land Transport Fund is contracting and paying the national police for its road safety-related activities. In most low income countries, the national police force is underpaid and corruption is the norm rather than the exception. This makes the enforcement of rules and regulations almost impossible. To have a special road safety police to be in charge of road safety and paid and supervised by a Road Safety Fund might be a better solution.

In general, road fund forms an excellent way for financing road safety. Unfortunately, not all countries have well functioning road funds. And while most of the road funds in the countries provide funds for road safety engineering measures, only few of them dedicate a significant part of their revenue to other road safety measures as well. The main reason is that most of them hardly receive enough funds to cater for all of their road maintenance needs, which are considered first priority. One alternative is to increase funding and dedicate a certain percentage of revenue to other road safety measures besides road safety engineering. For example, the Ethiopian Road Fund Board has recently proposed that up to 3% of the road fund could be allocated for road safety (Global Road Safety Partnership 2005). A second alternative is to create a separate Road Safety Fund that would need its own funding sources. Whatever alternative is chosen, charges in addition to the ones already collected from road users will be required.

Regarding the question on how can available funds be used more effectively,

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international experience2 shows that the most important is to establish a strong enough agency to manage the available fund. It is advisable that this agency should have following main characteristics (so-called six characteristics of a second generation road safety fund):

• Sound legal basic with a road safety fund administration and clear rules and regulation;

• Strong oversight by a board with qualified and powerful members from the private and public sector and representing all important groups with vested interest in road safety;

• Agency which is a purchaser, not a provider of road safety works and services;

• Revenue incremental to the public budgets and coming from charges related to road use and channeled directly to the Road safety Fund bank account;

• Sound financial management systems with lean efficient administrative structure;

• Regular technical and financial audits.

3) Traffic Safety Human Resource Development

There are two basic resources required to implement the traffic safety policy and measures: the human resource and financial resource. This section will discuss on the human resource.

The automobile society in Vietnam started in mid-1990s from the major urban areas such as HCMC, Hanoi and Haiphong. It was just recently that traffic problems it caused have become one of the country’s urgent social issues. Thus, the officials in charge in the responsible organizations do not have adequate experience and skills to address these problems. And the lack of academic experts in the field of traffic engineering and planning in the higher education system in Vietnam is one of the causes of lack of human resource.

There are also very limited professionals and practitioners in the road traffic sector at present. For comprehensive traffic safety development, various kinds of professionals are required such as facility engineers, traffic control and management planners, enforcement specialists, safety education specialists, psychologists, journalists, etc. Unfortunately, these kinds expertise are not developed in a short period of time; a longer time is required for the implementation of systematic and strategic approaches in cooperation with university, training institute and academy.

Basic knowledge and skills shall be provided in the higher education such as the universities and academy, and more practical training shall be provided in the training institutes and vocational schools. At present, however, there is no higher education or institution that provides traffic safety planning and education. Traffic Safety Planning is not offered as a core subject and usually is just a subject matter of different curricular subjects, resulting in very general treatment of the subject. General knowledge and

2 The Road Safety Cent. GTZ, Germany 2006

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Final Report

skills of the components of the traffic safety measure are included such as civil engineering, enforcement skills and psychology, but a dedicated curriculum for traffic safety planning which is composed of its various components for the development of traffic safety policies and strategies has not been developed yet.

The main objective of JICA’s ongoing technical cooperation program TRAHUD is to provide knowledge and practical experiences to traffic police, inspector and traffic engineers. While the project is being undertaken actively, resource development to ensure sustainability of the project has not been established yet. The following are some of the many issues encountered in the project: (i) lack of fundamental knowledge, particularly on traffic engineering; (ii) lack of trainers; (iii) lack of appropriate organization to provide continuous training and skills development for traffic safety; and (iv) lack of research and development to update traffic safety measures.

With the rapidly increasing and expanding motorization in the country, traffic issues such as increasing number of traffic accidents are expected to become more complicated and shall require additional staff that will have continuous upgrading of skills, knowledge and technical expertise. To ensure sustainable human resource development for traffic safety, the strategies that will be proposed are as follows:

(i) Improvement of higher education system related to traffic safety

(ii) Development of post-graduate program or training system, including international training

(iii) Capacity development supported by ODA projects

(iv) Promotion of research and development in the traffic safety sector

(v) Encouragement of private consultants for traffic engineering and traffic safety, etc.

8.5 Implementation Strategy for Institutional Development Program

One of the Master Plan objectives is to establish organizations to ensure comprehensive and sustainable traffic safety development in Vietnam. As discussed above, many institutional innovations will be required in the concerned sectors and numerous issues will be encountered due to the lack of experience and knowledge for the new interventions. Insufficient human resources and lack of leadership are also some of the other issues.

Institutional improvements discussed in this chapter are interrelated and thus will be more effective if treated as a whole. In addition, it requires the utilization of existing organizations in order to ensure smooth implementation given the limited human and financial resources. Figure 8.5.1 shows the proposed central organization system based on strengthening of the National Traffic Safety Committee. Four new organizations are proposed, namely: (i) National Traffic Safety Authority, (ii) Traffic Safety Center, (iii) Traffic Safety Foundation, and (iv) a Consultative Council which will be on top of collaborative activities of the other proposed organizations.

The National Traffic Safety Authority will play a central function for the traffic safety policy development work and its implementation. The Traffic Safety Center would be a think-tank for the policy development providing necessary advices and analysis data to

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ensure effective policy development based on scientific approach. The Traffic Safety Foundation is expected to promote traffic safety culture development with participation of non-government organizations and private companies, among others. The Foundation may be operated independently from the government organization, but close coordination with government policy is provided through proposed Consultative Council. The Council will be composed of representatives from the private sector, educational institutions and other concerned groups to monitor the policy development and implementation.

The National Traffic Safety Authority will cooperate with the Foundation through the Council, and vice versa. The National Traffic Safety Authority would be formed through the restructuring of the existing Traffic Safety Committee Executive Office and Traffic Safety Project Management Unit. Needless to say, the project management function currently exercised on the VRSP and other projects should be maintained as one of the function of the new organization. In line with this central organization, local Traffic Safety Committees and necessary institutional mechanisms shall be developed for the comprehensive and sustainable traffic safety development in the respective local areas. Local Governments shall play more significant roles in the implementation of the policies rather than central government agencies.

Figure 8.5.1 Proposed Organizational Framework for the Comprehensive Traffic Safety in Vietnam


Validity of the proposed organizational framework shall be further discussed with relevant ministries and agencies in order to play a significant role as a central coordination body among the sectors related to the traffic safety. The establishment of the new system will also require further environmental development to build a consensus among the concerned agencies, as follows:

Proposed new organizations

Traffic Safety Policy Act will legalize proposed organizational structure for Traffic Safety

Advisory Council National Traffic Safety Authority

（EO＋TSPMU）

Traffic Safety Foundation District TSCs

Provincial, City-TSCs

Traffic Safety Center • Traffic Safety Database • Research and Dev’t. • Human Resource Dev’t.

NTSC National Traffic Safety Committee

(i) Consensus among the relevant agencies and legalization of the system such as a traffic safety policy act or degrees.

(ii) Traffic Safety Master Plan and 5-Year Action Program shall be authorized as a national rolling plan, which will be formulated periodically.

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Final Report

(iii) Ensure that human resources shall be adequately capable to operate and manage new organizations.

(iv) Each component of the traffic safety database is collected and developed in the respective organization, thus the Traffic Safety Center shall integrate those database as one system and shall also develop communication network system with the respective organizations to share the common database.

(v) Non-governmental organizations and private companies shall be officially invited for the development of Traffic Safety Foundation with sufficient incentives assured by the Government of Vietnam.

The target of the institutional development will be confirmed in line with the National Economic Development Strategy to be an industrialized country by 2020, which means that appropriate institutional organizations should be established by 2020, including all the necessary human and financial resources, as well as database for the scientific policy development. Milestones toward the target will be divided into three stages. The first stage is the preparatory stage which includes the design and consensus-building of the system and human resource development. The second stage is the run-up stage for the full-scale trial operation of proposed system. An important issue during this stage is the development of the next 5-year action program (2015-2020) with the new organizational set up and resources. The third stage is the operation and evaluation of the full-scale implementation of activities based on the next five-year action program.

Even though a step-by-step strategy is being proposed, any feasible program that can be implemented at present should be prioritized in order to alleviate current serious situations. In particular is the dissemination of information to raise peoples’ awareness on traffic safety should be prioritized and undertaken soon as part of the traffic safety culture development, with possible support from the private sector to minimize the burden on the current limited governmental resources. However, the government should take responsibility in the establishment of an appropriate institutional framework.

Development of a Traffic Safety Center will be a long-term issue, particularly database development as the most critical issue, despite the need for and importance of the database highly justified as discussed above. However, at the very least, evaluation data and information of the ongoing projects and activities have to be collected and analyzed now. Therefore, this Master Plan is proposing that its function be started immediately even with a provisional organization or group of people.

Ongoing projects such as WB-VRSP and the forthcoming JBIC traffic safety project are significant opportunities to establish a new institutional system and to improve the human resources. However, how fast the proposed new institutional establishments can be developed will depend upon how effectively these ongoing projects would be implemented. Therefore governmental commitment for the institutional enhancement is urgently required. Table 8.5.1 shows the implementation strategy for the institutional enhancement including targets and milestones.

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Table 8.5.1 Implementation Strategies for the Institutional Enhancement 2008 - 2010 2010 - 2012 2012 - 2015 2015 - 2020

Preparatory Period for organizational establishment and human resources development (in collaboration with on-going projects: VRSP and JBIC)

Take off period for full-scale activities

Start of full-scale activities

National Traffic Safety Authority

• Detailed Design of the structure and its legal procedure

• Establishment of provisional organization

• Human resource development

• Implementation by the provisional organization

• Human resource development

• Establishment of permanent organization

• Preparation of next 5-Year Action Program

• Start of full-scale activities

• Monitoring and evaluation of the 5-Year Action Program

Traffic Safety Center

• Detailed Design of the structure and its legal procedure

• Establishment of provisional organization

• Human resource development for the Center

• Implementation by the provisional organization (project monitoring and data collection and analysis for the ongoing projects）

• Human resource development for the Center

• Establishment of permanent organization

• Research and analysis for the next 5-Year Action Program

• Start of full scale activities

• Data collection and analysis of the 5-Year Action Program

• Completion of Traffic Safety Database

Consultative Council

• Legal procedure • Start of activities• Review of the

organizational setup

• Periodical activities


Traffic Safety Foundation

• Legal procedure • Start of activities• Review of the

organizational setup



Technical Assistance from International Donors

Financial Assistance from International Donors


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Documents

7 MEDICAL EMERGENCY AND TRAFFIC ACCIDENT ...open_jicareport.jica.go.jp/pdf/11948668_03.pdfThe Study on National Road Traffic Safety Master Plan in the Socialist Republic of Vietnam