**Low-Carbon Quick Wins: Integrating Short-Term Sustainable Transport Options in Climate Policy in Low-Income Countries**

**Stefan Bakker 1,\*, Gary Haq 2, Karl Peet 1, Sudhir Gota 1, Nikola Medimorec 1, Alice Yiu 1, Gail Jennings <sup>1</sup> and John Rogers <sup>1</sup>**


Received: 5 June 2019; Accepted: 8 August 2019; Published: 12 August 2019

**Abstract:** In low income countries (LICs) in Africa and Asia per capita transport greenhouse gas emissions are relatively low but are expected to grow. Therefore, a substantial reduction in projected increases is required to bring emissions in line with long-term global climate objectives. Literature on how LICs are integrating climate change mitigation and sustainable transport strategies is limited. Key drivers of transport policy include improving accessibility, congestion, air quality, energy security, with reducing greenhouse gas emissions being of lower priority. This paper assesses the current status, feasibility and potential of selected low-carbon transport measures with high sustainable development benefits that can be implemented in the short to medium term, so- called 'quick wins'. It examines to what extent ten such quick wins are integrated in climate change strategies in nine low- and middle-income countries in Africa and South Asia. The research method comprises expert interviews, an online questionnaire survey of experts and policymakers in the focus countries, and a review of literature and government plans. Results indicate that sustainable urban transport policies and measures are considered high priority, with vehicle-related measures such as fuel quality and fuel economy standards and electric two- and three-wheelers being of key relevance. In existing national climate change strategies, these quick wins are integrated to a certain extent; however, with better coordination between transport and energy and environment agencies such strategies can be improved. A general conclusion of this paper is that for LICs, quick wins can connect a 'top-down' climate perspective with a 'bottom-up' transport sector perspective. A knowledge gap exists as to the mitigation potential and sustainable development benefits of these quick wins in the local context of LICs.

**Keywords:** low-income countries; low-carbon transport; sustainable mobility; climate change strategies; transport policy; Paris Agreement

#### **1. Introduction**

Greenhouse gas (GHG) emissions from transport are rising faster than any other economic sector [1]. Under a business-as-usual (BAU) scenario, global transport GHG emissions are expected to increase from 8 to 16 billion tonnes (t) by 2050. This poses a significant challenge to achieving long-term objectives outlined in the United Nations Paris Agreement, which set out a global action plan to avoid dangerous climate change [2]. Limiting global warming to below 1.5 ◦C will require GHG emissions being reduced to 2 to 3 gigatonnes (Gt) by 2050 and to up to 6 Gt for a 2 ◦C scenario [3].

Per capita transport GHG emissions in low-income countries (LICs) are approximately 0.1 to 0.5 t compared to high-income countries (HICs) at 2 to 5 t. The contribution of LICs to total global transport

GHG emissions is 0.5% [4,5]. Rapid motorisation in LICs is expected to increase future transport GHG emissions which threaten the long-term global climate objective of 0.2 to 0.6 t per capita for transport (assuming 10 billion in 2050).

LICs recognise the need to reduce transport emissions as part of international commitments, but this is not the primary driver behind many transport policy interventions. Other development concerns are higher on the political agenda such as improving urban mobility and accessibility, rural connectivity, efficient logistics, and sometimes energy security (i.e., reducing of oil imports) and health (e.g., improving in air quality and physical activity levels). For example, in Accra (Ghana) climate change was not prioritised in sustainable urban transport project assessment although air and noise pollution were included [6]. In Dhaka (Bangladesh) environmental criteria for sustainable urban transport included noise and air pollution but GHG emissions were not explicitly stated [7]. Within this context, low-carbon transport (LCT) can be seen as a co-benefit of sustainable transport policies (Figure 1).

**Figure 1.** Sustainable development and low-carbon transport (source: authors, based on [8]).

LCT can be defined as transport sector developments that emit less GHG emissions than in a business-as-usual (BAU) scenario. LCT interventions are those that contribute to climate change mitigation no matter what the primary policy goals are. This framing is consistent with 'low-carbon development' in which national and local development objectives are the starting point, and opportunities are identified to achieve these in a manner which emits the least GHG emissions [9].

Under the United Nations Framework Convention on Climate Change (UNFCCC), countries are required to report national climate change strategies in the form of nationally determined contributions (climate action plans) (NDCs), national communications (NCs) and biennial update reports (BURs) [2]. These strategies could be seen as reflecting a 'top-down' view of climate change mitigation at the national level driven by international agendas. However, climate policy objectives need to be implemented in each sector at the national and local level in the form of policies and measures related to transport development, vehicles and energy systems.

Reaching long-term climate targets requires short-, medium- and long-term actions which are described in recent literature, a synthesis of which can be found in [1], which also shows the benefits for sustainable development objectives. More detailed global climate change mitigation scenarios for the transport sector are described in [3,10]. Key measures include fuel efficiency improvements for passenger and freight vehicles; renewable energy in transport; electrification of passenger cars, motorcycles, three-wheelers, buses and trucks; as well as transport demand management, logistics efficiency and shifting from private vehicles to more efficient modes.

Global progress on these measures is mixed and falls short of what is required for a well-below-2-degrees scenario, as shown in the Transport and Climate Change Global Status Report (TCC-GSR) [4]. For example, while fuel economy of new cars is improving globally, city-level sustainable mobility planning is becoming more common, more cities are implementing low-emission zones, and the stock of electric two-wheelers is increasing rapidly (mainly in China and Europe), there remains limited progress on electrifying cars and trucks [11], implementing more efficient road

freight and logistics measures [12], realising envisioned shifts to more efficient transport modes, and increasing the share of renewables in the transport sector [4].

While there is a substantial body of literature on LCT at the global level and for developed countries, existing research on developing country mitigation pathways for transport is more limited and general. Figueroa et al. [13], for example, highlight the key role of informal transport and land-use planning, and Dhar et al. [14] link transport policies in India to the NDC. However, a research gap exists as to which solutions exist for LICs that can be implemented quickly, have GHG mitigation potential, and can contribute to climate strategies. Quick wins (QWs) are low-carbon transport policies and measures that can be implemented in the short to medium term, are relatively low-cost, and have high sustainable development benefits. This paper therefore aims to address the following research questions:


The research method and data sources used in the study are outlined in Section 2. This is followed by a discussion of the climate mitigation potential of QWs and how they are integrated in climate strategies (Section 3), i.e., the top-down perspective. A bottom-up analysis is undertaken of QWs in nine focus countries: six in Africa and three in Asia (Section 4), followed by a discussion of the results, main conclusions and recommendations.

#### **2. Materials and Methods**

The research method and data sources are summarised in the flow diagram in Figure 2 and described below. The corresponding sections are indicated in brackets.

**Figure 2.** Study method (with section numbers).

#### *2.1. Country Selection Criteria*

The study focused on the UK Department of International Development's (DFID) priority countries in Africa and Asia: Bangladesh, Ghana, India, Indonesia, Kenya, Nigeria, Rwanda, South Africa, and Uganda. These nine countries were selected through a robust, quantitative process based on their need for low-carbon transport interventions. This was assessed using the following criteria: motorisation rates, transport emissions currently, and projected BAU transport emissions growth in the future.

#### *2.2. Low-Carbon Transport Quick Wins Definition*

Transport QWs are defined here as actions which can be taken in the short to medium term and contribute to the low carbon transformation of transport (i.e., a well below 2 degrees or even 1.5-degree scenario). They provide different benefits (e.g., access, efficiency, safety and environment benefits) to local and national stakeholders and are main policy drivers with climate change mitigation as a co-benefit. QWs have been tested at scale and are replicable with the possibility for large-scale impact. They are technically and economically feasible in both developed and developing countries using available technologies. Finally, QWs address both passenger and freight transport and should be relevant to the Avoid-Shift-Improve (ASI) concept [15]. This is a sustainable transport policy framework that emphasises avoiding and reducing trips (A), shifting to environmentally-friendly modes of transport (S), and improving (I) vehicle energy and carbon efficiency of each mode [16].

#### *2.3. Selection of Transport Quick Wins for LICs*

From March to July 2016, a six-step process (see [15]) was undertaken to develop a list of QWs. An email invitation was sent to more than 100 international organisations working on sustainable transport and resulted in the compilation of a long list of over 100 measures. Through grouping and balancing measures across themes, modes and world regions, the list was reduced to approximately 40 options. These measures were further evaluated against sustainable development benefits, implementation barriers and coverage of 'Avoid-Shift-Improve' measures, and both passenger and freight transport. Expert feedback was received on the remaining 23 measures while an on-line survey of more than 100 stakeholders provided feedback on the definition and feasibility of the QWs. Finally, a more detailed assessment against the following criteria provided a final list of 10 QWs specifically for the purpose and context of the analysis:


The final 10 QWs for this analysis are:


#### *2.4. Method for Quick Wins Assessment*

Primary data for the QW assessment were collected from interviews and a questionnaire survey. From October to December 2018, semi-structured key informant interviews were undertaken with 23 experts from the nine countries (2–3 per country). Experts were from national and local transport government agencies, research institutions and implementing agencies. Among other questions, they were asked to rate each QW option on a scale from 1 to 5 on their appropriateness in the short to medium term for their country. Respondents were also able to suggest additional QWs.

From September to October 2018, a survey of low carbon, high volume transport knowledge and capacity in Africa and South Asia was undertaken of the stakeholder network of the Partnership for Sustainable, Low-carbon Transport. The online tool SurveyMonkey was used. The survey included qualitative and quantitative questions exploring how LCT knowledge is gained, how capacity is achieved, and how transport users and other affected parties are engaged. As part of one question in the survey, respondents were requested to rank the 10 QWs from 1 to 10 according to their appropriateness for the respondent's country. The survey was sent to 816 experts and received 67 respondents with 49 completing the question on QWs. The 67 respondents were equally represented across government agencies, private sector, research institutions and implementing agencies. However, most of the respondents were from African countries.

Secondary data on QWs implementation, integration in climate plans and mitigation potential was collected from existing peer-reviewed and grey literature as well as technical reports, government plans and reports, and additional sources such as online media. See below for further details on this data collection process. The findings from the literature review were validated and elaborated by stakeholder interviews.

#### **3. Results and Analysis Part 1: A Top-Down Climate Change Perspective on Transport Quick Wins**

This section briefly discusses general literature on low-carbon transport in the nine focus countries and then looks at the mitigation potential of quick wins and to what extent these are present in climate strategies in the focus countries.

#### *3.1. Mitigation Potential of Quick Wins*

Literature on transport and climate change mitigation exists for some of the focus countries, including economy-wide and transport sector-specific low-carbon scenarios. Gota et al. [5] compiled a comprehensive global database of mitigation studies and reports for 81 countries including six out of the nine countries. Transport was one of the sectors included in those economy-wide mitigation potential modelling studies; as these are based on energy-economy models, the level of detail is limited. These studies show that the reduction potential (averaged across multiple studies for one country) below BAU for the transport sector in 2050 is 62% for Bangladesh, 65% for India, 61% for Indonesia, 82% for Nigeria and 61% for South Africa, while for Kenya the potential is 37% for 2030.

Transport sector-specific literature shows more detail on the mitigation potential of quick wins. Among other low-carbon options, these show the importance of some of the quick wins as well. In India, Dhar et al. [17] modelled low-carbon scenarios for transport for a 1.5 degree scenario, with vehicle fuel efficiency, transport demand management (in passenger and freight), biofuels, modal shift (in passenger and freight), and electric vehicles (including two-wheelers) playing a key role. For Bangladesh, Gota & Anthapur [18] developed low-carbon freight scenarios, also estimating black carbon emissions, that consider broad Avoid, Shift and Improve strategies. Siagian et al. [19] modelled an economy-wide scenario for Indonesia, in which energy efficiency and biofuel use in transport can help in achieving NDC targets. In Kenya, e-scooters and vehicle efficiency for cars and trucks are included in the transport sector low-carbon scenarios [20]. Finally, Stone et al. [21] developed a detailed model to estimate historical fuel demand for road freight and passenger vehicles in South Africa. In short, there is sector-wide low-carbon transport literature for a few of the nine countries; however, the scenarios

include few short-term policy options and limited detail on these options, and the freight sector in particular is covered only to a limited extent.

#### *3.2. Mitigation Potential of Quick Wins*

A literature review was undertaken on the climate mitigation potential of the 10 QWs including global studies as well as research on the nine focus countries. The main methodology was a keyword search in Scopus and Google Scholar. Keywords included the 10 QWs, as well as "low-carbon transport", in combination with the names of the nine countries. In addition, relevant references from these articles were used. This resulted in 24 peer-reviewed articles, of which 14 cover climate change potential and 10 are indirectly relevant. In addition, 17 grey literature sources such as technical reports from international organisations were found by searching in Google using similar keywords. Literature was from the past five years (2013–2018) with a few sources from before this period if more recent sources were unavailable.

Table 1 summarises literature on transport sector GHG mitigation and shows the importance and potential of all 10 QWs in the nine selected countries.

For India, most mitigation options are included in low-carbon scenarios or studies for specific measures. For Indonesia, several studies are available as well. For Bangladesh and the six African countries, literature is limited, except for options related to fuel efficiency and fuel standards, where international organisations have done extensive analysis (even if not specifically on GHG mitigation potential). For some specific options (e.g., limiting imports of used trucks and introducing low emission zones) more analysis would be beneficial.




#### **Table 1.** *Cont.*

#### *3.3. Integration of Quick Wins in Climate Change Strategies*

To assess how QWs are integrated in climate change strategies of the nine countries, an analysis of the Paris Agreement reporting mechanisms (NDCs, BURs and NCs) (a methodology used by for example Stead [56]) and other strategies, such as climate change strategies (CCSs), climate change action plan (CCAP), low-carbon development strategy (LCDS) and National Climate Change Policy (NCCP) was undertaken. In Table 2, 'Y' means the QW is in at least one of the plans/reports. In most cases a QW is not included in all of these. One reason for this is that NDCs are often short whereas BURs and NCs present measures in more detail. In addition, it should be noted that all countries have submitted an NDC and at least one NC, whereas five have submitted one or multiple BURs, and five have additional national strategies.


**Table 2.** Quick wins in climate change strategies and reports.

NDC: nationally determined contribution; NC: national communication; BUR: biennial update report; LC(D)S: low-carbon (development) strategy; CC: climate change; NCCP: national climate change policy.

Fuel economy policies and non-motorised transport (NMT) infrastructure are the QWs that are included most often: six or more countries do so. Fossil fuel subsidy reduction, import restrictions, pricing measures, and diesel quality standards are included by 3–5 countries. SUMP, electric two- and three-wheelers, low emission zone (LEZ) and freight efficiency by zero or one country.

#### **4. Results and Analysis Part 2: A Bottom-Up Transport Perspective on Quick Wins for Focus Countries**

#### *4.1. Perceived Feasibility of Quick Wins for Focus Countries*

Figure 3 shows perceived feasibility of transport QWs according to the survey responses. Respondents regarded the following QWs as most feasible in their countries (noting that data are not sufficient to suggest a proposed ranking of these QWs on a country or regional basis):


Other key options from respondents include diesel quality standards, increasing freight efficiency, and paratransit reform and regulation. The paratransit reform and regulation option refers to changing from unregulated mini-buses and three-wheelers to a system where routes are organised by a regulator, potentially in support of high-quality public transport such as metro or bus rapid transport (BRT). Several respondents suggested this as an option to be added to the 10 QWs.

#### *4.2. Implementation Progress of QWs*

A review of planning and implementation of the QWs in the nine selected countries was also undertaken. The analysis was based mainly on peer-reviewed and grey literature from 2017–2018 which included reports and policy briefs, government official documents, and if no other sources available, news articles from online media. All sources are included in a matrix (see Supplementary Materials S2) with Table 3 presenting the summary assessment.

Methodology for the rating of the implementation status:


Three researchers independently rated implementation based on the same literature.

The detailed application of this methodology varies depending on the nature of each QW. For example, evaluation of regulatory measures such as diesel quality standards or limiting imports of used trucks import are more straightforward than more diverse measures such as improving freight efficiency or NMT infrastructure, which require a multitude of smaller interventions (see S2 Matrix on quick win implementation in Supplementary Materials).



There is progress across most or all nine countries for QW 4 (Limiting imports of used trucks) and QW 10 (Diesel quality standards). This could indicate an increased awareness of air pollution issues with both these options playing a key role in addressing diesel emissions. In addition, a number of international organisations are also promoting these actions (e.g., the International Council on Clean Transportation and UN Environment).

Options where progress varies among the nine countries are the following:


• QW 8 (NMT infrastructure): many cities are examining this option and consider it important, yet implementation is limited, with unsafe and inconvenient conditions for walking and cycling. Allocation of government budget to the various transport modes is a key issue, with for example the political economy in Ghana favouring road investments over NMT and rail [58].

There is little progress on the following options: QW 5 (Low-emission zones), which is not discussed in any project country yet with no clear examples in other LICs and MICs; QW 6 (Pricing for car-related travel) is being considered and discussed but with little implementation; and QW 9 (Freight efficiency improvements) with progress limited to isolated projects in some countries. This may be due to governments considering freight as the domain of the private sector and the complexity of such projects and plans.

Tables 2 and 3 show that more QW policy activity is taking place than reported in climate plans. Table 2 shows that diesel quality standards and import restrictions are included in only a few climate strategies. In addition, electric two- and three-wheelers are missing in climate plans, even though there has been policy progress in recent years, for example in India's electric vehicle support scheme FAME [59]. To some extent the same is true for SUMPs and freight efficiency measures. On the other hand, car-related pricing measures are mentioned in climate plans but with limited progress in policy development.

Although the reasons for these reported differences are beyond the scope of this paper, possible explanations could be that for some measures (e.g., vehicle import restrictions, diesel quality standards and SUMPs) the climate benefits, which are partially based on the warming potential of black carbon, are not explicitly recognised. It may also be that in climate plans, urban passenger transport and alternative fuels are better represented than freight and two- and three-wheelers [60].

It may also be noted that climate change reports are often from 2016 or earlier, whereas recent literature from 2017 and 2018 was used in Table 1. Electric two- and three-wheelers and SUMPs may have only recently received more attention and are therefore better reflected after 2017.

In summary, from an examination of the QW mitigation potential, QW in climate plans (top-down perspective, Section 3), QW implementation status, and QW perceived feasibility (bottom-up perspective, Section 4), the following observations can be drawn:


It should also be noted that some of the highly rated QWs are measures that are typical for LICs and MICs and are often less relevant for HICs, for example diesel quality standards, truck import limitations, electric two- and three-wheelers, and paratransit reform.

#### **5. Discussion**

#### *5.1. Interpretation of Results and Limitations of Data and Method*

The results presented here can be considered fairly robust. Nevertheless, the following caveats are noted. In the primary data collection (online questionnaire survey and interviews), nearly all of the respondents are from the transport sector. They may have knowledge about energy and environmental issues, yet their perspective and priorities may differ from experts that are primarily from the energy, industry and environmental sectors. This may impact the QW prioritisation outcome to some extent. In addition, most of the survey and interview respondents are from Africa.

The literature review covered a range of sources from peer-reviewed literature, grey literature, government reports and media articles, mostly from the last two years and nearly all more recent than 2012. It covered all focus countries and QWs. Although non-exhaustive, it provides an up-to-date picture of the literature on QW implementation and mitigation potential in the nine countries. The scoring of the implementation status involved a certain degree of subjectivity, both from a methodological perspective in assessing level of policy development and scope. For example, a large country such as India is not comparable to a small country like Ghana when it comes to implementation of NMT at the local level. Finally, the mentioning of a policy measure in climate plans does not necessarily mean it will be implemented and in what way (i.e., scope and level of ambition).

#### *5.2. Climate Change Strategy Development Process and Quick Wins*

Climate policy is still a relatively new phenomenon. Since the adoption of the Paris Agreement in 2015 it is higher on the political agenda, and developing countries realise that the climate change policy framework is here to stay. The Paris Agreement climate reporting mechanisms (NDC/BUR/NC) have resulted in developing countries thinking about aspects of low-carbon transport, as shown in [8] for Southeast-Asian countries.

LCT strategies require actions from a variety of government agencies. Transport-related agencies such as national or local transport or planning bodies develop and implement Avoid and Shift interventions while Improve measures related to vehicles are often in the mandate of other agencies such as national ministries of environment, energy, finance and industry [62]. Some options may involve all these stakeholders. Therefore, to develop a comprehensive climate strategy for the transport sector, collaboration and coordination between these various agencies is required. The NDC process has been shown to help inter-ministerial coordination for LCT in some Southeast-Asian countries, including in Indonesia [8]. However, various agencies may have different and sometimes conflicting objectives, for example, producing cars and reducing congestion, as was raised by an Indonesian respondent.

QWs may be an opportunity to improve integration of transport in climate change plans. However, more actions are being developed and taken than currently included in climate change plans. These can be discussed in future inter-ministerial processes for LCT strategies. In this way, QWs can act as an important bridge between the top-down and bottom-up perspectives on LCT, as described in Sections 3 and 4 above (Figure 4).

To further promote development of QWs as well as their integration with climate strategies, more information and analysis about how to implement these is required. This also requires more information about the mitigation potential of QWs for each local context, as well as distributional effects on various social groups and sustainable development benefits. International organisations such as the International Energy Agency, UN Environment and multilateral development banks also have a role to play as various global or regional initiatives are supporting QWs, in particular diesel quality standards, fuel economy policy, SUMPs/NUMP, NMT, electric vehicles (though not focusing specifically on two- and three-wheelers) and green freight [15]. Examples of such initiatives include the Global Fuel Economy Initiative, Mobilise Your City, Global Green Freight Action Plan and the Electric Vehicles Initiative.

**Figure 4.** Quick wins can connect top-down climate and bottom-up transport perspectives on low-carbon transport. (Source: authors).

#### *5.3. Broader Context of Long-Term Decarbonisation*

QWs have a key role to play in climate change mitigation; however, they are only part of the package of measures that is required to bring the transport sector onto a 1.5-degree pathway. Moreover, QWs do not substitute large-scale investments in low-carbon infrastructure (e.g., rail, waterways, and electric vehicle charging) infrastructure and vehicles that have to be taken in the short to medium term in order to avoid a long-term lock-in into high-carbon transport systems. Given the long lead time of planning required for such infrastructure to be operational, decision-making processes require a focus on low-carbon infrastructure investment.

#### **6. Conclusions**

For transport policy makers in LICs, climate change mitigation is generally not a high priority. Therefore, GHG reduction can be seen as a co-benefit of sustainable mobility. LCT interventions are those that are implemented to improve access, reduce congestion, increase equity, improve air quality and energy security, yet that also contribute to climate change mitigation. In this way, the transport sector can contribute to achieving climate objectives stipulated in the NDCs.

LCT QWs are interventions with high sustainable development benefits and can be implemented in the short-term. They can be seen as a bottom-up approach to integrate sustainable mobility options in climate change strategies, or in other words, can operationalise low-carbon development in the transport sector. This paper presents 10 such QWs. As the climate change mitigation potential of these is significant, they can play an important role in short-term decarbonisation of the transport sector and help to achieve long-term targets required under the Paris Agreement.

Analysis of nine LICs in Africa and Asia shows that fuel economy policies and NMT infrastructure are the QWs that are included most often in climate change strategies: six or more countries do so. Fossil fuel subsidy reduction, secondhand vehicle import restrictions, pricing measures, and diesel quality standards are included by 3–5 countries. SUMPs, electric two and three-wheelers, LEZ and freight efficiency by zero or one country. However, when investigating policy development in the nine countries, it appears more is happening than the climate change reports are showing. For example, most countries are pursuing diesel quality standards, import restriction, and, to a lesser extent, promotion of electric two- and three-wheelers, even though the climate reports do not show this. It should also be noted that these three options together with, for example, paratransit reform, are measures that are typical for LICs and MICs and are less relevant for high-income countries. In addition to these options, stakeholders in the nine countries prioritised SUMPs, NMT infrastructure, and fossil fuel subsidy reduction. However, low-carbon freight options are emphasised less by

stakeholders, literature, and current policy development, yet freight is responsible for 36% of carbon dioxide emissions from the land transport [12].

Based on the analysis of LCT QWs for LICs, the following recommendations can be made. Firstly, more country-level analysis on the various costs and benefits, including distributional impacts, mitigation potential and sustainable development impacts of QWs, would be beneficial in enhancing the knowledge base and awareness. Secondly, each QW requires a detailed analysis of design options to implement the measure, specific for each local or national context. Finally, improved coordination and collaboration between transport authorities (mainly Avoid and Shift measures) and agencies focusing on energy, industrial and environmental aspects of vehicles (mainly Improve measures) is key in bridging the top-down and bottom-up gap and achieving low carbon transport in LICs in Asia and Africa.

This paper contributes to a growing body of literature that connects transport and climate policy. It particularly increases the understanding of how transport-related policies and measures can support climate strategies in LICs while also contributing to sustainable development.

**Supplementary Materials:** The following materials are available online at http://www.mdpi.com/2071-1050/11/ 16/4369/s1, Matrix on low-carbon transport measures in climate plans, and http://www.mdpi.com/2071-1050/11/16/ 4369/s2, Quick wins implementation status matrix.

**Author Contributions:** Conceptualization, S.B., K.P.; methodology, S.B., K.P., S.G., N.M., G.J., G.H.; investigation, S.B., J.R., G.J., N.M., S.G.; formal analysis, S.B., N.M.; writing—original draft preparation, S.B.; visualization, S.B., N.M.; supervision, K.P., G.H.; writing—review and editing, G.H., K.P., G.J.; project administration, A.Y.; funding acquisition, A.Y., K.P. All authors have reviewed the entire manuscript.

**Funding:** This research was funded by the UK Department for International Development's (DFID) Applied Research Programme in High Volume Transport, Theme 3—Low Carbon Transport by DFID.

**Acknowledgments:** Feedback on a draft version by DFID and the comments by the anonymous reviewers are greatly appreciated.

**Conflicts of Interest:** The authors declare no conflicts of interest.

#### **References**


© 2019 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).

## *Article* **Addressing the Linkages between Gender and Transport in Low- and Middle-Income Countries**

**Tanu Priya Uteng 1,\* and Je**ff **Turner <sup>2</sup>**


Received: 1 July 2019; Accepted: 8 August 2019; Published: 22 August 2019

**Abstract:** The Millennium Development Goals (MDGs) specifies gender equality and sustainable development as their two central priorities. An area of critical importance for sustainable and gender-fair development is mobility and transport, which has so far been neglected and downplayed in research and policy making both at the national and global levels. Rooted in the history of the topic and the emerging ideas on smart, green and integrated transport, this paper presents a literature review of on gender and transport in the low- and middle-income countries. The paper presents a host of cross-cutting topics with a concentrated focus on spatial and transport planning. The paper further identifies existing research gaps and comments on the new conceptualizations on smart cities and smart mobilities in the Global South. Due attention is paid to intersections and synergies that can be created between different development sectors, emerging transport modes, data and modeling exercises, gender equality and sustainability.

**Keywords:** gender; transport; accessibility; smart city; smart mobility; low- and middle-income countries

#### **1. Women, Development and Transport**

There is a growing recognition, both among the research and the practice communities, that societies across the world are undergoing rapid mutation processes due to convergence of various forms of mobilities. The physical and virtual mobilities are intersecting at an ever-increasing pace in sync with what was originally discussed under the 'sociology beyond societies' [1] and the 'new mobilities paradigm' [2]. Yet, access to mobilities remains fractured and is unevenly distributed. Here, we would like to clarify the basic position of this paper—transport is distinct from mobilities. Mobilities encompass dimensions like access to opportunities, quality of life and wellbeing of people. The fact that the transport sector is among the top three contributors to GHG emissions, the biggest consumer of non-renewable energy and has most negatively contributed towards climate change, makes it a suitable candidate for further analysis in light of the mobilities agenda, particularly for the low- and middle-income countries (LMICs; the paper uses the terms developing economies, Global South and low- and middle-income countries (LMICs) in an interchangeable manner).

Unabated urbanization and a voluminous growth in personal motorization (driven solely on non-renewable energies) remains one of the key challenges in developing economies. Motorization is expected to continue to increase at an unprecedented rate in the developing parts of the world [3]. Urban areas in these parts are experiencing a dramatic increase in air pollution, roadway congestion, noise, health issues and traffic accidents as a result of increased car ownership. This is occurring in conjunction with substantial shifts from active modes to motorized modes, and a categorical lack of focus on public transport. Thus, issues concerning the environment, climate and renewable energy gains paramount importance here. Increasing public transport usage and a behavioral shift towards

reduced consumption seems to be the only realistic way to curb the negative effects on environment, climate and energy usage. For example, the urban population in India shot from 17% in 1951 to 32% in 2011 and is expected to rise to 35% in 2021 [4]. In absolute numbers, it is estimated that 91 million joined the ranks of urban dwellers in the 2000s. Regarding vehicular growth, 35% of the total vehicles in the country are concentrated in the metropolitan cities alone, which constitute just 11% of the population. Though public transport usage is high, the share of buses is negligible—two-wheelers and cars constitute 90% of the total vehicles on the road in contrast to buses, which constitute less than 1% of the motorized vehicles [4]. In the transport arena, the associated risk, uncertainty and irreversibility (RUI) issues gets exacerbated by the fact that decisions like constructing a highway or major road projects are both resource consuming, practically irreversible and generally operate on longer time horizons [5,6]. The dominance of road building exercises in the Global South, despite the majority of people walking or cycling, highlights that firstly, policies and investment decisions are based on imperfect and incomplete knowledge of the relationship between increased motorization and energy issues, climate change, etc. and secondly, there is a strong lack of a context-based planning methodologies/approach.

Simultaneously, for the first time in the history of policy-making and implementation, both Global North and South are immersed in resolving ways to restructure urban governance in light of Agenda 2030 as many of the areas targeted by the Agenda 2030 s 17 objectives are linked to social sustainability and yet ways and means to achieve these objectives remain diffuse. This is particularly the case for gender-based analyses and policy-making. As Razavi [7] notes "In the end, while six of the 17 goals include gender-specific indicators, the indicator framework under five of the goals can be described as 'gender-sparse' (Goals 2, 10, 11, 13 and 17) and for the remaining six critical areas it is depressingly 'gender-blind' (Goals 6, 7, 9, 12, 14 and 15) [8]." The reasons for this apparent gender neglect are many and diverse but one of the simplest explanations is that gender as a category of analysis is difficult to constrain in simple indicator-based systems, more so for systemic issues like climate change urban planning and transport. In the field of urban development and transport, the issue gets further complicated in the Global South, which does not have a strong quantitative data collection and analysis tradition, and thus social sustainable perspectives on thematic issues like accessibility, universal design, gender and diversity mainstreaming, equity, power and influence on planning and decision making, seldom finds its way in discussions and analyses influencing policy making. The primacy of forecasts (based on existing travel patterns) and technical models rule the roost and even when certain trends like 'women exhibiting more sustainable travel behavior than men' [9,10] are established, the prevailing norms of the sector simply do not allow for alternate ways of planning to emerge [11]. Even in societies with a firm agenda on gender equality like Sweden, research suggests that decisions on infrastructure investments and processes followed to reach these decisions are rarely in sync with the broad goals specified in the official documents [12].

This paper builds on the preceding arguments and is positioned in the domain of development planning with particular reference to spatial and transport planning. The paper explores the topic of gender, transport and mobilities in low- and middle-income countries and reflects on critical research gaps emerging from this review. A further layering to the discussion on mobilities/accessibility is provided by the 'smart' city agendas and smart mobilities, which currently pervades discussions undertaken in urban and transport planning domains across the world. The paper structures its arguments with due regards to the digitalization and smart agendas being currently discussed.

Our aim has not been to discuss one particular agenda in detail and given the multiplicity of topics covered in this literature review, we have borrowed from a number of theories. Section 2 highlights some relevant theories while Section 3 presents an overview of the current research findings and gaps identified under a host of topics including access to various opportunities and the issue of safety. Section 3 also highlights the spatial issues of the urban, peri-urban and rural areas of the Global South. The elements of cross-border trading and its importance for women are also discussed in this section. Section 4 initiates a discussion on the methodologies and data needs for addressing the topic of gender,

transport and mobilities, while Section 5 presents the identified research gaps to be addressed in future studies. Section 6 concludes the study.

#### **2. Theoretical and Methodological Underpinnings**

In this paper, we reviewed the current status of research knowledge available in the Global South and the research gaps to be addressed in future studies. Our aim was not to discuss one particular agenda in detail and given the multiplicity of topics covered in this literature review, we borrowed from a number of theories.

The complexity of the transport domain calls for a multi-theoretical approach, which considers macro level perspectives as well as the micro determinants for individual attitudes and behavior. Such theoretical foundations are not readily available and need to be constructed through bringing a host of theoretical standpoints to reflect on the theme of gender and transport in the Global South.

We present some relevant perspectives that hold the potential for taking the inclusivity agenda forward. Though the theories, we briefly touch upon here, have been discussed in the domain of travel behavior, they have not been processed to reflect on gendering of travel behavior. This lack gets further pronounced when the current mores of planning smart cities and smart mobilities are put under scrutiny. We propose that these theories merit further deliberation and have the potential to insert a thematic focus on gendered mobilities into discussions related to governance and innovations.

#### *2.1. Social Psychological and Feminist Theories*

Taking the element of perceptions forward, social psychological theories related to norms, emotions, attitudes and behavior could be further employed to illuminate peoples' opinions and sensitivity toward socio-technical conditions in the context of everyday travel and likely social and cultural trends. A key issue is also to map various 'cultures' and the gendered variations within different cultures for coping with changing mobility conditions. Relevant theories in this context are the theory of planned behavior [13], norm activation model [14] and theories including habits (e.g., [15]). Dijst et al. [16] provide a good discussion of different attitudinal models for understanding both the gendered nature of travel behavior and the kind of smart interventions, which promises most sustainable solutions.

Taking the agenda of prevalent norms, social and cultural practices, relations and organization of roles of institutions and the subsequent phenomenon of gendering [17,18], the feminist theory insists on studying gender both at the individual level but also at the organizational or institutional levels [11]. Feminist theory can be specifically employed in two particular ways to examine the field of transport [19,20]:


#### *2.2. Socio-Technical Transition Theory*

Socio-technical transition theory [21–25] builds on the premise that environmental problems represent major societal challenges, whose solution requires structural changes in key areas of society. A socio-technical transition is defined as " ... a major shift or step change, in which an existing socio-technical system—a cluster of aligned elements including technology, regulations, consumer practices, cultural meanings, markets, infrastructure, scientific knowledge, supply and maintenance

networks—is durably reconfigured" [26] (p. 1003). A key idea is that large-scale transformations are initiated by ongoing activities in small-scale networks (niches), which over time change prevailing practices, competences and knowledge that constitute the existing (transport) system.

The basic ethos of the socio-technical perspective is that transitions are non-linear processes that result from the interplay of multiple developments at three analytical levels: "Niches" (the locus for radical innovations), "socio-technical regimes" (the locus of established practices and associated rules) and an exogenous socio-technical "landscape" [24]. Within the transport system, various "green niches" have emerged like new mobility systems based on mobile ICT technology and electrical vehicles.

In discussing the gender component of mobilities, socio-technical transition theory is relevant since (i) it draws attention to a broad range of elements and actors and their interactions, (ii) analyses of past transitions tells about factors conductive to change and (iii) it shows the social interpretation of technology [26]. This conceptual framework can be applied in understanding both the social trends and driving forces, along with perceptions and access to solutions.

#### *2.3. Mobility Biographies Theory*

The biological markers of a woman's life have traditionally underpinned her freedom to negotiate the inside-outside boundaries. This is particularly true for adolescent girls and young mothers in the GS (Global South) affecting decisions to continue education, employment and seeking health interventions as accessing all the three domains remains interlinked with accessing spaces beyond the confines of home. In light of the importance of life-events, a useful theoretical departure is offered by the life course approaches or 'mobility biographies'. This strand of research in travel behavior studies underpins that both travel demand and needs change over the life course of individuals. Mobility biographies emerged as a reaction to the aggregate results emerging from analyses of travel surveys where travel demand on an individual level appeared to be relatively stable in the medium term. Once disaggregated by key turning points in life like changes in the places of residence, childbirth, education and employment [27], daily travel behavior underwent marked changes as the spatial distribution of activities and associated activity spaces altered.

The concept is further unpacked by Scheiner [28] as being embedded in other 'partial biographies', namely residential biography, employment biography and household biography. Studying 'mobility biographies' includes studying the tools, practices and context affecting daily travel behavior, and topics like ownership of mobility tools (such as cars, and access to public transport), factors influencing people to start, stop or significantly change their mobility behavior [29] become important sub-headings to be studied. Most of the studies employing this theory are from the Global North—for example, Chatterjee [30,31] confirm the effect of life course and turning events on the uptake of cycling, Clark [32] expands on the case of car-ownership while Priya Uteng et. al. [33] broach on the topic of car sharing. Thus topics like contextual change, intrinsic motivations, facilitating conditions and the interactions between structural factors and human agency take center stage in discussing travel behavior. The policy implications of studying when and how mobility behavior changes can open up a 'window of opportunity' to plan for and maintain (desired) behavioral changes [34].

From a methodological perspective, this approach urges us to go beyond the purview of quantitative studies and engage with the narrative-interpretative inquiries into the meaning and complexity of mobility biographies. This typology of engagement in the transport sector, even in the developed economies with a relatively matured transport research arena, remains scarce [35].

#### *2.4. Social Practice Theory (SPT)*

Social practice theory (SPT) attempts to bridge the gap between two primary approaches of treating human behavior—the *homo economicus approach* emphasizing that social order is a combination of individual purposes, intentions and interests and the *homo sociologicus approach*, which relies on the collective norms and values [36] (pp. 245–246).

Rather than treating these two entities of individual vs. collective as mutually exclusive domains, SPT urges us to conceptualize the body, mind, things, knowledge, discourse, structure/process and agent to localize the social within the practice as the main unit of analysis [36]. This essentially means that we focus on both the local or micro phenomena and large social phenomena [37].

SPT defines a practice as a routinized behavior consisting of a set of interconnected elements of *materials, skills and meanings* associated with a practice [36,38]. SPT provides a framework for analyzing the recruitment and retention mechanisms through seeking answers—how practices emerge, how they persist and how they are abandoned—and through analyzing both the product/service providers as well as their users and adopters.

Merging these different theories allowed us to combine results on in-depth analyses of day-to-day behavior with the broader perspectives of policy-making to comment on the fundamental question of "How do practices envisioned in policy-making and those who carry them actually intersect?".

#### **3. Current Research Findings and Gaps**

In the following points, we present some consistent findings emerging from studies focusing on gendered mobilities in the developing countries [9,10,39]:


We looked up the following terms in literature search covering both published works and grey literature (from UN and other development organizations and consultancy reports) to consolidate the findings emerging from across the Global South: Gender and transport ; Women and transport; Gendered moblities; Women and safety; Urban Women and safety, Transport; Women and cross-border trade; Women, development schemes in low-income countries/LMICs; Access to education, health and employment in LMICs; Urban and rural accessibility, women; Transport and post-disaster rehabilitation; Gender and space; Transport, capacity building; Women, informal transport; Women, informal employment; Transport in developing countries—methodologies; Transport in developing countries—data needs.

In the following sections, we briefly present both the established and emerging issues to frame the problematic of gendered mobilities.

#### *3.1. Access to Education*

Linkages between transport, (im)mobility, spatial/social stagnation and resultant poverty in Asia and sub-Saharan Africa have been well established. Instead of being an isolated issue of cultural restraints imposed on girls or a lack of physical access to schools, these two often intersect towards girls' low educational achievement. A study from Morocco highlights that in girls attending primary school tripled to 54% in the area of influence of major paved rural roads, while similar jumps were evidently absent in areas where physical accessibility was still an impediment [40]. Porter [41] presents research findings from a three-country study (Ghana, Malawi and South Africa) where it was consistently found that girls living in remote rural areas with poor roads and poor or expensive transport services were unable to access schools due to an interplay of a variety of cultural, economic and social factors. One of the cross-cutting factors, especially for young girls, is their contribution in the household chores. In the highland village in Malawi, it was found that a significant majority of the students were absent from school on the market days, held twice a week in the nearby towns. Girls were expected to headload local products for sale to the town, which becomes a time-consuming weekly routine since the villages were approximately 8 km from the paved road, with an irregular and erratic supply of public transport. There are myriad examples available from across the developing world, which will confirm the same (refer Box 1). In such circumstances, the inevitable outcome is that girls in remote rural areas often do not obtain even a basic education and further opportunities to develop a livelihood are severely curtailed.

#### **Box 1.** Cycling to school: Increasing secondary school enrollment for rural girls.

An innovative program was launched in one of the poorest states of India, Bihar, with an aim to reduce the gender gap in secondary school enrollment by providing girls who continued to secondary school with a bicycle that would improve their physical access to school. Using data from a large representative household survey, Muralidharan and Prakash [42] find that being in a cohort that was exposed to the Cycle program increased girls' age-appropriate enrollment in secondary school by 30% and simultaneously reduced the gender gap in age-appropriate secondary school enrollment by 40%. Distance to the nearest secondary school was a crucial element, and increases in enrollment mostly took place in villages where the nearest secondary school was further away. This suggests that the program was most effective in reducing the time and safety costs of school attendance by providing a bicycle. The Cycle program was deemed as being more cost effective at increasing girls' enrolment than comparable conditional cash transfer programs in South Asia.

Coordinated provision of bicycles or other accessible modes (school bus for a cluster of villages etc.) to girls has the potential to generate externalities beyond the cash value of the program. The cycle program went beyond the mere provisioning of a transport mode, and included positive externalities like improved safety from girls cycling to school in groups, and changes in patriarchal social norms that typically discourages and condemns female mobility outside the village, inhibiting female education and employment at large.

An extensive review of the data across 24 rural, peri-urban and urban sites is now available [43] pointing to major issues around mobility for education, even in urban areas, associated with cost and availability of transport as well as the constraints imposed by demands for children's work within the household.

#### *3.2. Access to Employment Opportunities*

Employment in the informal sector dominates the livelihood landscape in the developing countries. Even though the official numbers are typically conservative estimates, they remain staggeringly high—48 percent in northern Africa; 51 percent in Latin America; 65 percent in Asia and 72 percent in sub-Saharan Africa [44]. In the transport domain as well, informal sector dominates both in terms of absolute numbers of vehicles on roads and in the number of people, mostly men, employed in this sector. The informal modes—para-transit and non-motorized transport modes (NMTs)—are primarily the main public transport modes available in a number of developing countries. They form the main carriers of both the vast majority of population and of informal economies. Despite their pivotal role in connecting people to different opportunities, para-transits and NMTs are either unrecognized in

the transport plans or in some instances, rules and regulations insist on either removing them from circulation or barring their access on the main arterial roads.

Non-motorized modes like bicycles and rickshaws and para-transit play a significant role in the lives of women who are dependent on these modes to access employment and other opportunities [39,45]. In urban areas, where often zoning legislation separates commercial from residential areas, women remain the hardest hit if transport accessibility is affected in negative ways. The same is true for women in rural areas as well since they remain dependent on others to sell their products in the regional markets thereby minimizing their control over the profits. Further, availability, affordability and acceptability of transport remains contested. Most formal public transport supply caters to peak hours facilitating the formal sector workers. Additionally, the issue of pricing, and the physical safety of women on public transport also impact their freedom of movement.

The case of Bangladeshi garment workers invokes how a lack of focus on physical accessibility, particularly in the form of safe and reliable public transport, is counterproductive to the issue of making women financially independent and active participants of the society. The ready-made garments (RMG) industry of Bangladesh is a booming industry, which exports to over 30 countries in the world, employing about 1.8 million workers of which 1.5 million were women [46]. On one hand, this case can be celebrated as a major breakthrough of female employment in established sectors and yet a mere scratching of the surface of this success story reveals how both living conditions and capacity to save is severely affected by a categorical lack of affordable transportation facilities for workers on limited wages [47]. For example, planning decisions in Dhaka prohibits cycle rickshaws to drive on certain major roads where several garment factories are located thus putting a ban on the most viable transport mode for the female garment workers. Sharp differences in living conditions and saving potentials were further found among female workers who worked in factories proving bus transport as compared to workers who did not have access to such provisions (for detail discussion, refer to [10]).

Female employment in the Global South is also often within the premises of the household in a format popularly known as home-based manufacturing, which typically ranges from garments, consumable products to providing ancillary product creation for various industries. The savings potential of women employed in the home-based sectors vary greatly depending on physical accessibility to markets as illustrated through the case of home-based garment producers in Ahmedabad, India [48]. She concludes that development decisions need to include a focus on spatial mobility to improve livelihood outcomes of female producers and depending on the sector's market characteristics, an important intervention facilitating women producers could be improving access to the range and quality of markets available to them [48].

Microenterprise credit programs have received innumerable support in the past decades and a Nobel prize simply bolsters the effectiveness of this solution in addressing female empowerment. However, these mechanisms to support women's income generating opportunities and economic empowerment have been contested [49–56] and Omorodion [53] points to the inconclusive nature of the micro-credit programs in improving the economic situation of women. A reading on the topic of daily mobilities highlights that economic empowerment and mobilities remain interlocked. The first issue has already been raised in the previous point and concerns direct access to market. Women's inability to access markets and directly sell their products and make networks to access information greatly inhibits their saving potentials. The ability of this section of women to virtually access information and networks through mobile phones remains contested. Further, lending institutions need to take the accessibility criterion in consideration and locate their outlets for repayments close to markets, training centers and in communities involved in the program, enabling the women to make repayments without social and physical obstructions. The case of Esan women in Nigeria [53] highlight "The lack of financial institutions in rural areas meant traveling long distances to make loan repayments also contributed to the failure of the micro-credit schemes in Esan communities". Nigam [57] reinstates this point through assessing microcredit schemes in five countries—Nepal, Viet Nam, Egypt, India and Kenya. He states that the credit schemes can be truly effective in reducing the worst manifestations of

poverty only when credit dole outs operate in combination with basic social services. Access to market, repayment nodes, basic education and training are among the most vital elements of such services (refer Box 2).

#### **Box 2.** Spatial mismatch.

The comparative analysis of working and non-working women's mobility in Navi Mumbai, India [58] reveals that economic empowerment coupled with improvement in literacy levels could result in three to four-fold increase in an average women's mobility. The time and activity pattern study of the working women reflects greater obligatory time requirements, which results in lesser time for travel in comparison to those observed in more developed societies. It was also observed that there are spatial mismatches between the distribution of low paid female jobs and locations where low-income women live resulting in longer commuting by low income women compared to high income women. The working women also are greatly dependent on the safe, reliable and affordable mass transport systems for their long work trips journeys.

*Resettlement*/*subsidized*/*a*ff*ordable housing schemes.*

One of the most prominent responses of city governments, across the developing world, to the issue of slums and squatter settlements has been resettlement schemes, variants of which can be found under the name of subsidized and affordable housing schemes. These resettlement colonies are typically located in the peripheral edges of the city with poor or no public transport connection. The most immediate response to these resettlement programs has been the loss of livelihood for women, which were originally anchored in walking distance of the slums. The mesh created by distant relocation, inadequate transport services with respect to frequency, connectivity and affordability, unsafe public space designs (primarily bus tops, access pathways) invariably and continuously hits low-income women the hardest. Acknowledgement of these issues, and planning of residential housing areas, which are either mixed land uses or zoned with adequate provision for accessible services and employment opportunities continues to elude development authorities, donor organizations and development sector at large [10,59]).

#### *3.3. Access to Health Services and Well-Being*

Figures state that between 50%–60% of people in poor countries live more than 8 km from a healthcare facility [60]. Mortality rates for women in time-critical medical emergencies related to childbirth and infant illnesses continue to be high in a large part of the developing world simply due to a lack of availability of access to these health centers [61]. This is typically manifested in form of either lack of transport options, unaffordability or a combination of both (Mlay et. al. [62] illustrates this point through the case of Tanzania and similar case findings from Ethiopia are brought forth by Hamlin [63]). Similarly, to illustrate the prevalence of this incidence in all parts of the developing world, a study from Cebu in the Philippines quantified the (strong) association between infant, child and maternal mortality rates and distance to healthcare services [64] by calculating that a 10% increase in distance from a hospital was associated with a 2% increase in all three mortality rates.

The issue of head-loading continues to plague health deficits of women and is directly linked to their mobility burdens. For example, figures derived from 276 women fuel carriers sampled in Addis Ababa highlighted an average load of 36.2 kg (i.e., 75% of body weight) being carried for an average trip length of 11.7 km, and close to 17% of the women were carrying loads heavier than their body-weight [65]. With reference to the maximum carrying weight of 20 kg recommended by the ILO (International Labor Organization), it is not surprising that these women suffer from eye, chest and back pains coupled with high rates of miscarriage. Porter et al. [66] presents an analysis of load carrying impacts on children from 24 urban and rural research sites in Ghana, Malawi and South Africa, emphasizing substantial detriments to both children's health and their education. A full review of likely health impacts of head loading in sub-Saharan Africa highlights the need to build scientifically validated evidence base with health professionals.

The incidence of HIV has also been linked to transport availability and spatial concentration of medical services. Several cases from Africa highlight that comprehensive HIV services, primarily provided through hospitals, remain inaccessible to rural population. The cost of transport to these facilities is often high, and Amnesty International calls for a meaningful consideration to the transport

needs of economically and socially marginalized people, especially rural women at risk of or living with HIV.

One of the research gaps identified so far is that there is little recorded evidence in the form of research studies to highlight the constrained access of urban low-income women to health services. Most of the studies in urban areas have focused on the quality, patient–provider relationships, accountability and affordability of the health services [67]. However, referral services like assisted or non-assisted transport services have been rarely studied in the urban areas of the developing economies, except for studies such as that by Murray et al. [68] that focused on Lusaka, Zambia and there is need for much more rigorous research work.

Essentially, even in the urban areas, women and girls experience maternal death and a myriad of health-related problems for reasons similar to what has been consistently found in the rural areas—lack of affordable and reliable transportation to clinics and hospitals. A combination of lack of ambulance services to the urban slums and unaffordable public transport often leave women in extremely dangerous conditions [69,70]. During a focus group conducted with female residents of Bwaise slum in Kampala, Uganda, it was revealed that women were restricted by financial resources and distance. "It took at least one hour to walk from Bwaise to the nearest health centre, and there are reports of women giving birth en route. The only vehicular access to health centres is by boda-boda (motorcycle taxis) because of the poor conditions on the surrounding roads" [71]. One of the concrete suggestions put forth by the female slum residents was provision of an ambulance station (or a designated pickup point) in close vicinity of the slum.

#### *3.4. Humanitarian E*ff*orts, Post-Disaster and Post-Conflict Rehabilitation*

Massive humanitarian efforts and resources are put in the post-disaster/post-conflict rehabilitation processes. These processes of transitioning from relief to development offer unique opportunities to correct spatial development-related imbalances and reduce vulnerabilities to hazards [72]. However, decisions under these stressful circumstances are taken more as a response to establish immediate control rather than pre-mediated rehabilitation decisions with long-term consequences [73]. For example, the primary focus of post disaster investments in Honduras after Hurricane Mitch was on major arterial or secondary roads and not rural roads. Often, implementation of the transport sector's modern rhetoric of sustainability, gender and the environment are strangely absent. Post disaster reconstruction stages need to be streamlined to reconstruct with change thereby avoiding the creation of new vulnerabilities or exacerbating the existing ones. The International Forum for Rural Transport and Development [74] notes that 'prioritizing the rehabilitation of rural road networks to enable small farmers to access markets could potentially discourage post-disaster migration to vulnerable rural areas and urban slums. By continuing to listen to the needs of the poor in the post-disaster context, the transport sector has the potential to avoid creating new societies with even greater vulnerability.'. In light of the unprecedented urbanization taking place in the developing economies and issues like, which we expand on in the later sections of the paper, feminization of slums in the urban areas, cross-border trading in which women are heavily involved, inserting evaluation and implementation of accessibility modules in the rehabilitation processes becomes a necessity.

#### *3.5. Tra*ffi*c Injuries and Women*

The World Health Organization [75] reports that 90% of the world's road fatalities occur in low- and middle-income countries, even though these countries have approximately only half of the world's vehicles. Majority share of fatal injuries consist of 'vulnerable road users' comprising pedestrians, cyclists and motorcyclists. It is also reported that globally, three out of four road deaths are among men [76,77]. However, when we start analyzing disaggregated data in the low- and middle-income countries, a different picture emerges but is often under discussed as both access to and analyses of disaggregated data remains problematic in the low- and middle-income countries. For example, Ghanaian accident data highlights that over 40% of fatal road traffic accidents (RTA) involved pedestrians, and the majority of these were women [78].

As previous sections have highlighted, women constitute a major share of pedestrians in the LMICs owning to their livelihood options like street vending, hawking and unaffordability to use other modes of option than walking. Street vending across the LMICs operates through the modality of sharing road space with the motorized and non-motorized vehicles thus putting women in precarious situations. Further, Williams et al. [79] highlight the age dimension specific to the case of LMICs where the incidence of falls among elderly women remains much higher than men.

The intersectionality of traffic injuries remains an understudied topic, particularly in the LMICs. Reasons and the particular ways in which women are or become victims of road accidents needs further probing [80].

#### *3.6. Safety, Smart Cities and Smart Mobilities*

It is not new knowledge that women across the world are more fearful of crime than men. This fear gets accentuated by a combination of limitations to defend themselves in face of physical attack and a greater propensity to transfer past experiences and memories of victimization to present [81]. For example, in Chennai, India, 66 percent of female respondents stated that they have been harassed while commuting [82]. A series of studies document the prevalence of fears and concerns about safety in the developing world. They plot how such fears influence travel decisions taken by women and can have a substantial impact on both the volume and timing of ridership. In tandem with the main findings from a U.S. based study [83], studies from the developing economies come to similar conclusions—there is a significant mismatch between the safety and security needs and desires of female passengers and the types and locations of strategies public transport agencies use [59,84–89]. Studies focusing exclusively on safety concerns of women on their daily travels are scarce in the developing world. However, the ones that have studied this topic unanimously assert that safety concerns have strong contextual determinants—public lighting, characteristics of sidewalks, isolation and neighborhood characteristics [90]. Perceptions of insecurity in a variety of urban environments—at the bus and rail stations, on their way to and from the bus and rail stations, etc.—are a primal force restricting women from achieving their maximum potential not only in education, employment and health, but in their general well-being.

A major criticism of the smart cities approach is the gap between the technical/digital approach and quality-of-life approaches. Lauwers and Papa [91] claim the shift from conventional mobility planning towards smart mobility is primarily applying new technology to existing infrastructures instead of creating better solutions. For example, buses are being retrofitted with tracking devices rather than increasing public transport supply and checking outcome measures such as access to work, education, etc. In this sense, smart mobility concerns itself primarily with innovative technological or consumer-centric solutions rather than adopting a social sustainability lens to the entire mobility agenda.

Studies exploring the under-delivery of smart solutions for women are restricted to the Global North, but they have conclusively established the fact that smart solutions can be highly exclusive. Shaheen et al. [92] studied 23 bike-sharing programs in North America and found that the main obstacles identified for low-income groups were the need for smart devices, debit/credit cards, minimum bank balance or deposit to cover for vandalism or theft. Although there has been a considerable increase in smartphone users in most developing countries, and this continues to grow, the actual penetration level by population remains less than 50%. Further, there are examples of significant disparities in access to smart phones between men and women in some Asian and African countries. For example, women in India between the ages of 15–65 are 46% less likely than men to own a mobile phone, while in Bangladesh and Rwanda women of the same age group are 62% less likely than men to use the Internet (for details, refer to Box 3).

#### **Box 3.** AfterAccess: Uncovering the gender gap.

AfterAccess is a large-scale data collection initiative aimed at compiling comparable information and communication technology indicators for countries in the Global South. The survey has focused on creating comprehensive mobile and Internet use database for the Global South. Funded by IDRC and conducted jointly by DIRSI, LIRNEasia, and Research ICT Africa, AfterAccess surveys collect data on ICT access and use through household and individual surveys across 22 countries, covering a sample of 38,000 and counting. The sampling method allows for representation with a plus or minus 3% margin of error, and the sample sizes are large enough to allow for gender-disaggregation of the indicators collected. Among other factors, the surveys measure the gender gaps in mobile and Internet usage. The disparities reveal a sobering picture in some Asian and African countries. For example, women in India between the ages of 15–65 are 46% less likely than men to own a mobile phone, while in Bangladesh and Rwanda women of the same age group are 62% less likely than men to use the Internet.

Such analyses assist us in reflecting on the relevance of Smart Cities approach in current times. Before implementing smart solutions, which are primarily based on digital interface, we need to address the gender gap of women's (versus men's) access to and use of ICTs and gendered barriers of use to enable evidence-based policymaking.

Source: AfterAccess: Uncovring the gender gap (https://www.idrc.ca/en/research-in-action/afteraccessuncovering-gender-gap)

Another issue concerns the lack of digital literacy, knowledge, comfort and confidence to use smartphones. In many emerging economies, disparities in digital literacy compound disparities in basic literacy and reduce people's access to smart solutions and services.

Ride-sourcing (also known as 'on-demand-rides' or 'ride-hailing') is one of the most popular forms of smart mobility. However, there have been some considerable safety setbacks because cases of drivers sexually assaulting female passengers have emerged from across the globe. Given the emerging demand for safe transport services for women, women-only ride-hailing services (exclusively women drivers and passengers) have been launched in many countries, such as Riding Pink in Malaysia, LadyDriver and FemiTaxi in Brazil, See-Jane-Go in the USA and almost a dozen similar services in India. In Indonesia, where people often hitch rides, two women-only, motorcycle ride-hailing services, LadyJek and Sister Jek, were launched. Ways to factor in safety in the smart solutions need immediate and urgent attention [89,93].

On the positive side, apps like *Safetipin* facilitate mapping exercises that can greatly enhance weeding out unsafe spaces, corridors and routes (refer Figure 1). In 2014, Safetipin was launched in India to help women safely navigate the city by identifying its safe and unsafe zones [94]. It is a location-based mobile app that collects safety-related information and conduct safety audits of different places by calculating a safety score. Users of the app can identify how safe certain areas are and can plan their travel routes and timings accordingly. The safety audit is based on nine parameters—*lighting, openness, visibility, security, crowd, public transport (connectivity), presence of women and children, feelings of safety and presence of footpaths or walkways*. Safety scores for Nairobi are illustrated in Figure 1 (for further discussion, check [93]).

Each of the parameters, except for feelings (of safety), is measured objectively using a rubric and scored on a scale of 1 to 4 (from 'poor' to 'good' conditions). The safety data is available in multiple forms, including maps, reports and csv files, which can support urban stakeholders in making judicious urban planning and monitoring decisions, such as identifying areas that need more lighting, security, CCTVs and/or public transport at night. Safetipin has now extended to more than 20 cities, including some outside India, such as Bogota, Manila-Quezon, Jakarta and Nairobi.

**Figure 1.** Safety score for Nairobi (source: Safetipin [95]).

Such exercises have become relatively easy, cheap and accessible to planning authorities across the world. We urge a replication and continuous mapping of safety as part of the smart cities/mobilities agenda (for further discussion, check [93,96]).

The safety scores that Safetipin has generated in the case cities have driven city leaders to take action to improve women's safety. In Bogotá, Safetipin has assisted policymakers in helping to create a data-driven approach to women's safety in public space. City officials have been able to combine data based on the safety audits with other data sources in order to better understand urban problems. For instance, the city was able to overlay maps indicating Safetipin's security parameter rating with maps of police station locations and incidences of crime. Based on Safetipin data, the city identified five priority locations for interventions to generate a broader dialogue about women's safety at night that included local operative councils for women and gender, local women's organizations and citizens. These public engagement activities are key to educating people and changing people's perceptions and attitudes about women, gender and gender-based violence.

Data-driven approaches to women's safety are increasingly being adopted in other cities as well (for example, web-based interactive map campaign 'Free to Be' [97]).

#### *3.7. Feminization of Slums*

This section builds on the increasing feminization of slums and spatial development rationales. It establishes links between transport and housing policies and the need for these two sectors to work together to facilitate women's mobility.

Across a sample of 51 developing countries from Southern Asia, Latin America and sub-Saharan Africa, women are more likely to live in slums than men [98]. For a majority of the countries, there are 108 women living in slums for every 100 men in the same category. Living in slum conditions means that residents lack access to access to safe water, adequate sanitation, durable housing, sufficient living space and/or security of tenure.

For Kenya, housing the world's fifth largest slum by population size, there are 13 more women for every 100 men living in slum conditions. The figure is 15 or more women aged 15–49 for every 100 men of the same age group in other countries, including Swaziland, Gabon, Ghana, Cameroon and

Senegal. In Colombia about 11 and in Dominican Republic, Bolivia and India, about five more women aged 15–49 respectively live in slum conditions than their male counterparts.

There is a further spatial layering of center vs. periphery. Lima et al. [99] underline that land use in Recife's Metropolitan Area does not obey the center-periphery occupation pattern (European) or the periphery-center occupation pattern (US). This observation, however, is applicable to a host of developing countries. A common denominator to urban development in the developing countries is the fact that slums and poor communities are scattered throughout the municipalities, in conurbation with the richest neighborhoods. There are trends in some developing countries towards in-situ establishment and legalization of the slums. For example, in the case of Recife [100], through establishing special zones of social interests (known as ZEIS) in 1980s, legal right to the urban land of previously informal low-income settlements was recognized. This paved way for a spate of formal services being provided to the area to improve urbanization standards, provide basic infrastructure (e.g., sewage, drainage, pavement and water supply) and legal tenure of these settlements [100]. Contrary to this case, there are myriad cases of slum relocation and allotment of low-income housing in the peripheries of urban areas with little or no public transport available to these areas. Women remain the hardest hit group in these reallocation schemes with loss of employment and further isolation from income-generating avenues. Majority of slum dwellers in Kolkata predominantly walk (56%) for their travel needs followed by bus travel (26%) [101]. In terms of travel distance, nearly 50% of slum dwellers commute within 0.8 km, while 75% travel within 1 km. The percentage share of income on transport expenditure tends to increase for slum dwellers residing away from city centre, which exhibits that slum dwellers tend to limit their travel distance in order to optimize their travel expenditure. It was observed that with improved accessibility, per capita income of slum dwellers tends to increase due to better access to work opportunities. The per capita average monthly savings of slum dwellers is more sensitive with transport accessibility than accessibility to employment opportunity highlighting the importance of transport in improving standards of living of urban poor. In light of 'feminization of slums' (refer Figure 2), which is a rapidly increasing phenomenon, there is a need to understand the gender differences in this experience and report gender disaggregated travel patterns [102] (refer Box 4).

**Figure 2.** Urban females aged 15–49 living in slums for every 100 males aged 15–49 living in slums, 2007 or later (Source: UN Women calculations based on USAID 2018 [98]).

**Box 4.** Mobility, poverty and gender: Travel 'choices' of slum residents in Nairobi, Kenya.

Salon and Gulyani [103] present the gendered variations and the empowering potential of daily travels of female slum residents. Their findings are based on one of the most comprehensive travel data collected for slum population in the developing countries—survey of 4375 slum residents in Nairobi, Kenya. Analyses revealed that though majority of the slum population could not afford any of the motorized transport options in the city and coped by limiting their travel outside their settlement by often 'choosing' to walk, the burden of reduced mobility is borne disproportionately by women. Women faced distinct barriers to access, and though policies aiming to improve mobility and transport access for the slum population first and foremost need to address the issue affordability, but specific constraints faced by women needs additional support.

The story that emerges from our analysis is that both poverty and gender matter in explaining differences in the travel choices of working adults in Nairobi's slums. It is expected that poverty level would affect travel choices, but the gender effect that we find is surprisingly strong among adults. Characteristics of women's travel are systematically distinct from those of men in this population, even when controlling for poverty level.

Policy implications—four divergent policy implications emerge from their study, and other studies confirm that these are widely applicable in the developing contexts across the world:


For rural areas, the location of market and health centers, and access to vocational training and higher education gains paramount importance in ascertaining how much of the benefits finally percolate down to women. Specific and targeted interventions like providing cycles to girls in high school (Cycle program in the state of Bihar, India) greatly reduce the 'distance cost' of attending schools and related opportunities. "Comparisons with conditional cash transfer programs in other South Asian contexts suggest that the Cycle program was much more cost effective at increasing girls' secondary school enrollment than an equivalent-valued cash transfer. Given the importance of increasing women's education attainment in developing countries like India (especially in its most under-developed regions) and the fiscally-constrained policy environment, these results are important and suggest that the Cycle program was not just politically popular but also much more cost-effective than the most frequently considered and implemented policy alternative to increase girls' secondary school enrollment in developing countries in the past couple of decades (CCT's)." [42] p. 26).

#### *3.8. Space, Access and the Informal Economy*

"Engagement with informality is in many ways quite difficult for planners. Informal spaces seem to be the exception to planning, lying outside its realm of control" [104] (p. 155). What Roy further argues and builds in the same paper is that though informality is the exception, it is an outcome and product of the state. What is important to note that in the developing countries, informality encompasses all modes of production and access to these modes of production.

At the same time, informality continues to facilitate women. Women are either equal participants or, in some cases, dominate the informal markets, trades and usage of the informal transport modes. In urban areas, these three facets get typically expressed by:


iii. Borrowing and implementing best practice models, which might not be conversant and fit for the local context.

Another area of neglect is cross-border trading, both formal and informal, which severely affects the lives of rural women. Informal cross-border trade (ICBT), a trade arrangement, which is informal, and thus precarious, remains dominated by women traders in the rural areas. Though this fact is more pronounced in Africa, increasing evidences can be traced in Asia as well. Kusababe [105] (p. 582) puts it "Very little literature exists on the gendered effect of international borders. Of the few extant studies, scholars have elaborated how geographical borders define and label women's work. Cheater [106] shows how cross-border 'shoppers' in Zimbabwe were labelled as a security threat to the country. Vila [107], in her work on the US-Mexico border, demonstrates how borderlands, as margins of society, are seen as 'dangerous' and full of 'vice', and that certain gendered behaviours and attitudes are seen as characteristic of Fronterisas/os. Similar findings are reported by Biemann [108], who concludes that, 'The border thus becomes a metaphor as well as an actual material institution that capitalizes on the differences between the economic and the sexual' (p. 108)".

ICBT or in the absence of formal regulations around small-scale trade what is often deemed to be 'smuggling' has had positive effects for women, which is highlighted in the scattered research studies and reports found on this topic. However, to date, this form of trade is not typically recorded in government statistics leading to an obfuscation of data and consequently the roles and needs of women traders. The gendered effects are significant given that 70%–80% of African traders involved in ICBT are women [109–112].

Kusakabe [105] (p. 581) highlights how "the formalization of the border trade has changed women's 'sense of space' and their relations with men and other women". Her study highlights how international borders create different scales of places [113], and women's ability to access these scales depends on both material (transport connectivity) and social (societal and household's definition of gendered work) definitions of access. This is significant in the context of increasing efforts to improve the 'efficiency' of regional land borders through the introduction of technologies and harmonization of bureaucrat processes.

UN Women [114] notes that poor infrastructure in terms of poor roads, energy and communication is known to be one of the non-tariff barriers to trade, preventing women to access international markets. Across value chains infrastructure, access to market is a critical element, especially for transportation of perishable agricultural products, which are mostly traded by women informal cross-border traders.

A few of the research areas that should be further investigated while designing regional transport corridor development schemes are as follows:


It is to be borne in mind that limited sex-disaggregated data on gender and cross-border trading was found in this review and this inhibits sound empirical evidences. Studies should further delve into existing knowledge gaps on the opportunities for businesses owned by women in the context of procurement schemes, training facilities and access to markets.

Though the relationship between space and informality is beginning to emerge and accepted at the urban levels, this relationship is largely hidden in discussions on cross-border trade. Sadly, in tune with the neatly compartmentalized discussions in different sectors, though informal work or trading has been examined closely, the relationship between space, informality and access lacks similar

engagement. Studies documenting the incidence of cross-border trading highlight that international borders often create a space where income earning activities are being practiced, assigning both status and new roles to women [115–117] but due to the lack of public transportation and high transportation costs, women, in particular, faced hardships in directly accessing the market and claiming the revenues. Kusakabe [105] highlights this case through two examples drawn from Lao PDR—(i) cotton-weaving activities in Sayaboury province, and (ii) sticky rice box production in Kammoune province.

#### *3.9. Development Planning and Transport*

Lack of gender balance in decision-making, ranging from the macro level in parliaments to community and household levels have been routinely noted. Consequently, women's perspectives and priorities are not reflected in budget allocations and development related decisions. Seminal works like Male Bias in the Development Process [118] highlight that male bias is easy to understand, empirically testable and in principle can be rectified [119].

Given that a large share of low-income women is employed in the informal market, governance issues built on employment and related schemes need to strengthen their focus on accessibility. The fact that a large share of daily travel needs in the developing economies are met by informal public transport modes like tuk-tuk and jitneys, such bottom-up initiatives need to be both recognized and bolstered in the government action plans for transport, urban/rural planning and development at large. Even most basic infrastructure like mapping of these informal intra-city routes are largely amiss (most transport plans lean towards the case plotted in Box 5).

Women are typically less likely to find employment in the transport sector at large, but this is especially pronounced for the developing economies. This inadvertently results in rendering women's needs invisible, even in the provision of informal transport, which is largely market responsive and highly adaptable.

#### **Box 5.** National urban transport policy (NUTP) of India.

Realizing the importance of public transport and cycling and walking in the cities and equity concerns, the national urban transport policy (NUTP) spelt out the following objectives: (i) To bring about a more equitable allocation of road space to various users through building a people-centric rather than vehicle-centric focus. (ii) To encourage greater use of public transport and non-motorized transport (NMT) modes by offering central financial assistance for this purpose and (iii) to enable the establishment of multi-modal public transport systems that are well-integrated, providing seamless travel across modes [120]. Under the Jawaharlal Nehru National Urban Renewal Mission's (JNNURM) Urban Infrastructure and Governance (UIG) component, 24.2 per cent of the total allocations were for transport related projects. However, 13.3 percent of the transport related project was road widening and flyover building and only 8.66 percent was for mass transit development and the rest for parking and other small transport projects [121]. Despite a positive shift in policy objectives and priorities, the largest portion of the transport related funds in JNNURM were spent on road-building instead of allocating them to public transport projects.

The case of Dantewada, India, establishes how women can themselves tackle the deep-rooted inadequacies of the transport system, culminating from the inaction of both 'state' and 'private' actors. In the lack of any form of public transport connectivity, the tribal women of this remote rural area organized themselves through self-help groups. Through government-sponsored subsidy schemes, they have been successfully running E-rickshaws connecting rural markets, schools, etc (Figure 3).

The Kenyan case is also worth mentioning here (Figure 4). Though the Kenyan transport sector remains largely male dominated, women are increasingly participating in the (informal) transport sector as owners, drivers, touts, stage clerks and fleet managers [122]. The female workers employed in the informal transport sector in Kenya comment that they have no contact with the formal social protection schemes as they are categorized as being 'informal'. There are two sets of facts to be considered here for Global South at large. Firstly, there is a predominance of informal transport systems in the developing countries, which might provide employment opportunities to females. Secondly, given the eventuality that women do find a space in the transport sector, as in the case of Kenya, Kamau [122] raises the following questions:


**Figure 3.** Taking the daily mobility needs head-on. E-rickshaws and tribal women of Dantewada, India (source: Chhattisgarh:E-rickshaws drive a change in the lives of Dantewada's tribal women. (http://www.newindianexpress.com/thesundaystandard/2018/feb/03/chhattisgarh-erickshaws-drive-a-change-in-the-lives-of-dantewadas-tribal-women-1767909.html)).

**Figure 4.** Female (informal) transport workers in Kenya (source: [122]).

#### **4. Methodologies and Data Needs**

Though the presented findings are consistent for developing countries across the globe, they cannot be periodically corroborated as most developing countries do not conduct periodic travel

surveys or qualitative evaluation of the situation. This means that the gendered patterns of different and differentiated mobilities do not get highlighted and consequently are not acknowledged in the planning and design processes. The increasing penetration of mobile phones, even in the remote and poverty-stricken areas, in developing countries has to some extent changed the landscape of how women negotiate their daily mobilities. Developing routines and systems for data collection on revealed, preferred and digital mobilities, thus, holds the potential of assisting policy-making. The analyses emerging from these surveys can help the research and policy-making field to comment on:


Rather than advocating simple data collection, it is imperative that data collected in surveys is segregated at the level of gender, activities (land use) and time-use, which can essentially inform the transport planning authorities to take a more needs-oriented approach. Mobility-gap analyses should form an inevitable part of routinized data collection (travel behavior surveys) and analyses. An explanation of the gap figures, for example in terms of average daily trips and time used by different types of households, sheds light on the distribution of mobility opportunities among the respective genders.

Further, given the high incidence of no travel to work [123] and limited trips on a daily basis (a recent one-day trip diary from the city of Bengaluru, India revealed that only 20% of female respondents had taken a trip on the interview day (source: Personal correspondence, Tanu Priya Uteng), it is crucial that the popular methodology of the Global North focusing on a one-day travel diary is not adopted in the developing economies. Instead, at least a one-week trip diary approach should be adopted to filter out the trips that women are making over an expanded period of time (Box 6 illustrates a case from Indonesia).

#### **Box 6.** Time use allocation, transport poverty and social exclusion.

Through exploring the time use allocation and immobile behavior using a three-week time use diary collected in Bandung metropolitan area (BMA), Indonesia (one of the first multi-day time use studies within developing countries context), Susilo and Liu [124] establish clear differences of weekday and weekend patterns of time use allocations and mobility behaviors across different socio-demographic groups and gender. There exists a strong tendency of social exclusion due to transport poverty. As a typical patriarchal society in developing country, women are still responsible for housework and thus have a shorter contract time, free time and travel time but longer committed time than men on both weekday and weekend. Housewives also have a particularly low travel time, indicating that either due to unaffordable public transport services or lack of time, they may not travel a far distance.

Integrating data collection across sectors also holds the potential for addressing the needs of women in a more robust and target-oriented fashion. For example, maternal mortality indicators have received a lot of attention and are a good indicator for demonstrating the efficiency of an entire health system. However, unpacking this indicator, availability of transport, availability of medical supplies, presence of trained health staff and access to health facility are major factors affecting maternal mortality rates. Thus, programs aiming at decreasing maternal mortality should have a detail analysis of mobility component as well. In areas where this access is problematic, complementary programs to address this issue specifically should be introduced, either through training the nurses to ride bicycles/motorbikes, providing support for owning a community cart, etc. The broad aim of building capacity of the public health authorities to promote equitable access to primary health care services needs to be broken down into workable components, based strictly on the contextual realities. Given such benchmarking, it will become easy to assess the specific kinds of alterations needed in the mobility systems to adapt towards gendered needs (for example, usage of mobile phones to substitute the missed trips and access information). This applies at both rural and urban levels. Community health workers in rural Bangladesh and Indian's ASHA workers are both response to inaccessible hospitals in the rural parts of developing world.

Further, there exists a need to link the 'soft' or qualitative information to the 'hard' data information. This can aid in developing a model that corresponds much more to 'everyday transport functioning' than the much-used classical, techno-economical approach to transport model designing.

Projects can employ both traditional methods like focus groups/questionnaire surveys/measuring actual behavioral response to different measures (for example, concessionary bus cards, channelizing feeder services, a change in the bus frequency, assistance in getting mobile phones as part of the development schemes like self-help groups, etc.), and new methods like mobile app-based data collection, to understand the existing travel behavior and adaptive preferences of different groups. Studies conducted on these lines (e.g., [125–127]) have found that discretionary trips have a greater number of adaptation alternatives available from which to choose than non-discretionary work trips. This is applicable to the case of gendered mobilities in developing countries where a major share of women's trips caters to discretionary purposes of combining various household/social/shopping related purposes.

Analyses of travel behavior, constraints and accessibility need to be triangulated and complement quantitative and qualitative data collection techniques.

#### *4.1. Roadmap to Applied Research*

#### 4.1.1. Travel Survey

Travel survey data contains relevant information on all personal daily mobility, including information on multimodal trips, transport modes, distances and times. Such datasets additionally contain an extensive list of respondent and trip background variables, including socio-demographics, occupational status, home and work locations (possibly multiple), weekly working hours, occupational status, education, income, etc. Such datasets are generally not collected in the developing countries or collected as an adhoc exercise rather than being part of a regular data collection regime. We suggest using both the traditional and wherever applicable, the mobile interface to collect this dataset in the developing countries. Given the high penetration of mobile phones in the developing countries, an app-based method can be a viable option for data collection in the urban areas.

A one-day trip diary will invariably fail to capture the nuances of women's movement as there is a strong prevalence of a no-trip phenomenon on single days. Thus, the least time period assigned for trip data collection should be a one-week period to capture the clustered travel phenomenon.

Existing studies demonstrate that the use of location-based technologies reduces missing data on travel days and trips and improves the accuracy of departure/arrival locations and times over traditional travel survey data [128]. Modules are already available to extract the entire travel diary by accessing the smartphone data provided by the telephone operators. This data can be further enriched with local and regional spatial data from external sources, such as Open Street Maps, census, register and cadastral data.

#### 4.1.2. Attitudinal and Preference Survey

Attitudinal and preference travel survey distributed over different types of residential environments (inner-city, outer-urban, suburban, peri-urban and rural) and population categories within these regions will assist in capturing habits, attitudes, subjective well-being, perceived barriers and motivations with regard to the access to health, education, and employment opportunities [129]. Background information on personal and household attributes, preferences and lifestyles should also be collected as part of this exercise.

#### 4.1.3. Multi-Sited Ethnography Combined with In-Depth Traveller Interviews

Quantitative data inquiries should ideally be preceded and paralleled by collection and analysis of qualitative data. This is necessary not only to provide a full understanding of mobility experiences, barriers and motivations underlying the decision-making process of multimodal route, access, egress and transfer practices, but also to ensure that key questions are adequately identified for the quantitative surveys.

#### 4.1.4. Document Analysis and Informant Interviews

Document analysis and informant interviews form an important research tool in mobility mapping through (i) examining documents and records relevant to regional and urban policy-packaging, and sectoral development decisions having spatial dimension and (ii) key-informant interviews. Use of documentary analysis has become quite popular in transport research, especially when we are trying to evaluate the impact of an initiative. For example, a national government led approach to increase access to health facilities. Key informants, including politicians, international funders, policy makers, humanitarian organizations, the local and regional authorities, ministry officials directly involved in decision making on sustainable transport, etc., should be engaged to shed light on the topic of mobility and its inter-sectoral development dimensions. These experts can provide valuable insights when making recommendations for solutions.

#### 4.1.5. Exploring the Links Between Activity Participation and Subjective Well-Being

Concepts, terminologies and the will to explore linkages between the quality-of-life (QOL), subjective wellbeing (SWB) and daily travel have taken roots in the western research world in the past decade. This strand of research is primarily absent in the Global South. This could be partly due to lack of data for conducting robust studies to explore the relationship between QOL, SWB and daily travel. We propose that statistical methods like choice modeling, structural equation models, factor/cluster, etc. should be employed to identify and estimate the links between gender, daily travel times, time use, subjective well-being (SWB) and the extent to which the overall quality of life is affected by lack of access.

Studies based on similar approaches suggest important gender differences in activity participation, travel time, time use outcomes and resultant SWB [130]. They further find that travel times were unassociated with SWB for both genders. Instead, results were consistent with travel times serving as inputs in activity participation and therefore—at least for women—indirectly contributing to higher levels of SWB. These findings suggest that focusing on activity participation as a chief policy objective could yield higher quality of life benefits than a policy focus on travel time savings [130] (p. 10).

Transport planning in the Global South has been dominated by the logic of travel time savings, underpinning decisions on building highways, flyovers and road expansion programs. The field has simultaneously and consistently failed to serve a majority of the population. We therefore propose a

shift in the transport planning approach—shifting the focus from travel time reductions as the chief policy objective to a focus on activity participation, enhanced SWB and QOL.

Activity participation should ideally be analyzed at the macro, meso and micro levels and policies designed for these three levels should be interlinked and complement each other (refer Table 1).


#### 4.1.6. Accessibility Mapping

Continuing the above discussion, there is a dominance of the transport modeling approach based on the logics of travel-time savings underpinning the major transport infrastructure projects. Rarely is comprehensive land use and transport interaction (LUTI) models employed in the Global South to see the linkages between land use/activity participation and transport infrastructure provision.

We proposed that mapping of the interactions between accessibility with different transport modes to different land uses, and facilities like schools, employment and health centers, be undertaken for informing the design and implementation of transport infrastructure like public transport routes, bicycle network, etc.

In the following example, we presented a similar exercise for Bergen, Norway based on InMap (a simplified LUTI model), which links job accessibility by bicycle (and E-bike) and the land use plans (refer Figures 5 and 6). In this case, the supply of land was determined by the local municipalities through land use plans, while the demand for the land was estimated as a function of the accessibility to jobs, trade, general services and health services in the areas (from comparing E-bike accessibility with the land use growth potential, the authors found that it was possible to develop land use strategies to enhance the use of E-bikes. High job-accessibility with E-bikes close to the city centers supports the current general strategy of pursuing high density developments/transformation projects in these areas. The findings that the green field development areas were, in general, not found to provide any substantial accessibility with E-bikes).

**Figure 5.** Accessibility with bicycle and growth potential, Bergen, Norway. (Source: [131]).

**Figure 6.** Accessibility with E-bike and growth potential, Bergen, Norway. (Source: [131]).

#### **5. Research Gaps and Recommended Research Directions**

The research gaps identified in this study deal with the following three components and the interface between these components: (i) Organization/governance, (ii) infrastructure provision and planning and (iii) travel (spatial) behavior culture/education. These three components can be further broken down to address the specificities of rural, urban and peri-urban areas. The relationship between gender and transport should underline all developmental policies—social protection programs, welfare policies, rural development, slum resettlement programs and urban planning policies. We comment specifically on the identified research gaps and research directions in the following points.

#### *5.1. RESEARCH GAP 1: Inclusion of Gender from the Costs–Benefits Analyses, Which are Typically Used to Justify Investments Promoting Male-Biased Car-Based Urban Mobility*

Research direction: How can we insert gender in the equation of costs–benefits assessments and other routinized protocols that are used for decision making?

Accessibility to employment, health and education opportunities have tangible, economic benefits. These numbers can be calculated, and easy to convert into economic indicators. If these indicators are taken into the cost–benefit assessments, then the chances of prioritizing transport infrastructure facilitating public transport, walking and cycling will be substantially increased.

It is of utmost importance that research findings are linked to policy making and program formulation. Currently, we have active research engagement on the topic of gender, transport and spatial planning in the Global South and yet the research findings are almost routinely ignored in policy making and seldom taken forward at the program formulation stage.

#### *5.2. RESEARCH GAP 2: Acceptance of the Importance of (A*ff*ordable and Connected) Public Transport Provision for Facilitating Women in Transport Policy and Program Formulations*

Research direction: What kind of capacity, knowledge and cooperation modalities need to be built to include both formal and informal public transport systems in the different hierarchies of transport plans?

How should we design specific programs on the tax structure for public transport and fund allocation to prioritize PT (Public transport)?

A most basic and simple message is to prioritize public transport over providing for cars. Informal public transport options like shuttle bus, jitneys, boda-boda, etc. should be included in the different hierarchies of transport planning from national, regional to local transport plans. Provide adequate tax benefit and subsidies to promote public transport. Address issues of unsafe running and operation of the informal public transport modes. Design policies to respond to the 'special needs' of women in terms of trip duration, access-egress, length, trip-chaining and trip purposes (with special reference to accompanying trips—traveling with children, elderly, etc.).

Research direction: How can we insert economic support systems in the welfare domain to address transport affordability issues for low-income women of the developing economies?

Affordability (and thereby accessing public transport) is a major impediment for low-income women. This is further compounded if the employment spaces of women living in slum and squatter settlements are hit by resettlement programs. Programs to address affordability issues needs to be sewed in with other welfare programs. Free public transport tickets, bicycles and other innovative solutions can have positive impacts on low-income women's access to education, employment and health opportunities.

#### *5.3. RESEARCH GAP 3: Focus on E*ffi*ciency of Formal Sector Mobility and Transport System Performance Takes Precedence over Provision for Accessibility to Services and Opportunities for the Informal Economy and Communities*

Research direction: How to incorporate the transport needs for informal economy engaged in regional trade into formal regional transport corridor developments?

Research direction: How to fuse spatial development and relocation policies to cater to women's opportunities with respect to education, health and employment?

Conduct accessibility mapping for different transport modes and prioritize areas for future growth that support walking and bicycling. In areas that are already built, create infrastructure that ensures safe walking and bicycling.

Further, it is vital that land use planning and development programs recognize and make space for informality, as informal markets provide the lion share of working space available to low-income women in both rural and urban parts of the developing world.

Route mapping and route planning of both the formal and informal public transport supply can aid in linking low-income areas to the employment and education hubs.

Develop toolkits for the incorporation of informal economy engaged in cross-border flows into regional transport corridor planning

#### *5.4. RESEARCH GAP 4: Integration with Other Sectors is Missing—Transport is Operated as a Separate Sector without Recognizing its Deep Connections to the Health, Employment and Education Domains*

Research direction: How to frame a multi-sectoral approach—ensure the mobility for women (both urban and rural) to ensure their access to employment/markets, education and health centers?

Link policies of other social development sectors with the transport sector. Welfare and social protection programs can be built around the issue of access to promote access to education, health and employment (refer to the cycling program of Bihar, India).

#### *5.5. RESEARCH GAP 5: Lack of Clear and Visible E*ff*orts to Map and Address Safety Concerns and Incidences of Women on the Move*

Research direction: What are the exact policies, programs and tools needed to enhance women's personal safety? How to design more gender-sensitive public transport, walking and cycling space?

Safety is a major concern for women. Spatial and transport projects need to prioritize creating safe spaces at both macro and micro levels. At the macro level, smart solutions like Safetipin apps and safety auditing routines can be employed to map unsafe areas. Mapping without following up will be a wasted endeavor. Protocols need to be established on how to transform these unsafe areas, routes, etc. into safe, accessible areas [132].

At the micro level, for example, for spaces within the public transport, bus drivers and bus conductors need to be trained to deal with situations of sexual harassment. When the driver or conductor themselves are found to be culprits, punitive measures need to be in place for dealing with such actions [133].

Further, there exists a strong need for putting more emphasis on non-work related travel issues concerning trips made for care, household and household-based industry works.

#### *5.6. RESEARCH GAP 6: Labour Issues—Social Protection Programmes are not Linked with Employment in the (Informal) Transport Sector and Lack of E*ff*orts to Address Male-Dominance in the Transport Sector Workforce*

Research direction: How can we encourage more female participation in the spatial planning and transportation sector?

How can the stigma and discrimination associated with women in the transport industry especially in roles like driver, conductors, etc.—be tackled? How can laws that restrict women's participation in the transportation sector be removed?

Women face high levels of discrimination to both enter and work in the transport sector, which is often supported by restrictive laws in some developing countries (refer Figure 7).

Typically, women are either absent or marginally present on the different levels of transport domain. Actively encouraging and engaging women in the transport field, through targeted programs, can have major impact on the future of this field. The current transport field has blatantly ignored the needs and preferences of women, which may be corrected through inserting women in this sector. A first step could be to collect data on female employment both in the formal and informal transport sector and chart out ways to protect these workers through social protection programs.

**Figure 7.** Legal restrictions on women's employment in the transport sector (Source: [134]) Note: Ukraine removed restrictions after the data collection period ended.

#### *5.7. RESEARCH GAP 7: Lack of Smart City, Smart Solutions Research from an Inclusive Perspective*

Research direction: How can we design smart mobility and smart-city solutions to create inclusive settlements?

Smart cities and smart mobility solutions have changed the ways in which urban areas are being planned, utilized and consumed. It is vital that the element of inclusive settlements is inserted in this development on an immediate and urgent basis to avoid further pitfalls. Questions like who has access to these solutions? Who are the current users? How can we facilitate access to the other groups? What kind of solutions are needed? Are solutions based on bottom-up feedbacks? etc. needs to be routinely asked, monitored and fed into design solutions.

#### *5.8. RESEARCH GAP 8: Lack of Simple, Standard Indicators*

Research direction: How can the findings emerging on gender and transport be supported by simple (and non-complex) indicators for the benefit of policy makers?

How can programs like the results-based budgeting technical assistance (TA), which the World Bank has adopted in the field of Health Planning, be designed and developed in the field of transport planning in the developing economies?

The knowledge generated through periodic assessments and estimations of the macroeconomic and welfare effects of creating accessible (education, health and employment) opportunities, could potentially benefit two important groups of policy makers and government stakeholders—(i) officials responsible for infrastructure evaluating road construction programs as economic investments and (ii) welfare sector officials focused on promoting gender equality, social development and poverty reduction. For the first set of officials, core area of interest revolves around the relationship between the provision of road infrastructure and national income growth as measured by GDP metrics while the second group is interested in social development outcomes. These two analytical perspectives are seldom brought together to complement each other. Through creating the simple, standardized and context-informed methodology for the measurement of economic and social impact of road building and other transport intervention programs, both sets of policy concerns can be monitored.

Simple indicators, however, run the risk of oversimplifying situation, yet they hold the potential for providing an overview to the policy-makers. Indicators should be developed and routinely used, but subjected to periodical assessment and upgrading, based on both quantitative and qualitative assessments and contextualization.

#### *5.9. RESEARCH GAP 9: Tra*ffi*c Accident Data is Under-Reported and not Sex Disaggregated*

Research direction: Collect sex-disaggregated data on traffic accidents, which should include all forms of mobility—walking, cycling, public transport and car-based accidents.

Pedestrians form the biggest group who get either seriously injured or die in traffic accidents. If we analyze the predominance of walking among women in the developing countries, it will be no surprise that a greater number of (pedestrian) women might be dying in traffic accidents and yet a sex disaggregated analysis of traffic deaths remains unavailable. Disaggregated data analyses can assist in answering questions on the spatiality and temporality dimensions of the accidents—where (locations) and when (time) are male and female respectively meeting accidents?

#### *5.10. RESEARCH GAP 10: Unpacking the Linkages Between Feminization of Informal Settlements, Relocation and Livelihood Opportunities*

Research direction: Collect sex-disaggregated data on livelihood issues in light of relocation.

Informal settlements are increasingly becoming feminized with a relatively higher concentration of females than males living in slums in the developing world. Relocation decisions impact livelihoods of women to a much greater extent than men. Access to employment opportunities that suits the livelihood profile of slum women is hardly ever brought forth in relocation decisions. The interconnection between livelihood and spatiality needs to be out in focus.

#### *5.11. RESEARCH GAP 11: Knowledge on Mobility Options and Cross-Border Trading*

Research direction: A few of the research areas that should be further investigated while designing regional transport corridor schemes are as follows:


#### **6. Conclusions**

We have looked at the specificities of women's mobility and its implications for transport planning along with urban, regional, rural and social planning. We posit that the multiplicity of the issues involved in understanding a complex topic like gendered mobilities with both its traditional and emerging 'smart' variant necessitates that we borrow and build on a host of theories and analyses. To that end, we have used a combination of socio-psychological and feminist theories, socio-technical transition theory, mobility biographies and social practice theory framework to frame a discussion around the differentiated patterns of women's transport needs, usage and implications for future planning.

Currently, the transport sector in the Global South is becoming aware of the environmental consequences but is grappling with how to balance the development and the environmental agenda. Given this scenario, government agencies would do well to understand how the environmental meaning operates. If environmental meaning is a better retention mechanism than a recruitment mechanism, then appeals to environmental sustainability or reduced carbon footprint are not likely to change user behavior. Determining effective mechanisms for recruitment to sustainable mobility is an important agenda and our analysis reveals that women could be champions here. They exhibit

sustainable travel behavior and yet continue to be ignored. Transport systems will benefit greatly by becoming gender-responsive as the sector can then simultaneously cater to the three pillars of sustainable development—environment, social and economic pillars. As an initial step, it would be useful to have a simple and overarching framework that underlines the relevance of transport to women's employment/livelihoods/income security and unpaid domestic care work (i.e., 'production' and 'reproduction'). In other words, mobility/transport are needed to facilitate women's access to markets and jobs and to facilitate their access to services (e.g., health centers, schools, childcare centers, shops, etc.). Additionally, the transport sector itself can be a source of employment for women, contributing to becoming a source of livelihood but more essentially, influencing the norms dictating the field of transport at large to be more mindful of women's needs and preferences. Traditionally, the norms governing the transport sector remains heavily male dominated in terms of both employment and a technical orientation. Issues regarding safety, affordability, accessibility, availability, acceptability and accommodation are vital and need to be taken into transport design and planning.

The transport field is undergoing huge transitions both from a policy perspective with added impetus of Agenda 2030, and practice perspective with insertions of smart solutions. In light of these developments, the policy focus is actively promoting a shift from car-based daily mobility to a more sustainable one. However, given the prevalent 'norms' in the transport field, focus on 'hard' infrastructure persists and social-psychological elements benefitting women's daily mobilities are routinely ignored. Practice theory, for example, could be employed here to highlight and explain user adoption of innovations and provide for a richer understanding of the micro-phenomena that takes place on different life stages by which these stages can be targeted in the right manner. In light of the social (sustainable) practices adopted by women at large, the process of recruitment/defection and retention/reproduction needs to be better understood. In the parlance of practice theory, how a practice such as walking, bicycling and public transport usage can undergo formation and reformation in a manner that it can sustain itself needs to be studied.

The ways in which different groups of women engage with different forms of mobilities vary according to the life-stage, conditions and contextual circumstances. This set of knowledge, on user variations, offers tools for promoters with which the sustainable practices of majority of women can be upscaled to a mainstream or dominant practice of daily mobility. The relationship between user and promoter circumstances and conditions is not static, but co-evolutionary. Promoters respond to how users actually use their products and services, and, in this regard, every transport decision needs to be unpacked and scrutinized as a product delivery with an open discussion on who constitutes the target customers. These analyses, for example, can be used to bolster the agenda of creating the walking- and biking-friendly cities.

Further, the authorities need to seriously engage with the foremost issue of 'How to make data collection and analyses routinized processes?'. Links between transport and housing policies should be inserted in land use, housing and relocation decisions. The research gaps identified so far highlight that very few studies have looked at the interactions between urban housing policies and accessibility wrt subsidized housing, establishment of resettlement colonies and loss of livelihoods of women.

Studies on governance and cross-border trade should discuss ways in which firstly, informality is recognized and secondly, the transport sector is restructured to facilitate women's employment both within and outside the transport sector.

Additionally, how can the transport sector engage with women's organizations to hear their needs and demands? Such analyses should be carried at micro, meso and macro levels to ensure that local, regional and international (wrt cross-border trading) markets are available to women for expanding their capabilities.

From a methodological perspective, a multi-method approach (e.g., [135]) should be adopted to integrate both qualitative and quantitative data in knowledge generation and decision making. Plotting of existing data on travel behavior and survey data on individuals' subjective and self-reported preferences, acceptance of different mobility options, and attitudes related to the adoption of the

proposed solutions can be a suitable starting point. An easily accessible way to move forward would be through creating predictive scenarios of travel behavior by interlinking demographics data with travel behavior. Such interlinking should be augmented through identification of major trends and driving forces in the past and projections for future. Along with mapping out the gender effects, these scenarios could be used to discuss and assess the environmental, social and economic impacts of the projected travel behavior and future mobility. For the regulating and implementing agencies, such scenario assessments will map out the opportunities and challenges involved in formulating policies and programs to reach sustainability goals and assess the scale of the required changes. Ways to sew this knowledge into the specifics of designing social protection programs or niches for transition demands further exploration. The case of the Cycle program for rural students in the state of Bihar, India is an excellent example of such a niche.

**Author Contributions:** Both authors were involved in drawing the conceptual plan of this article. T.P.U. framed and wrote the first draft of the article, while J.T. provided valuable inputs on the content, structure and framing of the final draft.

**Funding:** This research was funded by UK AID through the UK Department for International Development under the High-Volume Transport Applied Research Program, managed by IMC Worldwide. Discussions on the 'smart' elements are inspired from a similar study conducted in the Global North by Dr. Priya Uteng for a Nordic Flagship Project SHIFT, funded by The Nordic Energy Research (grant number 77892) http: //www.nordicenergy.org/flagship/project-shift/.

**Acknowledgments:** We remain deeply grateful for the constructive comments received by the anonymous reviewers.

**Conflicts of Interest:** The authors declare no conflict of interest.

#### **References**


© 2019 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).

## *Article* **Disability, Mobility and Transport in Low- and Middle-Income Countries: A Thematic Review**

**Maria Kett 1, Ellie Cole <sup>2</sup> and Je**ff **Turner 3,\***


Received: 3 October 2019; Accepted: 2 January 2020; Published: 13 January 2020

**Abstract:** This paper discusses issues affecting the transport and mobility needs of people with disabilities in middle- and low-income countries and how disability intersects with a range of other factors to impact on transport needs, use and engagement. The paper is intended to stimulate discussion and identify areas for further research, and identifies a number of key issues that are salient to discussions around equitable and inclusive transport provision, including patterns of transport use, behaviour and experiences, solutions and policy directions, measuring access and inclusion, policies and intersectionality. The paper also identifies gaps in knowledge and provision, barriers to addressing these gaps, and some possible solutions to overcoming these barriers. These include shifting the focus from access to inclusion, reconceptualising how 'special' transport might be provided, and most importantly listening to the voices and experiences of adults and children with disabilities. Despite lack of transport often being cited as a reason for lack of inclusion of people with disabilities, there is surprisingly little evidence which either quantifies this or translates what this lack of access means to people with disabilities in their daily lives in low- and middle-income countries.

**Keywords:** people with disabilities; inclusive transport; high volume transport; accessible transport; low- and middle-income countries

#### **1. Introduction**

This paper aims to capture the current state of knowledge about the transport needs of people with disabilities in low- and middle- income countries (as defined by the Organisation for Economic Cooperation and Development's Development Assistance Committee list); and how disability intersects with a range of other factors to impact on transport needs, use and engagement. It complements other papers in this special issue, which focus on the mobility needs of young people and older adults; and highlights how these identities intersect and impact on choices. In line with the overarching aims of the special issue in focusing on sustainable High-Volume Road and Rail Transport in low-income countries, we have included the experiences of people with disabilities undertaking both urban and long-distance journeys.

While there has been some research that links a lack of transport to barriers to other services for adults and children with disabilities, such as education [1] or healthcare [2], there has been much less focus on the actual mode of transport used, or the journey itself. So, despite a lack of transport often being cited as a reason for lack of inclusion of adults and children with disabilities, there is surprisingly little evidence which either quantifies this lack or translates what this lack of access means to people with disabilities in their daily lives. Without this information, it remains challenging for planners and

policymakers to understand where, what and how they should best invest in making transport more inclusive of people with disabilities.

It is worth reiterating at the outset that while there is some literature on patterns of travel behaviour, types of travel and journey experiences in higher income countries, there is surprising little from low-income countries. Previous work has tended to focus on transport exclusion, rather than inclusion, and in turn how transport exclusion can create and perpetuate social exclusion [3]. As the authors note, social exclusion as a term is often poorly defined and measured, with the result that it is operationally and theoretically difficult to assess [3] (p. 2).

The paper starts by placing inclusive transport in the context of existing international agreements and global frameworks relating to disability rights. We then move on to discuss patterns of travel behaviours and journey experiences identified in the literature. These have tended to be from higher-income countries, but it is possible to identify some possible 'solutions' to current transport challenges that could be, or are already being, explored in low- and middle-income countries. These include adaptations of physical transport infrastructure, development of holistic/door-to-door journey approaches, specialised transport services, fare subsidies and technological innovations. The knowledge gaps about evidence of 'what works' in terms of disability inclusion align with existing gaps more broadly. Most reviews, for example around inclusive education or health, tend to argue for a 'twin track' approach [4]—both mainstreaming disability into services, as well as providing specialist targeted services for those that need them. From the limited evidence there is in the transport sector, the indications are that this is also the required approach to inclusive transport. Finally, we also explore the role of national policies and other institutional factors. The paper ends by identifying the gaps in the literature, highlighting the lack of research around transport issues for people with disabilities in low-income countries, and makes a series of recommendations for future research.

#### *Transport Issues A*ff*ecting People with Disabilities in Middle- and Low-Income Countries*

Transportation issues rate highly as a challenge for people with disabilities globally [5–7]. However, measuring access to transport, or indeed understanding who is the most severely affected, remains challenging [8]. However, the United Nations (UN) Convention on the Rights of Persons with Disabilities (CRPD) [9], has had an impact on both national and international policy and focus around transport. While the CRPD does not have a specific Article on transport, it does acknowledge the centrality of transport for people with disabilities to access a range of services including homes, schools, healthcare facilities, workplace and leisure [CRPD Article 9]. The CRPD enshrines the right of people with disabilities to access transportation on an equal basis with others. However, barriers to the enjoyment of these rights can be broadly divided into three main areas: institutional (legislation, political will, policy, etc.); environmental (infrastructure, vehicles, information); and attitudinal (transport staff, other passengers, lack of accessible information, etc). In reality, these often overlap.

Globally, there have been increasing efforts to address inclusion and ensure 'no one is left behind', culminating in the Sustainable Development Goals (SDGs) [10], with the aim of equity for all by 2030. While all 17 goals are relevant for people with disabilities, SDG 11 'Making cities and human settlements inclusive, safe, resilient and sustainable' has a specific target (11.2) that 'By 2030, provide access to safe, affordable, accessible and sustainable transport systems for all, improving road safety, notably by expanding public transport, with special attention to the needs of those in vulnerable situations, women, children, persons with disabilities and older persons'; as well as an indicator (11.2.1): 'Proportion of population that has convenient access to public transport, by sex, age and persons with disabilities'. However, SDG targets and indicators are adapted to the country context, and it is left to individual countries to set country-specific goals, indicators and targets to monitor their progress. Moreover, in the most recent SDG progress report, there is no mention of progress towards this target. The recent UN Flagship Report on Disability and Development [11] also reviewed progress toward SDG 11 as it relates to people with disabilities, though again, there is very little data or information on specific progress with regards to accessible transport at global level. This omission may be due to a lack of agreed definitions on what accessible transport is, and/or a lack of standardised targets and indicators. It could also mean that few countries have set targets, monitored their progress, or indeed actually focused in making any improvements.

In the Asia Pacific region, the Incheon Strategy (2012) is the benchmark for progress on 'making the rights real' for people with disabilities in the region [12]. Goal 3 of the strategy is to: 'Enhance access to the physical environment, public transportation, knowledge, information and communication', although it is interesting to note that while the overall target is: (3.B) Enhance the accessibility and usability of public transportation, the overall core indicator is (3.2) Proportion of accessible international airports. While this is a laudable target, it could be argued that it does not address the most likely day-to-day transport barriers faced by the majority of people living in the region.

Similarly, in 2013, a global online survey carried out by the Global Alliance on Accessible Technologies and Environments (GAATES) Transport Committee with its members (completed by 257 people from 39 countries) aimed to better understand what mobility issues people with disabilities faced around the world [13] (p. 1). According to the data presented, the two biggest challenges were inaccessible public transport vehicles and attitudes of drivers/staff. In terms of possible solutions, respondents were fairly evenly divided on four main areas: technical guidance on inclusive design solutions aimed at civil engineers, planners, etc.; guidance/information aimed at transport providers/senior management in transport companies; guidance/information aimed at people with disabilities to empower them; and guidance/information aimed at politicians about the UN Convention, etc. [13] (p. 7).

What these initiatives highlight is that even with a range of measures in place to facilitate inclusion, there may still be a gap between availability and use—demonstrating how these barriers often intersect. A second, related challenge is to measure the size of this gap. Estimating how many adults and children with disabilities have access to, and more importantly use transport systems, as well as their safety, affordability and reliability is challenging. Some countries collect transport data as part of a national census or other largescale surveys. However, even if they highlight a lack of access and availability, it is still challenging to attribute this as a sole cause to a lack of access to healthcare, education or employment, though it is certainly a contributing factor [c.f. 14]. However, regardless of the cause, it is unequivocal that barriers to accessing inclusive transport are found across most countries, in a range of contexts and for a spectrum of impairments, and result in a loss of education, employment and overall wellbeing (see for example, on reduced access to education [1,14]; for employment [15,16]; wellbeing more broadly [17]).

The knowledge gaps about evidence of 'what works' in terms of disability inclusion align with existing gaps more broadly. Most reviews, for example around inclusive education or health, tend to argue for a 'twin track' approach–both mainstreaming disability into services, as well as providing specialist targeted services for those that need them [4]. From the limited evidence there is in the transport sector, the indications are that this is also the required approach to inclusive transport. There are some innovative and potentially paradigm-shifting ways to deliver this, including 'Mobility as a Service' (MaaS), which use locally available and adapted structures with technology to provide the necessary 'total journey'. More work needs to be done to test these for a range of adults and children with disabilities in a range of contexts.

#### **2. Materials and Methods**

Whilst this was not intended to be a systematic review, a search of the literature was done to identify the key themes. There is a large volume of literature on the broad theme of 'accessible transport', and an initial search was done on the Web of Science database in January 2019, in line with the other articles in this series. The search operator was developed, based on similar operators used in other thematic areas of this study [18], to ensure consistency and include as wide a range of types of impairment as possible in selected geographical regions, and return results based on various transport-identifying expressions.

Results that were written in English from the year 2008 to present were chosen for review. This year was chosen as it represented both an approximate 10-year timespan but also marks papers that were written following the coming into force of the CRPD in 2008. Inclusion criteria were reports that focused on people with disabilities' experience and issues with using various forms of transport. Papers that were not primarily focused on transport were excluded; so, for example, the large volume of literature that exists around active transportation or that of road safety. These are of course relevant to wider discussions about policy, given the prevalence of road traffic-related injuries and disabilities [4] (p. 60), but were not the main focus of this review. Road safety—and the relation between road traffic accidents and disabilities in low- and middle-income countries—is one of the other themes of the overall review. It is worth noting that data on the number of people who survive crashes but live with disabilities are almost non-existent [19].

The search of the Web of Science databased returned 295 results. These results were screened by title and abstract, and a total of 23 results were selected for inclusion. A number of articles were excluded on the basis that they conceptualised 'mobility' as it relates to impairment, rather than transport mobility, so were screened and excluded on this basis. During the full-text review a further 12 articles were excluded due to inappropriate content or unavailability. Following the review of the returned results of the literature review, a further manual review was undertaken using Google Scholar using the same inclusion criteria. This review returned an additional 38 articles from both 'grey' and scientific literature. This literature was included to capture national guidelines on transport and disability inclusion, and reports from civil society and other actors which were not included in the database review. This is important as it provides a context as well as potentially identifies policies and practices not yet featured in the published literature. A total of 49 articles were included in this review. We manually coded and grouped together the main themes that emerged from this body of literature, as well as from existing literature and knowledge in the field using theme content analysis.

#### *Limitations*

This review included results from one database search—Web of Science—in line with other articles from this series. This limited the number of results included in the review, and some may have been omitted. This literature review is not intended to be systematic but rather thematic and comprehensive; the results included here give a helpful set of themes that emerge from the literature.

The search terms and inclusion criteria excluded returns from high-income countries, although some were used in the manual search to allow for comparisons to be made and to highlight important points in the absence of comparable low-income country returns. Transport issues in higher-income countries were not a focus of the review and these may have overwhelmed the search returns and skewed the emergent results. A further limitation to the operator was that if an article was about a specific country (for example, Kenya but it did not mention Africa), it may not have been picked up.

#### **3. Results**

In this section, we present the set of themes emerging from the literature and aim to highlight the persistent gaps, and some of the measures being developed to close them, in other low- and middle-income countries. These may also enable low-income countries to target this issue, and reach the global goals, more effectively

#### *3.1. Patterns of Travel Behaviour and Experiences*

Given the paucity of data on transport disadvantage, identifying 'what works' to overcome the disadvantage can be even more challenging, given the array of factors involved. Moreover, there is very little research on the types of journeys adults and children with disabilities make, the modes of transport they use, and their overall experiences of the journey, in particular from a participatory perspective.

To deliver an inclusive transport system requires a joined-up approach that focuses not only on the what, but also on the how. The type of transport provided, and how it is provided, varies

according to country and priorities. Many countries—particularly the higher-income ones—link the issue of accessible transport to broader legislation and commitments, including the CRPD (e.g., [20]). Higher-income countries can obviously provide more comprehensive transport options, though as recent analysis of the in the UK demonstrates, even with these in place, people with disabilities still face a number of challenges in using public transport. [21].

#### *3.2. Transport Infrastructure*

Many of the efforts to reduce car use and improve high volume (often public) transport have been in urban areas, in particular, cities. However, these initiatives have not always been accessible or inclusive for adults or children with disabilities, as for some, cars and/or taxis offer freedom, independence and mobility, which public transport may not. Research in a number of higher-income countries has shown that people with disabilities tend to favour cars—their own or others (such as taxi services) [22]—rather than, for example, waiting for a ramp to enable them to get on or off trains [23], or where there is limited provision of services (more so the case in rural areas). Cars can confer a level of independence, autonomy and safety that users do not always feel on public transport. Fear—of how to use the services as well as other passengers' attitudes—is often a key factor, and many users report feeling unsafe on any form of public transport; and parents of children with disabilities cited fear for their child's safety as one of the key barriers in their journeys to school [1,14].

#### *3.3. Long Distance Journeys*

People living in rural areas who need to make long-distance journeys are generally less well-serviced by public transport almost everywhere. This is partly due to limited demand, which in turn leads to reduced services [24]. A complex set of factors need to be taken into account when planning long-distance travel services. In countries with limited or no formal public transport system, cars or taxis provide one of the few means of getting around, particularly in rural or semi-urban areas and especially in emergencies. Use of hired vehicles raises the issue of additional costs for people with disabilities—the 'hidden costs' of disabilities [25,26]. However, there is limited data which quantifies the amount of these additional costs, or costs of lost opportunities, for example, for adults and children with disabilities who cannot afford transport to make (often long-distance) journeys for educational or income-generation purposes, or access other services and activities.

#### *3.4. A*ff*ordability and Subsidies for Individual Journeys*

Included in debates around the 'inclusiveness' of sustainable accessible transport are issues of cost and affordability. In part due to inequalities and exclusionary practices, in many countries around the world, people with disabilities experience poverty. One form of poverty is transport poverty, which can be related to cost, affordability as well as accessibility [27,28]. However, transport poverty is hard to measure, and there are no universally agreed definitions. Moreover, some question whether it even exists as a stand-alone phenomenon or whether it is simply an extension of being poor. Put differently, the question remains as to whether transport poverty a 'real' problem for individuals, or is it a systemic problem that has a systemic solution, and if so, what are these solutions? Given this, is it a problem that has a transport solution, or rather is it a broader issue of social welfare? [28] (p. 353).

In many (usually higher-income) countries, a range of measures have been put in place within transport policies, including concessionary fares, subsidised public transport services and free special transport services (STS) for eligible groups such as older people, children, and/or people with disabilities. As such, they are only viable where there are (public) transport systems in place.

South Africa provides a heavily subsidised public transport system for older adults and people with disabilities [22,25]. However, in his study reviewing provision of services, Venter found that it was access, rather than affordability, that was the largest barrier to use, and the solution was therefore to increase access more broadly, rather than to provide targeted subsidies:

"The overall implication is that the limited funds that are available for improving public transport in cities should go towards improving accessibility for all, rather than towards lowering fares for all disabled persons as a group. This is not to say that subsidisation is not needed: the evidence shows that both disabled and non-disabled commuters benefit substantially from having access to subsidised bus and rail services. But the benefit stems from the subsidies being available to all low-income workers." [25] (p. 138)

Such universal coverage may also help overcome the predictable eligibility challenges, as assessment of disability is already a complex and much debated issue, particularly in low-income countries which have limited mechanisms for assessment [29]. In addition, most of the debates in the literature tend to focus on the delivery structures and mechanisms, rather than eligibility criteria, so there is limited evidence on what are the most effective mechanism for assessment or identification of eligibility.

#### *3.5. Measuring Access to Services*

In addition to limited evidence about assessment and eligibility criteria, there are also significant gaps in the literature about what specific impact transport restrictions have on people with disabilities' lives (e.g., opportunities lost), or the additional costs that may be associated with this lack of access (e.g., hiring taxis to get to work, or not getting to work at all) [25,26]. This gap exists across high- [20] and low-income countries and is largely due to a lack of agreed measures to estimate access and inclusion. Of the limited literature available that does address this, intersecting issues of age, gender, poverty, ethnicity, disability, etc., come to the fore (e.g., [2,30–32]). These make it difficult to attribute transport—or lack of—as a singular cause for exclusion. In recent research undertaken by authors in Liberia [33], when asking matched household heads about barriers to accessing healthcare services, distance to health facilities was weighted similarly between disabled (11.0%) and non-disabled households (12.8%). Unfortunately, the study did not ask what the most commonly used mechanism of transport was, nor whether this resulted in additional costs, for example if persons with disabilities had to use more expensive means of transport (e.g., taxi cars instead of taxi motorbikes), or spend more on transport overall. Therefore, while the issue of transport—or lack of—is a barrier to access and inclusion in all aspects of life and is highlighted in many papers (e.g., [1,34]), there are few papers that identify mechanisms to quantify this.

One of the few pieces of research available that does attempt to do this is Venter [25] discussing the situation in South Africa. Here the research found that geographic location was a key determinant of the affordability of transport, with transport in urban areas being unaffordable for poor people generally, but not specifically people with disabilities or older people, whereas in rural areas limited travel options constrain everybody as much as affordability, thus the solutions again point to improving the affordability, availability and quality for all users, not just specific groups, as all users would then benefit [25] (p. 129).

#### *3.6. Transport Services Available*

One area of transport provision that aims to address a lack of mobility are special transport services (STS). These are designed to address services gap and are usually (though not exclusively) for people with mobility difficulties, such as older adults or people with disabilities. There have been some well-reported models in South Africa, Brazil and Russia [4] (pp. 178–184), all high middle-income counties and we found none from low-income countries. STS (also known by a variety of other names, including 'paratransit, or 'dial-a-ride' in other countries) vary not only in name, but also in delivery and funding structures, as well as types of vehicles used. Some supplement existing services, or link to feeder routes (such as mass rapid transport (MRT) services in Cape Town and Brazil), while others offer specific door-to-door services in adapted accessible vehicles (such as Dial-a-Ride in South Africa, which offers users a heavily subsidised service).

There are a number of debates about the provision of STS, particularly around equity, as they tend to offer a segregated service (see for example [16] p. 4), as well as cost. In some countries, provision of STS (e.g., to schools, hospitals, etc.) is a mandatory requirement by law, though provision can be costly, and demand likely to increase with an ageing population. They are often publicly funded, or at least subsidised. Some high-income countries are exploring different models of payment for these services (see for example [35]). Though their findings are from a wealthy country with high levels of service provision (Sweden), they do have some implications for decentralised budgets elsewhere—not the least of which is the need to coordinate service provision (e.g., school buses) and that overall improved public transport services can have a positive impact on access and inclusion more generally. According to one study from eThekwini Municipality (South Africa), the Dial-a-Ride service provided faces an array of challenges, including high costs, difficulty in managing high demand, scheduling of services and lack of flexibility in adapting route planning. In fact, demand was such that it had to be restricted to people going to study or work. Complaints about the tendering process were also made [30] (p. 35).

An excellent practical guidance for setting up STS in low-income countries but drawing on experience from high-income countries, suggests using a variety of state and non-state funding mechanisms [36]. The guide suggests utilising existing locally available transport mechanisms, including motorised auto-rickshaws, cycle-rickshaws, and similar vehicles operated exclusively or partly for mobility-impaired people. The one thing they all have in common is that they are "demand-responsive", which can be interpreted in one of several ways—pre-booked, scheduled or instant access. This approach strengthens the idea that public transport provision needs to move away from traditional delivery approaches, as well as addresses the challenge that the provision of STS does not address equity, inclusion or attitudinal and other barriers to transport access, nor does it confer independence or autonomy on users, as there is still a reliance on others to provide a service. On the other hand, if there is no way to get to a station or bus stop—no matter how accessible the route is, then it could be argued that the provision of special transport enables people with transport restrictions to make necessary journeys. To be genuinely effective, special transport needs to be included as part of a wider package of measures to address barriers to access and inclusion, such as increased and accessible information and financial aids, such as concessionary travel passes [37] (p. 54).

However, if users require a high degree of assistance, there are still limitations in most current transport provisions around driver capacity, attitudes and willingness to provide such services. Another criticism of STS is the extent to which such systems include alternative (as well as sustainable and healthy) modes of transport such as cycling or walking.

#### *3.7. Holistic Approaches*

People with disabilities in South Africa seem to enjoy more accessible transport opportunities than those in neighbouring countries, including subsidies to address any additional costs they incur. However, even there, when progressive legislation is in place to enhance the rights of people with disabilities, they still face a range of challenges. These include boarding the ostensibly accessible mass rapid transport (MRT) services in Cape Town—anecdotally, not all the MRT buses are fully accessible, so users who need them have to wait for the next accessible vehicles to come along, causing delays to their journey. By far, the most popular method of public transport for most people in South Africa are taxi minibuses. These pose a number of challenges for people with disabilities, ranging from inaccessible vehicles to other passengers and the drivers themselves. Research with people with disabilities and taxi drivers in the Durban area highlights that the actual operational structures of taxis or other private minibus services function, often unintentionally, to actively disincentivise drivers to pick up passengers with disabilities [30]. Given that taxi drivers often lease their cars from owners, time is money and drivers are less keen to stop and spend time trying to get a wheelchair into, or on top of, a vehicle, or wait for somebody with mobility difficulties to board. In their research, Lister and Dhunpath found little understanding of either side's perspective, which they suggest could be ameliorated by incentives, such as cash and/or training to encourage taxi drivers to pick up

passengers with disabilities, along with disability awareness training, and subsidised fares for people with disabilities [30].

#### *3.8. Mobility as a Service*

Taking the idea of shared, often private, services a step further is the idea of 'mobility as a service'. In some respects, such an approach may well be undertaken informally in a range of settings. While the idea of a barrier-free, door-to-door journey is not new, new ways to conceptualise what a 'total' journey, or 'continuity of travel chain' or even 'integrated mobility' might look like are in development. These factor in age, health, mobility status as well as a range of other intersectional aspects and move away from the more traditional 'special transport' models discussed above to more integrated approaches that acknowledge that what works in one location or for one group may not be effective or utilised in another.

One of the most innovative and exciting area that links up discussions about autonomy, choice, continuity of journey, as well as bringing in new technology is that of 'Mobility as a Service' (MaaS). Not specifically designed for people with disabilities, MaaS is a way:

" ... to see transport or mobility not as a physical asset to purchase (e.g., a car) but as a single service available on demand and incorporating all transport services from cars to buses to rail and on-demand services." [38] (p. 583)

Originating in Sweden, it offers users the opportunity for door-to-door integrated services, paying for a package of services 'as they go' via one (often online) payment system. Though most of the research around MaaS has been in higher-income countries, the concept has relevance to low-income countries, making it worth raising in this paper, and some very preliminary research about transposing it to such contexts has begun [39].

MaaS has the potential to cover a range of transport options, from self-drive cars (still under research), through to taxis (similar to Uber, which already operates via an app-based service), bicycles and even walking. However, despite the ideology, such tailored services can be expensive, and inefficient to deliver, so researchers have begun to conceptualise how journeys can be 'bundled', so users can and buy specifically tailored transport packages, in much the same way as they can buy satellite or cable TV packages to suit their specific viewing requirements [38].

The research focused on developing and delivering a broad range of options for both type of journey (work, socialising, etc.) and mode of transport (buses, taxis, etc.), which could be standardised to some extent to reduce costs. These 'service packages' could also be customised, perhaps including add-ons such as household travel-planning, availability of car space in localities, travel training, ICT training, providing a driver for own car and learning to drive [38] (p. 590). These were offered as alternatives to car ownership, increasing car-sharing to reduce individual ownership, and therefore increase sustainability, but at the same time maintaining independence and freedom of movement. As the researchers note, whilst MaaS was not specifically set up for use by people with disabilities, the system could offer opportunities for flexibility and autonomy. Viewing transport as part of a service package has the potential to move discussions away from seeing transport provision for older adults and people with disabilities as a welfare issue, as, they argue, it currently is. Although they caution about the need to take the social benefits of mobility into account when thinking about MaaS too [38].

While MaaS offers an exciting potential for people with disabilities, it was not (necessarily) designed specifically for people with disabilities, but rather it is a transport system that *can* be used by people with disabilities. In this, it is similar to existing 'community' or 'flexible' transport' systems, usually privately-funded or run cooperatively. Community transport can be funded and provided through a variety of mechanisms, including shared transport (such as cars or taxis), and may be a viable option in low-income countries, as they may lessen costs for passengers, as well as reduce the number of vehicles on the road. However, there are debates about the extent to which they are likely to be viable as a long-term solution to reduced mobility in rural or semi-urban areas, in particular for

people with disabilities, as they do not solve broader issues around mobility, including social aspects, such as independency and autonomy.

#### *3.9. Technology*

Technology has enabled significant improvements across a range of domains, including transport-specific services such as Uber and MaaS, as discussed above, as well as facilitate mapping of journeys to better understand patterns and usage and adapt services accordingly. There is already a significant body of literature exploring the benefits (as well as some of the more negative aspects) that technology can bring to the lives of people with disabilities, in particular how it can support and maintain independence [40]. This is reflected in the array of transport-focused literature on technological advances in the transport sector, some of which may have been specifically designed and intended for use by people with disabilities, though not all. However, all have had a major impact on the ability to travel. These fall largely into two categories: technology which provides information; and technology which provides a service. Some, but not all, of these are mainly used in higher-income countries, but all have the potential for transfer and adaptation.

Information-providing technologies include apps which give live updates about planes, trains, buses and other (usually public) transport, as well as live trackers, digital maps, etc. These often use location-tracking devices, such as GPS. Use of these tracking devices has extended to support independent travel for people with disabilities [15,41,42]. Whilst all these examples have been tested in higher-income countries with existing infrastructure and services, what the results demonstrate is that whilst accessible infrastructure is a necessary condition, it is not enough. Many of the challenges faced are related to, but not inherent within, the transport system, such as uncertainly about scheduling or routes. This indicates that not just the transport mode, station or service need to be inclusive, but the whole journey, requiring a joined-up approach to inclusive transport.

Technologies which support service provision include online ticketing systems, as well as automated and integrated payment systems. However, whilst convenient, for some users with disabilities it has been argued that these integrated payment systems can also present challenges. In their work in Durban, Lister and Dhunpath talk about these in relation to the Muvo Card, a single smartcard that can be used across all three of Durban's transport systems. Users in Durban report difficulties with locating the machines, drivers being in a hurry, no signalling facilities for blind or visually impaired users and numerous other problems with the machinery [30] (p. 40).

Similarly, in their findings from the Philippines, Cendana et al. [43] argue that such a single-use smart card could be a mechanism for more equitable urban transport, though their main concern was about implementation and eligibility. To overcome this, they argued for a provider that would enable the implementation of the use of the smart card across multiple transport platforms (hence multiple providers) to enable discounts to be systematic to eligible travellers.

However, in the end, while technology is an enabler, a facilitator for accessible and inclusive transport for people with disabilities, it is not in itself enough. Much more research is needed on the systems within which it is embedded—including the costs (demand and supply) and user needs (especially the voices of adults and children with disabilities who will use the services—see [1]). Moreover, focusing solely on access tends to lead researchers to create solutions to overcome physical and environmental barriers, rather than attitudinal or social barriers [44].

#### *3.10. Intersectionalities, Inequalities and the Lifespan*

Disability, like gender and age, is a factor that cuts across mobility, access to transport services from operational and employment perspectives [45]. However, much of the existing research around accessible transport has tended to compare transport use between disabled and non-disabled populations, rather than between different groups of people with disabilities. As a result, there is limited evidence of what works for specific groups, but as noted above, it is clear there is not a one-size-fits-all solution to these challenges. Perhaps as a consequence, increasingly in both high- and low-income countries, researchers and advocates have drawn attention to the need for a broader focus on inclusion, making it accessible and inclusive to all, not just people with disabilities, but also those with temporary mobility difficulties, older adults, people using pushchairs or prams, small children, cyclists and many other groups as well. However, while these design-led solutions tend to address the access issues, there are fewer indicators of measures of success around inclusion, or the socio-political changes required more broadly (see [46] for discussion around the application of these principles in South Africa). Moreover, such universal approaches may unintentionally benefit most those who need it the least if underlying issues such as poverty or fear are not addressed.

These issues have been discussed more widely in the fields of gender and to some extent ageing (see for example [47,48]). Ahmad (2015) highlights how in Pakistan, in order to make public transport accessible for women, including women with disabilities, planners and politicians need to consider religious and social issues as much as financial and logistical ones, as it is these that have the most impact on women. He draws on work which focuses on the gendered aspects of public transport access and provision (e.g., [31,47]) to show how dialogue between disability scholars, feminist critiques, and transport planners is needed to address continuing gaps [49].

Overall, less is known about the complex interactions of disability with a range of other factors including age, sex, location, class, caste, etc. One aspect highlighted in the literature is the unavoidable fact that as people age, their ability to drive safely is compromised, so there is also a safety aspect to reducing the number of older drivers on the road—for example, through mandatory vision screening [50]. This raises challenges when much of the research highlights how cars confer a sense of independence and autonomy, but which can be taken away at the very point when it is most needed, often leaving older adults with disabilities without alternatives.

There is a significant body of research that highlights the changing patterns of transport use across the lifespan, as well as according to location (e.g., [31,51]). However, the majority tends to focus on older adults in higher-income countries, with much less focus on children or young adults (for some exceptions, see [52,53]). Other researchers have highlighted the social aspects of public transport for older adults [54]. Older people have also become a focus for advances in travel technology (see for example, [55,56]). However, there is much less evidence on these complex intersections in lowand middle-income countries. One study, from Mexico, highlights the range of factors that mediate access to transport, with subjective 'transport deficiency' being strongly associated with being female, illiterate, having a mobility disability and using assistive walking devices [31]. The researchers also noted the most commonly used mode of transport for older adults in Mexico City is private car, followed by walking, with a range of factors given for this, including fear, geographical location and limited accessibility of transport options for older adults in Mexico City [31]. Similarly, data in South Africa also suggests that travel options are limited by factors other than affordability [25].

Venter suggests that it is spatiality, rather than affordability or even accessibility, that determines use, a finding also found in other higher-income countries [21]. Venter further suggests that initiatives such as road and footpath upgrading in rural areas would improve access and use [25] (p. 138). Moreover, he suggests that current subsidies in South Africa actively disincentivise older adults from using public transport. Sammer et al. [37] go even further in highlighting the intersecting, and accumulating nature of transport inequalities, referring to 'mobility impairment' more broadly:

"In the past, mobility problems of physically disabled or sensory-disabled people were the focus of attention, whereas, more recently, problems of the elderly have been recognized as well. However, if such problems concern other groups, such as immigrants and people with learning disabilities, they have been more or less neglected" [37] (p.46)

These findings highlight not only how disability can lead to exclusion, which comes about from a complex intersecting of factors, but also the inequalities this exclusion can create. It is clear from the literature that disability can lead to inequalities more broadly within the transport sector, particularly with regards to access and inclusion, but also health inequalities more specifically. As noted above, this paper has not included the vast literature around road traffic accidents, the impact of which can be most severely felt by people in low-income countries, where there is often less regulated transport systems, poor infrastructure and limited availability and access to emergency services.

It is also clear that beyond these negative aspects, adults and children with disabilities may miss out on the mental and physical benefits of travel (see for example Vancampfort et al. [57] for a discussion about the associations between active travel and physical multi-morbidity). As Mindell [58] notes, disability and illness, along with age, is associated with 'non-travel'; and recent research has shown that urban residents in the USA with health conditions that limit travel, particularly driving, are more likely to limit their travel than their rural counterparts (Henning-Smith et al., 2018, cited in [58]). This is problematic from a number of angles, not least of which is social isolation and loneliness, all of which impact on mental and physical health. Transport policies that are good for health and reduce inequalities are low carbon, sustainable approaches, promoting active travel and public transport use, and reducing private car use [58]. Moreover, Mindell notes that in the majority of countries, motor vehicles are owned and used more by the rich while the adverse health effects, such as injuries, air and noise pollution, and community severance are experienced primarily by those with fewer resources [58] (p. 1). This implies that not only are people with disabilities less likely to travel, but they are at higher risk of the consequences of the overall health effects of non-travel.

There is also a cautionary note to this, in that much of the discussions around inclusion in the transport sector have not focused on sustainable alternative modes of transport, such as cycling or walking. It is worth noting that there is almost no literature that focuses on redressing these inequalities, from legislative or other perspectives, for people with disabilities, and there remains a gap in the literature addressing the inequities of the health benefits of active travel and transport for adults and children with disabilities.

#### **4. Solutions and Policy Directions**

From the evidence above, there remains a gap between global goals toward accessible, sustainable and inclusive transport provision and addressing the specific transport needs of children and adults with disabilities. Nevertheless, there have been attempts to address this gap, starting with policy. What lessons can be learnt from these, and are they transferrable to other contexts?

This growing shift is evident in much of the literature in the transport sector and reflects moves away from a more straightforward focus on accessible transport 'solutions' (e.g., infrastructure, connectivity, adapting environments and policies) to that of 'inclusive transport'—a broader understanding of the wider impact of transport exclusion (see for example [1,14]). Nevertheless, many guidelines still focus on physical access. In the UK, both public companies such as Transport for London, as well as private companies such as Uber promote themselves as accessible and inclusive. Inclusive transport is not only for people with disabilities but reflects a desire for a truly encompassing and integrated system. However, this is the central challenge—creating a system that works for everyone, whilst ensuring that the specific needs of individuals are catered for. Nevertheless, whilst some of these mechanisms have been aimed primarily at people with disabilities, including legislation and access standards, negative attitudinal and other barriers persist [21].

Having political backing may at least enable these issues to be raised in the first place. Many countries have developed context-specific access standards, including the Government of India, which supports a largescale national campaign on accessible public transport and buildings [59], though recent newspaper reports question how successful these have been [60]. However, whilst these access standards and audits can be contextually relevant, another barrier is the absence of agreed (and universally comparable) definitions over what constitutes 'accessible travel' or its opposite, 'transport impaired' travel. How are these measured if, as argued above, there has been a more general shift away from 'access' to 'inclusion'? In the wider development context, there are few tools or indeed markers, of what inclusion, participation or empowerment actually are, let alone how they are measured.

To address this gap, a team of researchers from Australia have developed and tested a set of tools which combined access audits and road safety audits with inputs from people with disabilities in Cambodia to create a 'Journey Access Tool' (JAT). The JAT is used to measure personal and interpersonal experiences on a regular journey taken by a person with a disability, for example when they utilise health, employment or education services, or wider community access. The authors caution that while the tools were overall a success in the trial, the interventions and interpersonal dynamics (e.g., the personal assistants, interpreters and relations of the people with disabilities) were more difficult to address, as there was a tendency for care givers and assistants to speak on behalf of the person with a disability or interpret their views, risking skewing the data. Key messages may also be overlaid or misinterpreted through the interventions of (often well-meaning) others [61]. Though the tool is only at the trial stage, these findings illustrate the crux of the debates about accessible transport provision: the extent to which it is the transport system itself, or wider systemic issues, that create the biggest barriers for people with disabilities. The examples provided here demonstrate that while overall there is an awareness of the need to shift from focusing solely on access—which can be measured and audited by sets of standards and other tools—to broader discussions on inclusion, what actually constitutes meaningful inclusion, as well as what disabled and other 'transport impaired' people want themselves, is still largely missing from the discourse.

Whilst it is clear from the literature that a conducive policy environment is necessary for accessible and inclusive transport, it is also clear that policies alone are not enough. As the examples from South Africa and other countries illustrate, without engaging with local political and other contexts, the best intentions can go awry. Integrating and upgrading locally available transport systems requires more than just accessible vehicles and paved roads. It also requires political will, budgets, monitoring of the process, and recourse if legislation or policy is not upheld. There also needs to be regular engagement with, and training of, public and private transport workers, unions and, crucially, people with disabilities with a range of transport and access needs themselves. Even then, the picture can be mixed. For example, another paper from South Africa highlights the positive changes that, they argue, have come about through constitutional and legislative changes in the country [62]. The paper explores taxi drivers' experiences of, attitudes towards, and beliefs about passengers with communication difficulties in Gauteng Province. In addition to again demonstrating user preference for taxis because of the level of independence that they conferred on people with disabilities, the paper also found that the drivers included in the study viewed people with communication disabilities:

" ... as equals, with no negative stigma to a communication disorder... Participants regarded individuals with communication disorders as 'good', normal people. This finding, arguably, indicates a positive and embracing culture rather than a negative and discriminatory one, facilitating participation and inclusion." [62] (p. 6)

However, while the researchers credit the positive and enabling policy environment in South Africa for these findings, they acknowledge it is a small study, and the results are not necessarily generalisable to other contexts. They also note that many of the people with communication difficulties did not travel alone, which reduces their autonomy, as well as the strength of the research findings. Another recent piece, again in South Africa, draws attention to the very positive policy context in the country, in particular South Africa's Bus Rapid Transport (BRT) services, and linked upgrading and integration of existing services to promoted accessibility. However, this has provided challenges to realise, due to the limited implementation of the BRT system and the majority of passengers that rely upon a combination of conventional buses, trains and minibus taxis. The authors note that:

"While we need to continue to improve the access offered in the formal system, the slow rollout means that the number of disabled people benefiting from these changes (i.e., 'horizontal equity') are likely to remain proportionately very small for the foreseeable future." [22] (p. 184)

Behrens and Görgens argue that there are two key reasons for this failure: over-expectation about the role of the state in delivering transport services on the one hand, while on the other, an underplaying of the role—and power—of the private sector (in this case, taxi-minibuses) in South Africa. They argue this has led to a lack of an understanding of the complexity of delivering the promised accessible and integrated transport system in a context where the formal (state) and informal sectors intersect, compete with and occasionally complement each other [22] (p. 185). They conclude that a key focus for the promotion of universal access in South Africa should be the minibus-taxi operations and provide a range of options to encourage this in line with existing policy. These include universally accessible infrastructure and wayfinding information provided at minibus-taxi ranks and at public transport interchanges; state-supported incremental fleet renewal of existing taxis to more accessible vehicles; a (partial) shift to user subsidies, for example, cashless fare collection technologies for designated passengers (eligible for concessions/subsidies) and financial incentives to the minibus-taxi operators to carry passengers who would otherwise not be served [22] (p. 194). It could be argued that the authors could have also included something around disability awareness raising and training—though perhaps, just the use of accessible buses, wayfinding information, etc. would raise awareness of drivers and other users anyway.

Finally, it is worth noting that there is a striking absence of literature from low- and middle-income countries on the extent to which the voices of any people with disabilities are included in arenas where transport policies are decided, monitored, evaluated or governed.

#### **5. Discussion**

Whilst throughout this paper we have been keen to demonstrate that there is no 'one size fits all' solution to the provision of inclusive transport, it is interesting to note that despite the diverse range of literature included here, the income levels of the countries and types of impairments written about, there are a number of common threads the emerge across the literature. These can offer some guidance about creating sustainable, accessible and inclusive high-volume transport systems in low-income countries that avoid some of the pitfalls outlined above. Addressing legislative, environmental and attitudinal barriers by improving access, delivering specific targeted services and policies and practices, as highlighted in the World Report on Disability [4] remain key. However, whilst transport is widely acknowledged to be a barrier to equity and inclusion, the size of the exclusion gap remains difficult to measure, and what works to close it remains difficult to know, particularly in low-income countries. This may be because of an overall lack of understanding about transport needs, in particular from the perspective of those who need it most and are most affected by these gaps. The voices of adults and children with disabilities themselves are rarely heard in the literature. We found very little evidence of discussions around costs or user satisfaction, particularly around new technologies. It is also apparent that transport is not seen as a right—yet without it, rights will not be attained. Understanding and appreciating the "full social benefit of mobility services" [38] (p. 590) is yet to be realised in many countries. There is then an urgent need for more research in this area.

It is also clear that more work needs to be done to support adults and children with disabilities to use transport services, but this should and could be done by integrating it more fully with other interventions, including education and livelihoods, shifting away from seeing it as a 'transport' issue per se. Overall, the research highlighted the possibility that improving general public transport (including door-to-door access) would enable more people with disabilities to use these services.

A supportive policy environment is necessary, as is a Universal Design framework, but it seems it is not actually the mode of transport that makes the biggest difference to use, rather convenience and autonomy. Even in countries with relatively good, regular public transport systems, and subsidised services (including paratransit services), many people with disabilities prefer to use cars (or taxis, and motorbike taxis—though there is very little on the use of motorbike taxis and people with disabilities). If high volume transport networks are extended, it is worth considering how adults and children with disabilities can and will be included for the whole journey. To do this, there first

needs to be a shift by providers about transport access as a right, based on freedom of choice, rather than as a welfare provision (whilst still acknowledging that some people may benefit from additional assistance). Viewing transport provision for people with disabilities as a welfare issue is tied to how current funding mechanisms and delivery structures target and work for people with disabilities (in particular, concessions and STS). Universal concessions remove some of this stigma but can be politically motivated; moreover, the evidence about their usefulness was mixed, with several reviews arguing the money would be better spent on general subsidies [25]. Nor was there much evidence in the literature on the commercial benefits of including adults and children with disabilities into mainstream (existing) transport structures, rather the focus has been on the costs of providing special transport services. Again, this is a lost opportunity.

In the examples from higher-income countries such as South Africa and elsewhere, one common theme that emerged was the need to 'twin track' [63] accessible and inclusive transport—both upgrading and ensuring new buses and mini-buses, etc. are accessible, but also actively incentivise bus and taxi drivers to pick up passengers with disabilities. This could be via a range of methods, including providing additional cash incentives (e.g., subsidising fares), but also providing training and education for drivers and vehicle owners. There should also be public awareness campaigns to promote transport as a safe space for all users, and recourse mechanisms for those who do experience discrimination whilst using public (or where possible private) transport. Such information could be collected through complaints mechanisms, even text-message numbers to report instantly, as well as from passenger surveys. All this information will lead to a rethinking of how to target resources more equitably—and effectively—based on evidence from the users themselves, and in turn help focus delivery of these resources.

However, none of this can be done without listening to the voices of children and adults with disabilities themselves. To date, there is very little research from low-income countries that genuinely includes these perspectives—what the absence of transport means to people with disabilities, why they do not use it, what would enable their access and increase their inclusion. Not only are their voices absent, but there is an almost total absence of any literature from low-income countries on the extent to which people with disabilities are included in governance and decision-making around transportation. Moreover, people with disabilities are not a homogenous group and their identities intersect across age, sex, social class, ethnicity, etc. Listening to these multiple voices and perspectives help us understand the transport and mobility needs (and rights) of other marginalised and excluded groups, including women, older adults and young people. This would seem to be key to moving the inclusive transport agenda forward.

Overall, the focus on inclusion still needs work to shift from a focus on solely access—which can be measured and audited by sets of standards and other tools—to broader discussions on inclusion. However, solutions need to be mindful of ensuring that the onus is put on adapting the environment, not the person, to ensure they are in line with the human rights principles of the CRPD. One issue that has yet to be resolved is how to measure and monitor transport access and inclusion for adults and children with disabilities across a variety of settings, with a range of impairments, incorporating issues of safety and security, independence and autonomy. Crucial to this discussion is what 'inclusive transport' actually means for people with disabilities, and not what other (often well-meaning) people think it means. It is clear from the literature that despite the lack of transport provision to rural areas both within low-income countries and globally, merely providing accessible transport to these areas will not be enough to increase inclusion. Evidence from urban areas shows that provision has not in itself universally increased public transport access in these areas in higher-income countries, and people continue to rely on cars for autonomy and convenience.

There is also a lack of evidence on what inclusion looks like—as noted above, though countries are tasked with developing their own indicators for the SDGs, it is unclear that these are being meaningfully translated regionally or nationally, nor are there any agreed universal targets or indicators for inclusive transport. In order to deliver global commitments, as well as local ones, transport solutions need to

move away from putting the onus on adapting the person and focus on adapting the environment and behaviour change. While there are some interesting examples of accessible transport solutions, including from low- and middle-income countries, there are almost no examples from low-income countries of systemic adaptations or accommodations, such as universal travel concessions for eligible passengers, or indeed any examples of prosecutions of companies or people who break the law regarding discrimination in access to transport in low- or middle-income countries. It is clear that significant knowledge gaps remain.

#### **6. Conclusions**

In order to move this agenda forward, a number of recommendations emerge from this review. The first is the need for much more research on what inclusive transport is—or should be—from the perspective of users in low- and middle-income countries, as noted, there is an overall paucity of research from low-income contexts to review. Secondly, there is a particular need for the voices of adults and children with a range of disabilities to be heard in order to better understand their transport needs. Thirdly, while the review has highlighted some positive examples of favourable policies and joined-up services facilitating access, as the example of STS demonstrates, this has not necessarily led to inclusion. In order to enable a shift to inclusion, planners not only need to consider access from a holistic perspective (Universal Design, whole journey approach, subsidies and adapted/specialised services), but also as a right (for example the right to health, education, etc.). In order to do this, planners should consider a 'twin track' approach to inclusive transport—making improvements to services, training staff, etc., whilst at the same time ensuring that the specific needs of adults and children with disabilities are met. The review has also highlighted how travel and access needs change over time and vary according to a range of factors, including age and location—one size will not fit all. This does not mean accessible approaches cannot be implemented, but planners will need to listen carefully to a range of voices to understand who may be left out, and what alternatives can be developed for them.

In order to facilitate this shift, incentives for existing structures should be developed, taking passengers, transport providers, drivers, unions and other key players into consideration., It is vital that people with a range of impairments are included in planning discussions, on access panels, and in audits of existing services and structures. Linked to this, governments need to develop a locally and contextually appropriate sets of standards, targets and indicators, in collaboration with local disability organisations (e.g., disabled people's organisations) to measure availability, accessibility, affordability, acceptability and quality, as well as safety and security, independence, and autonomy. Complaint mechanisms for users must be developed and adhered to, with appropriate recourse mechanisms, and disciplinary measures for those that do not adhere to them.

Finally, the review has only been able to touch on the range of technologies available to facilitate access and inclusion—much more research on existing and new enabling technologies appropriate for low- and middle-income country use is needed.

**Author Contributions:** Article conceptualisation, M.K. and J.T., methodology, M.K. and E.C.; validation, M.K. and E.C.; formal analysis, M.K. and E.C.; investigation, M.K. and E.C.; resources, J.T.; data curation, M.K.; writing—original draft preparation, M.K.; writing—review and editing, M.K., E.C., and J.T.; visualization, M.K. and J.T.; supervision, M.K and J.T.; project administration, M.K. All authors have read and agreed to the published version of the manuscript.

**Funding:** This research was funded by UK AID through the UK Department for International Development under the High Volume Transport Applied Research Programme, managed by IMC Worldwide.

**Acknowledgments:** The authors would like to thank Gina Porter for her comments on an earlier draft of this paper.

**Conflicts of Interest:** The authors declare no conflict of interest.

#### **References**


© 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).

## *Article* **Older People, Mobility and Transport in Low- and Middle-Income Countries: A Review of the Research**

**Mark Gorman 1,\*, Sion Jones <sup>1</sup> and Je**ff**rey Turner <sup>2</sup>**


Received: 16 July 2019; Accepted: 22 October 2019; Published: 4 November 2019

**Abstract:** Older populations are rising globally, which in high-income countries has helped to generate a growing literature on the impact of ageing on travel requirements and transport policy. This article aims to provide an initial assessment of the state of knowledge on the impact on transportation policy and usage of the increasing numbers of older people in low- and middle-income countries (LAMICs), through a review of the literature relating to older people and transportation. As both the academic and policy/practice-related literature specifically addressing ageing and transport in LAMICs is limited, the study looks beyond transportation to assess the state of knowledge regarding the ways in which older people's mobility is affected by issues, such as health, well-being, social (dis)engagement and gender. We find significant knowledge gaps, resulting in an evidence base to support the implementation of policy is lacking. Most research in low-income countries (LICs) is either broad quantitative analysis based on national survey data or small-scale qualitative studies. We conclude that, although study of the differing contexts of ageing in LAMICs as they relate to older people's mobilities and transport use has barely begun, institutions which both make and influence policymaking recognise the existence of significant knowledge gaps. This should provide the context in which research agendas can be established.

**Keywords:** ageing; disability; gender; mobility; older people; poverty; transport; urban

#### **1. Introduction**

There is by now a substantial body of literature discussing the impact of an ageing population in developed countries on travel needs and required changes to transport policy. An age-friendly built environment, including safe, affordable, and convenient transportation, has been identified as a critical factor in enhancing the quality of life for increasingly large numbers of older people. Studies across high-income countries have recognised that "Access to transport is regarded as a major determinant to achieving a good quality of life in older age" [1]. A number of reasons have been proposed to explain this growth of interest in ageing and mobility, the most immediate being the global increase in the absolute number and share of older people. This interest has also been facilitated by a substantial growth in the evidence available for high-income countries since 2000. However, very little is known about older people outside high-income countries [2]. This article aims to provide an initial assessment of the state of knowledge on the impact on transportation policy and usage of the increasing numbers of older people in low- and middle-income countries (LAMICs), through a review of the literature relating to older people and transportation. As both the academic and policy/practice-related literature specifically addressing ageing and transport in LAMICs is limited, the study looks beyond transportation to assess the state of knowledge regarding the ways in which older people's mobility is affected by issues such as health, well-being, social (dis)engagement and gender.

While there are many similarities between the experiences of mobility and transport use between high-income countries and LAMICs, there are also important differences. For example, transport infrastructure in many low-income settings is significantly poorer than for the "developed" world and some middle-income countries, and transport choices for older people who have to rely on public or shared transport services are extremely limited in many situations. It has thus been pointed out that context is significant, including, but not limited to, geographical settings: "Mobility is not just about the individual ... but about the individual as embedded in, and interacting with, the household, family, community and larger society" [3].

This consideration of context also highlights the need for a review of research into age-related issues of mobility and transportation to move beyond a narrow biomedical model of ageing. For Schwanen and Paez context comprises four domains: the social relations of household, family, friends, acquaintances and community; the built environment, including transport, communication and other infrastructures; the institutions responsible for the built environment, policies and other forms of regulation; and the cultural norms and expectations that underpin travel practices and the regulation of mobility. In addition to these domains, life-course trajectories provide a history of past events and experiences for individuals, households, families, communities and societies, which impact significantly on issues to mobility in later life. So too do gender and ethnicity. Finally, old age, itself, is often treated as a fixed and stable category in transport studies [2]. This is notwithstanding that as long ago as the 1990s social gerontologists were pointing to the importance of understanding "the causal linkages between aging and social and political structures" rather than seeking inherent cultural meaning in the biological process of ageing [4]. Mobility and utilisation of transport is simply another example of how the meaning and definition of "old age" and "ageing" are culturally and geographically variable and socially constructed.

The article is structured as follows. After a review of the research materials and methods used we address global policy responses to ageing, mobility and transport, and this leads to a consideration of some of the evidence and policy gaps identified. This is followed by sections which address specific dimensions of ageing and its impact on mobility and transport. These are gender, social isolation and social support. Finally, consideration is given to ageing impacts and responses relating to mobility and transport requirements in humanitarian emergencies before a discussion of research gaps and emerging issues.

#### **2. Materials and Methods**

While this paper is not intended to be a systematic review, a literature search was undertaken utilising the Web of Science database, Google Scholar and other sources (including online material available from major international agencies). The search was undertaken between December 2018 and March 2019, and included material in English from 2000 onwards, just prior to the UN's first major plan of action on ageing relevant to the developing world in 2002. Criteria for inclusion was material focussed both on the experience of older people in utilising transport, and on the barriers due to age related to disability, gender and poverty. Search terms used were Older people AND mobility AND [Africa, Asia, Latin America]; Older people AND transport AND [Africa, Asia, Latin America]; Older people AND travel AND [Africa, Asia, Latin America]; Elderly AND mobility AND [Africa, Asia, Latin America]; Elderly AND transport AND [Africa, Asia, Latin America]; Elderly AND travel AND [Africa, Asia, Latin America]. The search on Web of Science database returned 82 results. After screening by title and abstract, 22 were selected for inclusion. In addition, a manual review was undertaken through Google Scholar and other sources which returned 69 relevant items from scientific and grey literature. Eighty-two items were identified through database searches and 22 items were included; 69 items were included from manual search out of a total of 81 items.

In addition to the Web of Science database, a manual search was also undertaken. The search terms selected here were chosen to extend the inquiry beyond a focus on ageing and older people (which would produce limited results) to include related issues such as gender, disability and poverty. Countries selected aimed to achieve a representative geographical spread of LAMICs in Africa, Asia and Latin America. As articles and other publications were identified, citations they contained were used to identify other research of potential relevance on the World Bank's Open Knowledge Repository was searched, and the online resources of UN agencies (the World Health Organization, the UN Department of Economic and Social Affairs (which houses the UN's Ageing Programme), the UN Development Programme and UN Habitat. Other "grey" literature, included are the materials of Help Age International, and the publications of other non-governmental organisations working in related fields. (It should be noted that some of this material was developed for advocacy rather than objective research purposes and their conclusions should, thus, be treated with more caution). Our review also draws on the authors' extensive practitioner experience of work with older people, in a major international organisation dedicated to this field, including engagement with international and national policy makers, NGOs and communities in diverse LAMIC contexts. We are confident that we have been able to adequately identify eligibility and quality of the material we present in this paper.

#### **3. Results**

#### *3.1. Ageing, Transport and Global Policy*

The broadest context for population ageing is at the global level. Demographic change and population ageing are now global trends, not ones confined to high-income countries. The growing numbers and proportions of people living into later life in all societies pose new questions about their transport and mobility requirements and the extent to which transportation policy and practice will be responsive to the mobility needs of older people. The policy response at the global level is an indicator of the extent to which demographic ageing has elicited a policy response, and the degree to which an evidence base to inform policy has been developed.

At a global level, policy parameters are now set by the Sustainable Development Goals (SDGs), whose call to leave no one behind requires that the SDGs are met for all of society, at all ages, with a particular focus on the most vulnerable, including older women and men [5]. Even before the advent of the SDGs various UN agencies addressed the impact of transportation issues on ageing populations in the context of wider agenda-setting debates. Prior to the United Nations' second global assembly on ageing in 2002, Kalache and Keller noted the importance of adequate public transport to enable more independent life well into very old age, noting that "one of the major challenges is to ensure access...to all older persons—including the poor and those who live in remote areas" [6]. The UN's international plan of action on ageing which emerged from the 2002 World Assembly included as a priority "Ensuring enabling and supportive environments—Transportation is problematic in rural areas because older persons rely more on public transport as they age and it is often inadequate in rural areas" and called for investment in local infrastructure, such as transportation [7].

The UN's New Urban Agenda (which lays claim to being "a paradigm shift based on the science of cities; it lays out standards and principles for the planning, construction, development, management, and improvement of urban areas") also makes broad commitments to be age-inclusive, from data collection through consultation to policy-making. Specifically in relation to urban transportation, commitments are made to enable access to safe, efficient and sustainable transport systems for all [8].

In its Global Ageing and Health Report (2015) the World Health Organization addresses the interactions of the different dimensions of an older person's context (social relations, the built environment, policy and regulation, and cultural norms). "Mobility is influenced not only by an older person's intrinsic capacity and the environments they inhabit but also by the choices they make. Decisions about mobility are, in turn, shaped by the built environment, the attitudes of the older person and of others, and having both a motivation and the means to be mobile (such as by using assistive devices or transportation)". The Report goes on, stating: "Specific consideration will need to be given to the needs of older people to ensure that environments are accessible, including homes, public spaces and buildings, workplaces and transportation" [9].

The World Bank has also recognised that "Vulnerable and special-need groups (including women, children, persons with disabilities, and older persons) are underserved by public and private transport systems...because users and providers do not carry the full societal costs of excluding vulnerable groups". The World Bank argues for "equity and inclusivity [to be] at the heart of Universal Access. This objective...places a minimum value on everyone's travel needs, providing all, including the vulnerable, women, young, old, and disabled, in both urban and rural areas, with at least some basic level of access through transport services and leaving 'no one behind'" [10]. Both the Sustainable Development Goals and the New Urban Agenda call for expended, age- and gender-responsive public transportation that responded to the challenges faced by all.

More broadly, the NUA calls for age-and gender-responsive approaches to policy and planning processes, design, budgeting, implementation, evaluation and review, and this indicates the important potential of focussing on universal access, rather than transport-related solutions aimed at older people alone. The World Bank has addressed ways to ensure universal access, but again the research basis is lacking, at least as far as the participation of older people is concerned. The World Bank itself notes that "While there is no widely agreed upon method of measuring universal access, there is a general agreement that sustainable transport should leave no one behind. Data that measure access to transport infrastructure and services for urban areas are not readily available on a global scale. The data that do exist suggest that the accessibility gap is huge, and potentially growing ... " [11].

#### *3.2. Evidence and Policy Gaps*

Notwithstanding the concern of the UN and other global bodies to establish these broad declaratory frameworks, evidence-building and analysis have not been prioritised. For example, while the World Bank makes significant reference to the evolving requirement for sustainable and accessible transport arising in part from the changing requirements of older populations, no supporting evidence is cited for statements such as "The ageing of the population is likely to have significant effects on mobility..." The evidence base for a research agenda to support the implementation of global policy is therefore lacking [11]. Moreover, these global policy concerns are very rarely reflected at regional and national levels. National policymakers cite resource constraints and the absence of evidence for these policy gaps [12]. Thus, while a number of studies conclude with proposals for policy interventions, these have not been translated into practice [13,14].

More recently greater attention has been paid to the global implications of population ageing for transportation and transport policy [15]. A number of studies in LAMICs have been undertaken, often with the stated intention of influencing transport policies. A study of Hong Kong, for example, took as a starting point the rapid growth of the older population, which was expected to significantly affect the public transport systems, and "to provide suitable policy recommendations that cater to the travel needs of an ageing society" [16]. Other work has relied on the WHO SAGE data for China, India, Mexico, Ghana, Russia and South Africa, which are, thus, studies of small samples of older populations in middle- rather than low-income countries [17]. Datasets comparable to the SAGE data do not exist for low-income countries [18].

Other countrywide studies are rare and those that exist use broad national datasets, such as USAID's Demographic and Health Survey. Although the DHS is conducted in around 90 LAMICs and provides data for approximately 30 indicators in the Sustainable Development Goals, its data on older people are of limited value. While interviewees are women aged 15-49 and men aged 15–49, 15–54, or 15—59, data on older people are collected only through a whole-household questionnaire. Only two countries (South Africa DHS 2016, Haiti DHS 2016) have extended or lifted the upper age cap in individual questionnaires. Thus, in sub-Saharan Africa for example, only one significant national transport study has been undertaken with older people [19]. As we have seen, urban studies are confined to West Africa, particularly Nigeria. For rural areas the literature is very meagre [20]. As we have noted, studies in both south Asia and Latin America also concentrate heavily on urban settings.

These significant research gaps should be seen in the context of the overall lack of both empirical data and theoretical development on ageing and older people in LAMICs [14]. This in turn impacts on planning and policy formation. Commenting on the lack of data sources for an inquiry on active ageing in the Philippines, for example, Pettersson and Schmöcker note that better datasets are a basic requirement for urban planning in developing and newly developed countries [21]. Constraints such as these apply particularly in Sub-Saharan Africa where, despite an intensification of debate on ageing and formal expressions of commitment on the part of national governments, comprehensive policy action is still lacking. "The impasse reflects a lack of political will and an uncertainty about required policy approaches, engendered by wide gaps in understanding...in the region" [21]. A review of research relating to care-seeking behaviours among older people finds that apart from a number of small-scale, qualitative studies, no systematic, country-level evidence exists. Their findings, which point to the negative impacts of physical and logistical access difficulties and financial barriers related to service fees and/or transport costs, thus have no means of translation into policy-making [22].

This highlights a particular problem in relation to population ageing and older people. Parker et al. point out that "Aging in the west is often viewed from a biomedical perspective where the emphasis is on medical treatment and health and social care arrangements. Biomedicine also dominates international health strategies, organizations, and the funding streams for aid..." [12]. From this perspective, the wider implications of ageing as another stage in the life course receive much more scant consideration, and the familial, social and economic relations which structure older people's lives tend to disappear from view. Furthermore, older people are often excluded from data collection mechanisms; for example, much of the data available for LAMICs comes from household surveys, which set age restrictions and, therefore, do not routinely include older respondents. They often provide data and analysis at the household rather than the individual level, and data, where collected, is not disaggregated and analysed by age [23]. Exceptions to this, such as the World Health Organization's "Study on global Ageing and adult health" (a longitudinal study collecting data on adults aged 50 years and older), have very small sample sizes and tend to focus on middle-income countries where datasets may be more reliable than in the least-resourced settings [24].

The inattention to the needs of older populations in transport policy may also reflect the relative lack of political participation by economically and socially disadvantaged older people, and their consequent inability to influence decision-making on mobility services and investment. A low level of political participation has been noted as a key measure of the social exclusion of older people in middle- and low-income countries [25]. While the participation of older people in decision-making processes is restricted, the relative weight given to perceived economic value, social participation and reducing inequalities is likely to remain limited. Porter et al. point out that "Transforming evidence into policy and practice is particularly challenging in the transport sector which is dominated by male, middle-aged, middle-class engineers whose principal focus is road construction rather than transport services and where there is still a common reluctance to engage with users or with qualitative data" [20].

The lack of evidence that the perspectives of older people, amongst others, are considered when planning public transportation has been noted by, for example, the Institute for Transportation and Development Policy (ITDP), which recognises the democratic deficit created as result of local and national government transportation investment and planning decisions which fail to consult with and include urban residents, particularly those who are often the most marginalised [26]. In terms of investment and impact assessment, even in high income contexts, there is little existing guidance for comprehensive transport equity analysis that includes all groups of people [27].

#### *3.3. Ageing, Health and Mobility*

The relationship between ageing and health is complex; it is now well recognised that a global epidemiological transition from diseases, which mainly impact children, to non-communicable diseases (NCDs), which are more common in adults, has accompanied the demographic transition with population ageing at its core. The combination of disability and ageing potentially provides a significant limitation on the mobility of older people in LAMICs, though again the evidence base is relatively sparse, since very little research has been conducted on moderate to severe disabilities affecting mobility, communication and mental function in later life [28–30]. For example, a comparative study across urban settings in Latin America and the Caribbean, while addressing gender differences in later life health and functional status, similarly did not establish a connection between limited functional capacity and transport utilisation [31], this notwithstanding that the research utilised data from the SABE study ("Survey on Health, Well-Being, and Aging in Latin America and the Caribbean"), the first health study of the old people in Latin America and the Caribbean to include transportation among the physical environment determinants which it assessed [32].

What does seem to be clear from the evidence is that the outcomes of disease and injuries are increasingly undermining the ability of the world's population to live in full health. A recent review of data from the WHO "Global Burden of Diseases, Injuries, and Risk Factors Study" noted that (after anaemia) the leading cause of impairments (by number of individuals affected) were hearing loss and vision loss. These sensory organ disorders were also the leading causes of impairments in 22 countries in Asia and Africa and one in Central Latin America, while lower back and neck pain was the main cause of disability in most countries [33]. There is some recognition that these disabling conditions can be critical for the wider social participation of older people. There is little published data on the potential health benefits of active travel in low and middle-income countries, although some evidence exists. For example, studies (which again drew on WHO's widely-used SAGE data for six MICs, or the related INDEPTH datasets) found a correlation between increasing age and reduced active travel (walking or cycling), translating into a higher risk of being overweight and raised BMI [34,35]. A smaller-scale study in peri-urban areas of Nepal elicited similar results [36].

Problems over access to health care facilities is the most frequently cited transport-related issue for older people in LAMICs, with physically remote clinics and hospitals necessitating costly and difficult travel a key barrier. A common finding was that poverty and mobility constraints combined to reduced older people's access to healthcare [37]. Data from the WHO's World Health Survey (2002–2004) indicated that, in total, more than 60% of older people in LAMICs did not access health care either because of the cost of the visit, or because they did not have transportation, or they could not pay for transportation. Transportation may be a particularly important issue for older people who live in rural areas because services are often concentrated in large cities far from people's homes and communities [38]. A study in rural Kyrgyzstan, for example, found that one in five older people lived more than a 30-minute travel away from a health facility, with access particularly problematic for those with a limiting longstanding illness or disability [39]. The structure of health care provision is also problematic, noted by a study in South Africa of care and treatment for older people (50+) living with both HIV and other chronic conditions, which found that services were typically provided at different health facilities or by different health providers, necessitating multiple patient journeys [40].

Psychological factors, such as depression, may also play a role in limiting mobility. A study to identify the most burdensome functioning domains in depression and their differential impact on the quality of life using SAGE data from countries in Asia, Africa and Latin America found that affect, domestic life and work and interpersonal activities were the domains most affected by depression, with gender also playing an important differentiating role [41]. A lack of self-confidence in physical capacity, leading for example to a consideration of the risk of falling, as well as concerns regarding traffic, have also been identified as limiting factors. The risk of falls is a prevalent factor in activity restriction by older people in a variety of settings. Even among a physically active older population in the Colombian Andes the risk of falling decreased physical activity with negative effects for self-perceived health and depressive symptoms [42–44].

Again, however, and notwithstanding the high and rising level of death and injuries from road traffic accidents in LAMICs [45], and the significant proportion of older victims in some contexts, research on the impact of traffic accidents on older people remains undeveloped [46]. This may reflect

a context in many low- and middle-income countries, where poor quality transport infrastructure (including poorly maintained roads, pavements, crossings, shelters, as well as poorly maintained and inaccessible vehicles) affect people throughout the life course. Accident rates are high, affecting whole populations. In these circumstances it is perhaps unsurprising that the specific impacts on older people receive relatively little attention.

The evidence that does exist indicates that older people, whether walking or using public transport, have a significant exposure to accidents and injury [47]. Even crossing roads in busy urban environments in LAMICs may (rightly) induce feelings of anxiety and fear, with a consequent impact on quality of life [48]. Although data limitations mean that studies have tended to be small-scale, they nevertheless raise important issues. For example, a study of the constraints on the travel of older people in a Nigerian city found that issues such as vehicle design, long access and waiting time as well as poor facilities at bus terminals were serious constraints to the effective mobility of older people [49]. Similar conclusions were drawn from a study in Pakistan, which pointed to safety and security issues, as well as attitudinal behaviours on the part of service providers, as key factors in the mobility and transport utilisation of older people [14]. These are issues to which we return below.

#### *3.4. Ageing, Transport and Gender*

As noted above, a key cross-cutting issue affecting the mobility of older people is that of gender, which has now become a well-recognised issue in transport research, and one that intersects with other factors to increase disadvantage. A study in Bogota, for example, which summarized recent research on unequal access to transport systems, focused on the ways that gender and socioeconomic inequalities may be exacerbated by differences in transport accessibility [50]. Nevertheless, again the intersection of gender with age has attracted far less attention, despite this being a feature that research has shown to be clearly recognised by older people themselves [51]. Moreover, there are no systematic gender and age inclusion procedures for transport, either in terms of training of professionals, participation of users or the design and planning of systems, services and equipment. Again, as international institutions such as the World Bank have pointed out, a lack of evidence limits progress in policymaking, particularly regarding gender issues in transport relating to older people in the developing world [52].

While other international institutions have drawn attention to the intersections of age and gender, again, a clear evidence base substantiating their assertions is lacking. The UN Economic and Social Council (ECOSOC) for example, has pointed out the economic impacts of differential access to transport for women. They noted in 2009 that women in low-income countries were seriously constrained in their access to transport, limiting access to labour markets, increasing production costs and reducing the amount of goods which could be taken to market. The ECOSOC report focussed on issues such as poor access to transport, affecting girls' school attendance, women's use of health and other public services and maternal mortality. While older women were not specifically mentioned, evidence was noted regarding the lack of access to transport services affecting women who spend long hours hauling water and fuel and walking to and from farm plots. Head-loading was cited as a major health hazard to women, as was the potential to suffer higher accident rates through walking on crowded roads with heavy burdens [53]. Other evidence indicates that these are impacts which fall on women who continue to work into later life [20].

A small number of studies do address age and gender as features affecting access to transport and impacting on mobility. Research in urban settings in Pakistan, Iran and Malaysia all found that age and gender, together with other factors, such as car ownership, travel time, travel cost, household size and income, were significant factors in influencing individual choices in transportation. These studies all included higher-income households, and demonstrated the importance of car ownership in travel frequency, though even here gender played an important role, with older men making significantly more journeys than older women [14,54,55]. Other evidence points to the limitations in "choice" that older women in particular may have; a study of a urban setting in Nigeria found that gender, along

with increasing age, education and monthly income, were significant in determining walking as the mode choice, in a situation where over 70% of older people lacked access to motorised transport [56].

The impact of gender on transport access in Africa is also examined in a recent field study which assessed whether gender mainstreaming in rural transport programmes in Tanzania has had a transformative effect on women. The study found that despite the attention given to gender issues, women's participation in designing and implementing rural travel and transport programmes was limited by negative views of women's potential to contribute effectively to such programmes. On the other hand, road construction did lead to improvements in transport services and expanded travel options for all women, including those in later life, who had more time both for family and to pursue multiple projects [57].

#### *3.5. Mobility, Transport and Social Isolation*

Gender thus has clear impacts on mobility and helps to bring into question the role that mobility plays in enhancing or mitigating loneliness and social isolation. The World Health Organization has recognised the importance of attitudinal factors for older people, commenting that "Mobility is influenced not only by an older person's intrinsic capacity and the environments they inhabit but also by the choices they make. Decisions about mobility are, in turn, shaped by the built environment, the attitudes of the older person and of others" [9]. Characteristics of the built environment can function to restrict older people's mobility and participation in urban life [58,59]. Nevertheless, research evidence for the role that transport access plays in influencing older people's social isolation is sparse for low-income countries.

In recent years a significant number of studies have made a direct causal link between transport accessibility and social exclusion [60]. Again, the great majority of these studies have been undertaken in high-income countries where both income poverty and lack of transport are relative rather than absolute states. There are few studies on the relationship between transport and social disadvantage in LAMICs, where income poverty is absolute and where access to transportation is very limited [61]. Studies addressing the social exclusion of older people in relation to transport in low-income countries are still rare [62–64]. While some studies discuss the part played by physical mobility in older people's social isolation, the role that transport access plays in this is not examined [65].

For those living in LICs, social isolation is a significant risk with increasing age, again mediated by factors such as gender and poverty. A primary issue for older people in these situations is the impact of psychological factors. WHO notes the importance of the attitudes of older individuals and of others in decisions about mobility, and the motivation (and the means) to be mobile [9], p.180. A small number of studies has addressed the links between confidence and behaviour, to assess the influences on older people's decision-making relating to mobility. Fear of crime and concerns over the safety of public transport have been identified as a limiting factor in older people's mobility in a number of different settings, albeit with wide national and regional variations [66].

WHO studies highlight a number of issues that influence decision making related to older people's use of transportation. These include availability of services, affordability, reliability and frequency, appropriateness of service destinations and the availability of specialised and priority services. Comfort is also highlighted as a key concern, with respondents to focus groups in studies in Rio de Janeiro and Mexico City citing hard, uncomfortable and bumpy journeys exacerbating existing health concerns and discomfort. Similar concerns were raised by focus groups undertaken in five cities in Argentina, with issues such as struggling to board buses because of the height of the initial step. Multiple elements are necessary to make public transport an attractive alternative for older people, including physical accessibility, the availability of information and ease of way finding [67].

Social exclusion has a number of features which may be identified with the experience of older people in relation to transport in the developing world, and which have been the subject of studies which address older people's mobility and transport needs only obliquely. These features of social exclusion are broader than income poverty alone, and include a lack of participation in social, economic and political life. They are also multidimensional and cumulative: for example, limited financial resources and security are often reciprocally linked to low education and skills, ill-health, and, as noted above, limited or no access to political influence. Social exclusion is also dynamic, and subject to changes over time, as well as directly affecting individuals and households as well as neighbourhoods and local communities [68]. Curl and Musselwhite have pointed out that, despite policy and discourse (at least in high income countries) placing strong emphasis on the maintenance and extension of independence and "ageing in place" as vital requirements for a dignified healthy later life, changes in later life income, lifestyle and ability to use transport present significant challenges for the provision of appropriate transport services [15]. Where and how people live impacts day-to-day life, particularly in the urban built environment. Spatial barriers interact in complex and specific ways with the intersecting identities that individuals carry, creating unique patterns of disadvantage. For example, lower income people (in which older people, together with other disadvantaged groups such as women, children, are also disproportionately represented) are increasingly pushed to the periphery of cities in their search for affordable housing [26].

In some cases, this is as a result of deliberate government policy and this has an impact on access to affordable transport. This was noted by a study of peri-urban areas in South Africa, which found that location along the urban-rural continuum significantly affects both transport expenditure levels and the perceived severity of transport affordability problems for marginalised people, notably those with disabilities and older people [19].

#### *3.6. Mobility, Transport and Social Support*

One important motivation for mobility and travel for older people is to access social support, particularly from family members, and a factor mitigating against the need for mobility in many low-income settings in Asia remains the fact that normative support for filial obligations to ageing parents is widespread. A recent study of older people in Myanmar for example, found that the majority of rural-dwelling older people had an adult child co-residing or living nearby, facilitating intergenerational exchanges of material support and personal services, and reducing the need for travel [69]. In the same vein, a review of studies on long-term care systems in sub-Saharan Africa noted that "the provision of long-term care rests overwhelmingly with family members, in line with customary sub-Saharan African norms of family solidarity and obligation". However, the review concluded that the evidence also revealed that "a substantial group of older people received no family care whatsoever" [70]. Again, studies which address the implications the care received by older people in terms of their mobility and transport requirements are almost non-existent for low-income countries. This is equally the case for evidence of older people as caregivers, despite the recognition of the important role that they play in many contexts. A study in Kenya, which found that older women AIDS-caregivers reported high disability scores for mobility and low scores in self-care and life activities domains, indicates that this comes at a high cost to older individuals [71]. Similarly, a Ugandan study showed how older women caregivers faced drastic disruptions of living arrangements, including lengthy travel times and absences from their homes to care for PLWAs [72]. Nor should it be assumed that care-giving is ensured simply by the traditional norms of extended family relationships, when families are spatially separated. For example, a recent study of the mobility constraints experienced by married and externally-resident daughters providing end of life care to parents in northern Ghana shows how these younger women had to negotiate conflicting responsibilities to provide parental care [73]. Similar issues are identified for settings in a recent comparative study on Manila and London [74].

Urban locations are by no means the only settings where security issues play a part in older people's travel choices. For example, both the lack of paved main roads in rural Myanmar and security issues in some regions have been found to be a significant barrier to older people's access to health services [69]. A study in Papua New Guinea examining the impact of road development on people with disabilities found that while road development improved service access, inaccessible road and

transport infrastructure remained insurmountable barriers to easy and safe travel. Roads were planned for the needs of vehicle users, and planning around road infrastructure did not involve consultation with people with disabilities [75].

#### *3.7. Mobility and Transport in Crises and Humanitarian Emergencies*

The particular vulnerabilities of older people in times of systems breakdown is an area which has had some attention in relation to humanitarian response. Clearly mobility plays a decisive role in periods of crisis and humanitarian emergency, and is a major potential issue for older people, (as it is for people with disabilities and children). This has elicited some response from humanitarian agencies which have developed guidance on making services accessible to older people with mobility constraints [76]. However, in comparison to the attention paid to people with disabilities, older people have received less attention from the international agencies, and their transport needs have been largely ignored. The United Nations High Commission for Refugees (UNHCR) has produced guidelines on "Working with Older Persons in Forced Displacement", but while the companion guidance on working with people with disabilities in forced displacement has recommendations for accessible transport, that for older persons does not, confining itself to a broad recommendation to "Help older persons to access services by providing transport" [77].

More recently, a consortium of humanitarian agencies and academic institutions working in the fields of disability and ageing have recognised the overlapping and often coterminous vulnerabilities of older people and those with disabilities in emergencies in establishing key standards for achieving the inclusion of both groups in humanitarian action, by, for example, addressing barriers that affect participation and access to services [78]. However, a more specific focus on transport requirements remains lacking, reflecting a lack of studies on the specific mobility and transport requirements of older people in emergency situations.

The work that has been done reveals some familiar issues. For example, a recent study, based on focus group interviews with older displaced persons in Sudan, found that many older people with disabilities faced a number of physical barriers such as having to travel long distances to distribution points, a lack of accessible transport, as well as inaccessible housing, toilets and public buildings. Family and friends were identified as key providers of both physical and financial assistance, including, notably, paying transport costs, but the cost of transport to key points, such as health facilities, was a constant source of stress [79].

#### **4. Discussion**

This review indicates that, notwithstanding growing recognition (at least at a global institutional level) of the implications of population ageing for transport policymaking, this has yet to be translated into significant investment in research in LAMICs. Such research as has been done in LICs is small-scale and based on qualitative evidence, which may be dismissed by policymakers as "anecdotal". This lack of systematic national-level evidence makes translation of any research findings into policy highly problematic. We have noted the predominant role that transport infrastructure planning plays in many LAMICs, to the detriment of consideration of social value. Such policy biases reflect the fact that policymaking is not a rational, evidence-based process, but is the outcome of numerous interactions between policymakers and other actors (including researchers, but also politicians, lobby groups and advocacy organisations). While evidence plays a role in illuminating policymaking, so too do other factors, such as political voice. As we have seen, the relative lack of political participation by disadvantaged older people limits their ability to influence policy and, by extension, research decisions. This may be both a cause and effect of the exclusion which we have noted of older people from many data collection mechanisms.

There is equally limited consideration of the ways in which age intersects with other factors, particularly gender, differential physical and mental capacity, and poverty. Here we have seen that the lack of age-disaggregated data is problematic. The imposition of upper age limits in data collection

is a significant barrier to understanding the characteristics of ageing, whether at the individual or the population level. Furthermore, despite the diversity to be found within older populations, disaggregation by age has been analysed very little. The lack of gender disaggregated data and analysis is also noticeable, notwithstanding the frequent references in policy documents to the particular challenges of public transport for older women.

Access to services is often a strong focus of current work regarding older people's mobility. The difficulty of accessing health services is, as we have seen, frequently cited, but there is a limited perspective on the wider needs of older people beyond basic health. Issues of mental health, social isolation and loneliness are rarely discussed. The roles played by older people as care-givers or recipients, and their mobility implications has become an increasingly significant area of research in Western contexts, and is also an important issue in LICs. This is an area that clearly needs greater attention. Research on mobilities across generations is also a major gap, with little attention paid to relational mobilities, despite the clear importance of intergenerational connections, notably (but not exclusively) related to care-giving.

However, we have also noted an emphasis in research related to population ageing which focusses attention on medical and social care arrangements, to the detriment of considering the social and economic contexts in which people live the later stages of their life course. We have noted that some work has been done in this regard. For example, a number of studies have emphasised the important place that the continuing need to earn a livelihood has for many who enter later life in poverty. Older people's mobilities and the role of transport in relation to livelihoods is, thus, another important area of inquiry but, again, is a significant research gap in LICs (where income earning must continue into old age in the absence of adequate pension provision). In this regard, the affordability of transport, economic needs, subsidy issues and income categories are all areas for research which require further attention [19].

Research undertaken on psychological effects which act to limit the mobility of older people, and the impacts of social isolation, has been reviewed. Issues ranging from concerns over road safety to harassment, personal security, stigma, shame, discrimination and the impact of crime have all been shown to pose significant barriers to older people's mobility. Many transport services, whether public or private, provide physical hazards for older people, as does poorly maintained physical infrastructure. Again, with limited exceptions, these problems are inadequately addressed in the research literature. While the potential value of virtual connectivity (through mobile phones for example) to replace or complement physical mobilities has been examined, both the benefits and costs of virtual connectivity remain to be researched further [20].

In the absence of access to relevant national-level quantitative data, it may be useful to consider other innovative research approaches. For example, action research, involving interventions followed by in-depth monitoring of impacts over a period of time, which involve older people as active research participants, has potential. However, while there is a growing rhetoric around the involvement of older people in research process, and some action has been taken, older people tend to remain respondents. The value of using co-investigation approaches has been demonstrated by work in Tanzania and in Papua New Guinea [19,20]. New methodologies, such as the use of geo-mapping alongside participatory inquiry methodologies to explore the social and spatial barriers to access of urban services, also need further review and analysis [20]. To develop the necessary expertise, in academic institutions, governments and NGOs, to conduct mobility studies with older people there is also a need to build research capacity, both in-country and external expertise.

This review has indicated the importance of taking account of great diversity in the ageing experience, across widely varying contexts. Influences on ageing range from societal and political attitudes to older people to the built environment, population density, climate, topography and land use. As we have aimed to show, study of these differing contexts of ageing in LAMICs, particularly as they relate to older people's mobilities and use of transport, has barely begun. At the same time, as we have seen, policymaking institutions recognise these issues, and assert the importance of prioritising the widest possible inclusion in policies promoting transport and mobilities of people at all ages, so that, in the words of the Sustainable Development Goals, "no one will be left behind" [80]. We have seen that those institutions which both make and influence policymaking recognise the existence of significant knowledge gaps, some of which have been discussed in this article. This should provide the positive context in which research agendas to answer some of these key questions can be established.

**Author Contributions:** The article was conceptualized by M.G., S.J. and J.T.; the methodology was developed by M.G., who also undertook the validation, and formal analysis.; the investigation was undertaken by M.G. and S.J.; the original draft preparation was by M.G.; the review and editing was by M.G., S.J. and J.T.; project supervision was by M.G and J.T. and project administration was undertaken by M.G.

**Funding:** This research was funded by the UK Department for International Development.

**Acknowledgments:** This research was funded by UK AID through the UK Department for International Development under the High Volume Transport Applied Research Programme, managed by IMC Worldwide. Special thanks to Gina Porter for her support in developing the literature search and reviewing the output.

**Conflicts of Interest:** The authors declare no conflict of interest.

#### **References**


© 2019 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).

## *Article* **Meeting Young People's Mobility and Transport Needs: Review and Prospect**

**Gina Porter 1,\* and Je**ff **Turner <sup>2</sup>**


Received: 18 August 2019; Accepted: 25 October 2019; Published: 6 November 2019

**Abstract:** This paper reviews published and grey literature on young people's daily transport and mobility experiences and potential, with the aim of identifying major research gaps. It draws on literature across a range of disciplines where interest in mobilities has expanded significantly over the last decade (transport studies; social sciences, notably geography and anthropology; health sciences). We focus particularly on young people from poorer households, since poverty and mobility intersect and interact in complex ways and this needs closer attention. Although youth transport issues are set in their global context, the focus on poverty encourages particular attention to lowand middle-income countries (LMICs), especially countries in Africa and Asia. Key themes include education, employment, travel safety and the role of mobile technology. This review demonstrates how young people's travel experiences, needs and risks are embedded in power relations and vary with gender, age and location. It also points to the scale and range of uncertainties that so many young people now face globally as they negotiate daily mobility (or immobility). Significant research gaps are identified, including the need for more in-depth action research involving young people themselves (especially in Asia), and greater attention to the impact of mobile technologies on travel practices.

**Keywords:** children; mobility; transport; Africa; Asia; youth voice; school; work; road safety

#### **1. Introduction: Young People's Mobility and Transport in a Rapidly Changing World**

Young people remain a remarkably neglected constituency in the world of transport planning globally (with the exception of road safety), despite the vital importance of their access to education, health and other services for our future progress and for sustainable development. This omission is of particular concern in the many low- and middle-income countries (LMICs) where well over half the population is under 30 years old and, in some, over half the population is under 18 years old. Two particularly pertinent trends for the discussion that follows are expanding urbanisation and expanding youth populations. It is estimated that by 2030, 60 percent of the world's population will live in cities and that 37 percent of the world's population will be under the age of 20 [1]. There will be 1.3 billion young people aged 15–24 years by 2030 globally [2]. Given the size and importance of the youth constituency, and growing concerns around the potential political risk implied, especially by large concentrations of un/underemployed youth living in cities, young people's transport and mobility needs require urgent attention from policy makers.

Access to services and facilities has massive implications for young people, not only in terms of their current wellbeing but also for their livelihood potential and life chances. The importance of transport for urban young people is specifically recognised in Sustainable Development Goal (SDG) 11.2: provide access to safe, affordable, accessible and sustainable transport systems...with special attention to the needs of those in vulnerable situations (specifically including children). However, better access to mobility/transport will be crucial to achieving almost all the Sustainable Development

Goals: in particular, SDGs 3, Good health and wellbeing, 4 Quality education, 5 Achieve equality and empower women and girls, 8.5, Full and productive employment and decent work for all...including for young people, and 8.6, Substantially reduce the proportion of youth not in employment, education or training. It is unlikely that current inter-generational cycles of poverty can be effectively broken without significant, sustained attention to the mobility of young people and their access to transport worldwide.

This paper reviews the available published and grey literature on young people's daily transport and mobility experiences and potential in order to identify major research gaps. The review draws on the authors' extensive personal knowledge of published and grey literature in this field (in which both have been active participants since the 1990s), searches in the international transport/mobility journals (for instance the Journal of Transport Geography, Transport Policy, Transport Reviews), child and youth-focused journals (for instance Children's Geographies and Children, Youth and Environments) and Google Scholar, plus Web-of-Science searches undertaken for the period 2000–2019 using the following search terms: Young people/Children/Youth AND Transport/Mobility AND Africa/Asia/Latin America. Overall, references in Web-of-Science are far fewer for Asia than for Africa and even fewer still for Latin America: for instance, a search on Young people AND mobility AND Africa produces 63 references, but only 19 for Young people AND mobility AND Asia (and just 8 for Latin America); Children AND mobility produces 176 references for Africa, 62 for Asia and 28 for Latin America. Literature specifically focused on young people with disabilities was reviewed separately in a companion paper by Maria Kett.

There is insufficient space to review wider mobilities associated with migration in this paper: the focus is specifically around the daily mobilities that shape young people's access to education, work and general well-being. Similarly, space precludes consideration of the substantial evidence regarding the importance of transport services for the health of children and young people beyond the traffic accident issues noted in this paper. Consequently, the impacts of transport and mobility on vaccination, maternal health, access to TB, malaria and eye treatment, ARVs and sexual and reproductive health are not included here. Similarly, the effects transport and road infrastructure have on health professionals' decisions regarding work place selection are also omitted. These latter (health-related) topics have been covered in other publications of the first author, who has undertaken field research and published widely in the field of daily mobility, transport and access to services for vulnerable populations in Africa since the late 1970s and with specific reference to children and young people since 2000.

The paper draws on literature from a diversity of disciplines, extending from transport studies and health sciences through to the social sciences (notably geography and anthropology) where interest in mobilities research has expanded significantly over the last decade. Where possible, the spotlight throughout is on young people from poorer households, since poverty and mobility intersect and interact in complex ways and this needs far closer attention. Youth transport issues are set in their global context but with particular reference to LMICs, especially countries in Africa and Asia. Africa is the focus of particular attention in this paper because it is demographically the world's youngest continent: by 2050, the estimated number of young people entering the labour force in Africa will exceed that of the rest of the world combined [3]. This fact may help explain why there is a more extensive published and grey literature pertaining to Africa than to Asia.

The paper addresses seven topics, the first of which briefly explains the specific age focus of interest, while the following six topics represent key aspects of recent research/debate that can be drawn from the literature reviewed here:


#### **2. Age Categories**/**Definitions: Who Is Included in the Category 'Youth' and 'Young People'?**

Various terms are used when identifying young people—'child', 'young person', 'youth'. Formal definition of these terms may vary according to a country's legal code or to a particular institution/agency's decision, but it is also often informally shaped by cultural context: all these categories are, in essence, social constructs. The papers reviewed below adopt varying age definitions when talking about children and youth so it is not possible to work with any one specific definition. We note, however, that childhood is commonly associated with the period prior to puberty, while 'youth'—particularly in papers with an African focus—now often includes reference to people well into their 30s. This accords with the fact that growing levels of unemployment in Africa and the cost of setting up an independent household are putting many young people into an increasingly prolonged period of dependency [4,5].

#### **3. Youth Voice**

Young people's role in governance and decision-making globally is small but it is beginning to expand rapidly, associated with a growing recognition of the potential political risks associated with their unmet needs. An increasingly vocal mass of youth is drawing on its expanding expertise in social media to help build extensive communities of interest and promote its growing demands for better representation in governance, whether in local, national or international contexts, and this is well characterised by youth usage of social media in the 'Arab spring'. Youth parliaments, mushrooming across the world (for instance, in India from 2002; African Youth Parliament of 50 countries from 2003 onwards, etc.), are a good example of the efforts currently being made to support and enhance youth voice.

In the transport planning sector, across the globe, young voices have played only a very small part to date (perhaps in part because transport planning has been seen largely in terms of motor-mobility and young people are usually not legally allowed to drive until their mid/late teens) [6]. However, demands for social inclusion and mobility justice are growing [7,8]. Even in those rare cases where transport has been planned with attention to youth needs (mostly in developed country contexts), it has very rarely been planned with youth. Participatory planning has mostly been viewed by officialdom as a process of engagement with adults. However, given increasing recognition of the need for policy change towards low-carbon sustainable transport (more emphasis on public transport, cycling and walking), youth transport strategies that directly engage with the youth of today will be of vital importance: new travel behaviours are more likely to be learned and adopted by young people [9].

The (albeit very limited) literature available shows how young people can provide vital understanding of their transport challenges (which may be inaccessible to adults) and have valuable insights into how these can be best addressed [10]. In LMICs, what appears to have been the first participatory research with children and young people (aged 9–18 years) on transport issues started in 2004 with pilots in India, Ghana and South Africa, followed by a major study across 24 sites in Ghana, South Africa and Malawi. This incorporated in-depth qualitative research taking an ethnographic

approach plus an extensive survey (N = 3000) [11–16]. The research went beyond adults simply asking young people for their views on transport issues. In the first place, it involved training 70 school children (aged 11–19 years) as co-researchers to identify key issues and questions, mostly through in-depth interviews, photo-diaries and small surveys with their peers. This study, which was followed up by a further phase of academic-led qualitative and quantitative research in each site, drawing on the key issues and questions raised by the young co-investigators, has arguably enabled a much stronger understanding of significant daily mobility issues affecting young lives than might have been achieved through a conventional academic research study alone.

Subsequently, there has been a slow turn towards promoting young people's voices in the transport sector in LMICs through the adoption of participatory approaches, including Simpson and Collard 2019 [17]. However, the constraints which tend to minimise poorer women's voices (not least supposed lack of competence to contribute to what is perceived as the domain of middle-class male engineer experts) continue to play an even stronger role globally in the case of children and young people [14,18,19].

#### **4. Education: Making the Journey to School**

There is substantial literature around the journey to school in the Global North but much less work in the Global South. In the Global North, focus has moved from road safety to expanded attention to the decline in children's independent mobility associated with increasing car use and growing concern with child obesity and the need to expand young people's active travel (walking and cycling) [20–22]. A similar trend can now be observed in the Global South [23]: among middle-class urban children, obesity issues are also emerging, with clear linkages to the expansion of motor transport usage for school journeys [24–27]. In China, in particular, the one-child policy encouraged many parents to adjust their life patterns to provide better education for their children, including chauffeuring their children to and from school if they could afford to do so [28]. In a Nairobi context, parental perception of positive neighbourhood social cohesion, positive environs and connectivity, all of which reduced their child safety concerns, encouraged positive child physical activity outcomes [29]: these factors are likely to be pertinent in many LMIC urban contexts [30]. While programmes in many developed country cities now promote the idea of 'walking school buses' and 'bicycle trains', in order to encourage more active travel [1,31], in LMICs, these are much rarer, although there have been experiments, notably in South Africa and Dar es Salaam [32].

Travel to school experiences in LMICs, especially among children from lower-income families, tend to differ substantially from the norm prevailing in many countries of the Global North (where parental escorting of younger children to school is common and private motorised transport often dominates) [33]. In many LMICs, escorting is mostly a task assigned to older siblings and the journey is far less likely to involve private transport. For children from poorer households, in particular, challenges around physical access to school are closely aligned with issues of journey time and distance—in Africa, mostly entirely conducted through pedestrian travel, in Asia by either walking or cycling—and its associated dangers [14] (chapter 3) [34]. Information per se—and particularly qualitative information—on school travel experiences is far more extensive for African than Asian contexts where, in recent years, the focus has been principally on analysing large-scale survey data. Consequently, Africa dominates the following discussion.

#### *4.1. Travel from Rural Homes to Schools and Training Opportunities in Urban Centres*

Globally, secondary schools, further, and tertiary education are likely to be located in urban centres, restricting opportunities for skills development and the take-up of learning and training opportunities in more remote rural areas [35]. Transport and travel are likely to play a crucial 'cause and effect' role in exacerbating poor skills and low productivity, especially in contexts where transport density is low and subsidised transport is unavailable. In rural Africa, where transport availability is much sparser and more costly than in Asia, the impacts are particularly significant [36]. Thus, in Ghana, it has been

observed that the closer the secondary school, the more likely that children are sent to primary school, as continuity of the child's education is feasible [37].

Across sub-Saharan Africa, children will be seen trudging each early morning and mid-afternoon along major highways as traffic hurtles past. Such long daily walks to and from school due to lack of or high cost of transport bring attendant problems of lateness and encourage late 'over-age' enrolment (especially of girls), truancy and early drop-out. The common alternative of 'home boarding' in town (renting a room alone in the absence of sufficient cheap school boarding places) is particularly fraught with dangers for young girls, who are often targeted for sex by predatory older men [14]. Data from the 2003 South Africa National Household Travel Survey indicates that just over three-quarters of 'learners' walked to school and just under one fifth of the 16 million total spent over one hour each day walking to and from their schools, which are commonly located in smaller or larger urban centres [38].

In remoter locations of rural Asia, poverty similarly forces many pupils to walk to school, despite the greater availability of regular transport than in most of sub-Saharan Africa. In such circumstances, in Bangladesh, Matin et al. [39] described how it is the norm for such children to walk in groups to school for safety reasons, just as they do in Africa. Unsurprisingly, parents in India, Thailand and China are reportedly more likely to allow girls to carry on with their education where transport services are reliable and safe [40]. In Delhi, India, where sexual harassment on public transport is now a notorious issue for women, a correlation has been found between young women's college choice and their perceptions of route safety, despite the higher transport fares thus involved (though without evidence of direct causal connection between the two [41].

It is also important to note that the performance of children and young people at school or in training programmes may be shaped by transport constraints at home. Such transport failures, particularly (but not only) in rural environments, may require young people to undertake a series of tasks before they leave for school or after they return home: these commonly include carrying water and (less regularly) firewood, together with other domestic work such as cleaning, sweeping, washing clothes and caring for younger siblings [42].

#### 4.1.1. School Travel within LMIC Urban Areas

Within LMIC urban areas, motorised transport is available, but fare costs limit its use by school pupils. This is a major factor shaping the very heavy dependence on pedestrian travel (together with bicycle travel in Asia). In urban Africa, generally well over 90% of pupils travel to school on foot: 96% in a Nairobi slum according to Salon and Gulyani [43], 98% across eight diverse Ghana sites and 99% across eight diverse Malawi sites studied by Porter et al. [14] (chapter 3). Journey times can be far more substantial than in Asia given such high levels of dependence on pedestrian travel and the low availability of cycles to school pupils [14] (chapter 3). In peri-urban neighbourhoods in Ghana, Malawi, South Africa and Kenya, pupils report walking considerable distances, especially where there is a preference for a (usually better) school, or where the nearest schools are full [14,43]. In Soweto-Johannesburg, for instance, over a third of primary-school-aged children were found to travel more than 3 km one way to school, nearly two-thirds attended schools outside of the suburb where they resided, and only 18% attended the school closest to home [44]. School quality considerations are often a significant factor shaping school selection, even among relatively poor households. See also Hunter's research in Durban [45]; he makes the point that this applies to poor—but not the poorest—households.

In urban Asia, the sparse published material available suggests that school pupils make more substantial use of informal public transport and of bicycles. However, as cities expand in Asia, the school commuting distance is inevitably growing, as Li and Xhao and Zhang et al. showed using data from Third and Fifth Travel Surveys of Beijing Inhabitants, respectively (with some children travelling over 5 km) [28,46].

#### 4.1.2. Hazards of School Travel

Walk-along interviews with pupils are particularly powerful in demonstrating the fear of harassment and attack for both boys and girls that are widespread in low income urban and rural neighbourhoods, as Porter et al. showed for Ghana, Malawi and South Africa [47]. See also Phillips and Tossa 2017 [48] for child-led walks in Thailand. Overall, children from particularly deprived neighbourhoods tend to face the most constraints on their movement, as Adams et al. observed in a study across urban and rural neighbourhoods in Western Cape [49]. But even in somewhat less deprived neighbourhoods, children's mobility can be restricted by diverse factors, as Benwell pointed out with reference to baboon troops, domestic 'guard' dogs, traffic and the impact of family composition in suburban Cape Town [50].

Across LMICs, the wider hazards of school travel by motor transport are numerous, whether dedicated school transport or informal public transport is utilised: overcrowded poorly maintained vehicles without seatbelts are driven by poorly trained drivers over poorly maintained roads. The situation is no different today across most of Africa and South Asia than was observed in rural Brazil two decades ago [51]. However, in South Africa, where the Safe Travel to School Programme was recently implemented by a national child safety agency, there have been some indications of improved practice [52]. This has stemmed from a focus on driver road safety awareness, defensive driver training, eye-testing, vehicle roadworthy inspections with selected upgrades, incentives for safe performance, and implementation of a vehicle telematics tracking system with regular, individual driving behaviour information updates.

#### 4.1.3. Subsidised Pupil Travel

Subsidised transport for pupils, as an effective policy measure to increase access to education, is far less widespread in LMICs than in the Global North and seems unlikely to advantage them significantly in practice in many locations. Pupil reports in Cape Coast, Ghana, of being forced off the bus when seats are needed for full-fare passengers are unlikely to be unique. In Dar es Salaam, where, under a government scheme, children pay 33% of the adult fare (but without compensation arrangements to operators), children are often unable to even board the bus in the first place, being barred by the conductors [53]. Similarly, they face exclusion from buses in Karachi because of the requirement there to charge only half-fare [54]. However, across the globe, pupil transport subsidy remains a sensitive, complex issue [55].

#### 4.1.4. Gender Issues in School Travel

Girl pupils face even higher transport constraints and hazards than boys in LMICs and this contributes to girls' lower school enrolment rates. A review in Niger utilizing DHS surveys noted that only 41 girls per 100 boys were at school in rural areas (as opposed to 80:100 in urban areas), and pointed to distance to school as a key factor behind this difference [56]. Improved road access and associated availability of transport appear to have the potential to improve girls' school attendance significantly in some contexts. In Morocco, assessment of a major road programme (National Rural Roads Program (NRRP-1)) entrusted to the National Highways Authority showed that the probability of girls' attendance at primary school increased by 40% with the opening of a paved road [57–59]. Road improvements in Asia appear to have similarly improved girls' access to education, even more than boys, as Mohsin et al. showed for Bangladesh, and Pilgrim and Chanrith for Cambodia, in the latter case with benefits seemingly accruing principally following improvements to a provincial road and a national road as opposed to purely local rural roads [60,61].

The negative impacts of distance, coupled with poor transport, on rural girls' education in Africa and South Asia can be related to a number of factors: girls' heavy household duties (typically heavier than boys' duties); negative cultural perceptions concerning female mobility and girls' education; also perceived dangers for girls who travel a long way to school or alternatively must board far from home in the school neighbourhood (as noted above) [14,62]. The safest travel procedure in African rural and urban contexts, especially for girls, tends to be to walk together, as a group. However, when there is heavy traffic on urban streets and no separation of pedestrians from motorised transport, such group walks have the potential to cause traffic accidents [14] (Chapter 7). The first cause of death among children aged 5–14 years and young adults 16–29 years is road traffic injury [63] (a point further discussed in the Road Safety section below). Data for low income countries are inadequate but the limited data available indicate that the vast majority of young people in such environments are pedestrians rather than passengers in motor vehicles when they are injured [14].

Even where regular transport is available (mostly in urban contexts), its cost and the potential for harassment tends to impact more strongly on (usually less well resourced) girls [14]. To date, there is less research on gendered patterns of school travel in Asian contexts but survey data from Kanpur City, India, suggests that girls are less likely to travel independently than in sub-Saharan Africa: they are either dropped off from personal vehicles by richer families or accompanied by mothers in families without such transport [64].

Cycles play a relatively small role in school travel scenarios across much of Africa, in particular, and there is much evidence across Africa and Asia to show that critical mass is essential to their widespread use, especially among girls [65,66]. Increasing emphasis on low-carbon transport may help future efforts to promote cycling to school (crucially, if accompanied by training on cycle riding and repair). However, if girls are unable to attend school because of the demand for domestic porterage, as is often the case in Africa, broader Intermediate Means of Transport (IMT) interventions such as push carts aimed at the family may be of greater significance. In Pakistan, a World Bank pilot offered a stipend to girls living a long way from the nearest school [67]. Another initiative which could help protect children against harassment and rape is the development of a 'walking bus' (whereby adults chaperone children along a set route, acting as driver and conductors), if this is adapted to local context [32].

#### **5. Youth Employment: Transport to Work and Transport as Work**

On average, unemployment is likely to be three times higher for youth than for adults globally, but five times as likely among youth as among adults in South Asia and South-East Asia [68]. Even in situations where open unemployment among youth is relatively low, as in most low income countries in sub-Saharan Africa, there is much 'working poverty': temporary, low-paid work in the informal sector with poor working conditions [69,70]. Transport's relationship with youth employment has two significant components which are explored in this section: firstly, its role in getting young people to work places (whether places of employment or places where they are building their own enterprise), secondly, with regard to employment within the transport sector.

#### *5.1. Transport to Work*

Firstly, with regard to accessing employment opportunities (whether provided by others, or of their own making, as, for instance, in the case of much petty trade), young people in both rural and urban locations face considerable challenges. Transport availability, reliability and cost are key factors shaping young people's access to employment. In LMIC rural areas, where employment outside agriculture is often seen as key to improved incomes, accessing non-agricultural employment tends to require long daily journeys to the nearest urban centre. In Western Kenya, this has led to the depressing picture of rural youth 'tarmaccing', as young men trudge along pot-holed (tarmac) roads from rural areas to the city in search of work and back again home when they cannot find employment [71].

Even in urban areas where transport availability is much higher, the distance from affordable suburban dwellings to central employment areas (including potentially more lucrative trading locations in the case of young entrepreneurs) can be a particular challenge for young people in poor households. This is a factor that affects poorer young people's access to work opportunities in cities across the globe [72], but in LMIC cities, transport constraints are often particularly limiting. There, the urban poor

often live in unplanned settlements and slums on the periphery of cities while employment densities are commonly greatest within the central area. Transport systems (including road infrastructure, formal or informal motorized transport, and non-motorized transport) linking to these opportunities are often extremely congested, unreliable and unsafe [1]. In cities such as Lagos and Manila, journeys from periphery to the city centre can take hours, especially in wet weather when transport demand everywhere increases and potholed roads become impassable. Moreover, the informal para-transit that dominates motorised travel in such contexts is simply unaffordable for the very poor. Unsurprisingly, many young women run small businesses from their own home, at least in part so that they do not have to travel out of the home to work.

In South Africa, poor access to transport is one of a complex mix of factors that results in young people actually stopping actively searching for work. When they leave school, they may have high hopes of finding good employment, but such dreams tend to be quickly dispelled as job applications fail. 'Actively discouraged' youth not seeking work is estimated at 61 per cent in the 20–24 years cohort: a response to feelings of hopelessness and despair [73]. Elsewhere in sub-Saharan Africa, where the informal sector is much larger and there are no social grants, most young people tend to continue to search for work and to take on whatever tasks they can find because, as is so accurately observed by Filmer et al., 'most Africans simply cannot afford to be idle' [69] (p. 3). This comment also applies to many Asian contexts. However, Jeffrey's observations in a north Indian city, where neoliberal economic change had cut back employment opportunities for educated (lower-) middle class young men, suggest conditions somewhat reminiscent of South Africa [74].

In studies of urban transport provision in 1990s Accra, which included specific consideration of its impact on young people, Grieco et al. and Turner and Kwakye, showed how the falling off in transport provision associated with the economic reform measures in place at that time (increased cost of vehicles and spare parts due to devaluation raising the cost of imports, etc.) actually increased dependence on the work of young women and children [75–77]. Children had become increasingly central to the economic organisation of households and would be taken in as foster-children to reduce the transport stress of middle-aged adults faced with transport under-provision: they acted as domestic anchors, compensating for the absence of adult household members delayed in distant markets by transport problems. Additionally, children experienced high levels of local mobility due to domestic tasks required of them, such as refuse removal, water and fuelwood collection and other activities including petty trade. Such conditions still prevail in Accra and probably also in many other African and Asian cities where traffic congestion is high and transport provision poor. Sibling care, especially in AIDS-affected households, adds to the pressures faced by many girls across LMICs [78].

#### *5.2. Transport to Work for Young Women*

For young women living in the poorer households of LMICs, conditions are often particularly difficult in the absence of appropriate inexpensive and timely transport, as Venter et al. demonstrated for rural South Africa and Esson et al. for Accra, urban Ghana [70,79]. Cultural barriers to mobility vary (see Kjeldsberg et al. regarding variations in rural Nepal [80]) but for some young married women, these barriers can be insurmountable, especially if they cannot find reliable transport for their return journey home. This tends to be particularly important because of consequent delays to evening meal preparations, possibly coupled with male suspicions of the reason behind their delay. The *unreliability* of transport is a common but under-reported factor constraining young women's trade and entrepreneurial aspirations in both rural and urban sub-Saharan Africa [81,82]. This uncertainty/unpredictability may encompass not only concerns about how long the journey may take, but whether the journey can be done at all. Moreover, it can as significantly affect the young urban woman trying to establish a regional trading business in farm produce or fish as the rural woman hoping to sell her perishable plantain or cassava at a city market. Uncertainty with regards to the transport of the perishable foods that so often underpin young women's early efforts to build a trading business can have a particularly stultifying impact on emergent entrepreneurship.

In urban areas, women often must forego potential travel to find and engage in work because males in their households have first priority on sparse funds for transport fares. Young women are more likely to be unemployed and, if they manage to find work (whether working for someone else or in their own enterprise), walk to their place of employment or undertake this work from their own home. The work tends to be predominantly in very low-paid service-related informal sector jobs. Globally, there is a tendency for women to focus on more local (often less well paid) employment opportunities in their neighbourhood because of the financial costs (and also often the time costs, given family caring demands) [83]. This is particularly evident in LMIC cities such as Nairobi [43], Accra [70], Delhi [84] and Tunis (author fieldwork, 2019). As Langevang and Gough emphasised with reference to Accra, it is important to reflect on young people's movements as tactics of social navigation, recognising the importance of spatial mobility to young people's everyday well-being and their processes of social becoming [85].

In some better-provisioned cities in China, both women's and men's journeys for employment are seemingly less arduous. In Shanghai, for instance, only a small percentage of work journeys (13.0%) are longer than 60 min [86]. However, there, the dominantly residential zones are associated with service jobs and it is likely that women's work will predominate in such contexts. Poor access to education among girls and women in many low-income contexts meanwhile limits their ability to read maps and bus information so they unsurprisingly feel safer working close to home, as has been described in both southern Ghana and Buenos Aires [87,88].

#### *5.3. Young People's Employment in the Transport Sector*

In LMICs, the transport sector often provides an employment niche for the poorest, including young people. In both rural and urban areas, inadequate or costly transport can encourage adults to look to children to fill the 'transport gap'. This dependence on youth porterage, which can contribute substantially to children's time poverty and deficiencies in schooling, is still regularly overlooked in both transport and education research. There is still insufficient detailed information about children's work as load carriers apart from studies of the 'kayayoo' girl porters in Accra, Ghana [76,89] and the research referenced earlier conducted with young people 9–18 years across 24 urban and rural sites in sub-Saharan Africa, which incorporated research on load-carrying and its (negative) impacts on education and well-being [14] (chapter 4) [42].

Employment in the transport sector is highly gendered across LMICs. Beyond their mid-teens, boys rarely carry (nor are they expected to carry) loads in domestic contexts (e.g., water carrying for the household): this is considered work for women, girls and young boys [14,90]. Porterage of goods for commercial purposes is a different matter and many young men also work as push truck operators, as, for instance, in Ghana's urban market centres, usually for very low returns [75]. Other work in the transport sector involving motor vehicles, by contrast, is widely perceived across the LMICs as belonging firmly within the masculine domain. There is occasional publicity around women taxi drivers such as Ghana's MissTaxi [91] and India's motorbike taxi service Bikxie [92] but these are extremely rare, not least due to perceived safety and security issues where women operators are concerned.

For many young men in Africa and Asia, it is the motorcycle or tricycle taxi which has become the most important employment opportunity in the transport sector. Operating a motorcycle-taxi (known as *boda-boda* in much of East Africa, *okada* in much of West Africa) can offer them a relatively lucrative livelihood, whether as independent riders or, more commonly, through a renting arrangement with the motorcycle owner (usually an older, better resourced man or woman). Young men are, in some cases, demonstrating significant entrepreneurship as they move out of less lucrative activities (for instance, charcoal production in Kibaha district, Tanzania) and into motorcycle taxi operations. However, negative impacts are widely reported in some regions: these may include not only reckless driving and increased accident rates, but also violent crime and expanded sexually transmitted diseases (STDs). The latter is, in part, a product of relatively high incomes and consequent high bargaining

power for sex, as noted early in their expansion by Nyanzi et al. for south-west Uganda [93] and Waage for Ngaoundere, Cameroon [94]. In rural areas of Lao PDR, Doussantousse et al. similarly found that motorbikes and mobile phones had expanded the sexual territory of indigenous youth at a time when international commerce and a cash economy along improved highways were bringing new people into the region [95]. Among the concerns for their health and safety are at-risk behaviours involving alcohol and sexual practices, especially HIV and sexually transmitted infections. Such issues have led to much government concern, such that, in Ghana, motorcycle-taxis are still banned nation-wide and many countries have city-centre bans in place. However, such bans do not take into account the crucial level of access that motorcycle taxis deliver for people in informal and peripheral urban areas, such as the satellite towns around Abuja in Nigeria. There, the personal mobility they deliver to young people wanting to be independent is widely appreciated not only by young men but also by the many young women passengers who use them extensively (author fieldwork 2019; see also Adamu regarding the impact on northern Nigerian women of *shari'a*-related campaigns to stop them riding commercial motorcycle-taxis [96]).

There is a rapidly growing literature on motorcycle taxi operations by young men (rarely are women involved, except as passengers), for example Burge on young male entrepreneurs in Sierra Leone, Olvera et al. on west and central African cities, and Jenkins and Peters on post-conflict Liberia [97–99]. An extensive review of the recent literature on this theme is now available [100]. It is important to note that motorcycle maintenance and repair is a growing support industry too, both for private and commercial motorcycles, but again mostly employs men.

#### **6. Road Safety and Other Aspects of Young People's Personal Mobility Safety**

#### *6.1. Road Safety*

The bare bones of the global road safety issue are clearly presented in a recent World Health Organisation (WHO) road traffic injuries factsheet [101]. This demonstrates that, while globally, people from lower socioeconomic backgrounds are more likely to be involved in road traffic crashes, more than 90% of road traffic deaths occur in LMICs and road traffic injury death rates are highest in the African region (at 26.6/100,000 people), followed by South-East Asia (20.7/100,000 people). Africa has the highest proportion of pedestrian and cyclist mortalities at 44% of deaths: unsurprisingly, pedestrians, cyclists and riders of two- and three-wheeler motorcycles are especially vulnerable as a result of being less protected than car occupants. However, vulnerable road users are still largely ignored in the planning, design and operation of roads. Across Africa and Asia, most roads still lack separate lanes for cyclists or adequate crossings for pedestrians, while motor vehicle speeds are too high [102].

So far as children and young people are concerned, the statistics are particularly sobering: road traffic injuries are the leading cause of death globally for the 5–29 years cohort. The vulnerability of younger children to road traffic relates to their physical, cognitive and social development stage compared to that of adults. Given their small stature, they may find it difficult to see surrounding traffic and for drivers, in particular, to see them. They are likely to have more difficulty judging the proximity, speed and direction of moving vehicles. Impulsivity and a shorter attention span could affect their ability to cope with simultaneous events. In a road traffic crash, their softer heads will make them more susceptible to serious head injury than an adult. Adolescents, meanwhile, are found to be especially prone to take risks that compromise their road safety [63].

In urban areas, most of those injured in public transport accidents are either paratransit passengers or pedestrians (commonly including young people trying to hawk goods between slow moving traffic). In Ilesa, south-west Nigeria, a small study of child accident victims found that the majority (89%) were pedestrians and most were over 5 years old; 60% of them were injured either while hawking by the roadside or when undertaking an errand [103]. Twenty per cent of cases involved motorcycles. This excludes potentially wider damage to young people's health in urban areas associated with vehicle-generated air pollution.

During interviews in the 24-site child-mobility study across Ghana, Malawi and South Africa, teachers were questioned about road safety education. Whatever national programmes exist, their evidence seems to suggest that many children in school obtain little quality road safety training [14] (chapter 8). This mirrors conditions across many LMICs, despite the level of traffic injuries sustained by children. However, efforts have been in progress in a number of countries to promote road safety, funded, for instance, by the UK Department for International Development (DFID) and the Danish International Development Agency (DANIDA) and, since 2012, through the International Automobile Federation (FIA) Road Safety Grants Programme. The FIA projects aim to meet the objectives of the UN Decade of Action for Road Safety (2011) of halving the number of deaths and injuries from road traffic accidents by 2020, with active programmes in diverse LMIC countries including Tanzania, Nigeria, Brazil, Morocco and China [104].

Recent research in the Global North has drawn attention to the value of training parents about road safety [105] but in LMICs, where many children travel to school and other locations without parental accompaniment (see above), this is unlikely to have a significant impact. There, early training of children on pedestrian road safety is crucial. Salmon and Eckersley proposed that to become skilled pedestrians, children need to move 'beyond a view of traffic as rule-bound and develop dynamic adaptable strategies for crossing roads' [106] (p. 729). The reportedly successful local programme they developed in Ethiopia, based on the UK Kerbkraft concept, entailed practical exercises on local streets, enabling children to develop techniques for identifying safe crossing-places. FIA foundation projects such as South Africa's Safe Schools project take a similar approach [107]. A recent project by the Non-Governmental Organisation (NGO) Amend in a Lusaka school that includes addition of a raised platform pedestrian crossing, footpaths, fencing and a school zone warning, removal of vehicle parking which blocked sight lines, and reduced operating speeds of passing vehicles, has reportedly had significant impact [108]. Other examples show how high the returns from such investment can be: in Korea a school zoning scheme, together with improved school bus regulation and road safety training schemes, reportedly reduced traffic accidents among children under 14 years of age by 95% between 1998 and 2012 [101]. However, finding means to bring road safety training to the many children who either never attend school or leave before the year in which road safety training is introduced, is also vital [109]. Here, road safety NGO interventions that support short courses for groups such as young traders (at particular risk as they rush to vehicles to sell, darting across roads and within the path of other vehicles) would be extremely valuable [14] (chapter 8).

Motorised traffic is also a growing danger for those who operate it or travel in it. In Cambodia, Kitamura et al. argued that speeding by young people is promoted by road improvements that occur alongside underdeveloped traffic legislation and limited public awareness and knowledge of road safety [110]. They emphasise the importance of implementing the "three Es", namely Engineering, Enforcement and Education in low income countries such as Cambodia but note that the role of education to increase people's road safety awareness is neglected compared to the other two dimensions. Across LMICs in Africa and Asia, there are widespread issues associated with poorly regulated (privately operated) public transport, limited vehicle maintenance, deficiencies in law enforcement, high traffic mix and little separation of vulnerable road users from high speed motorized traffic. When coupled with the lack of seat belts, overcrowding/standing passengers, poor road infrastructure and, overall, very hazardous road environments, it is clear that the conditions in which young people navigate the city are often potentially lethal. The dangerous practice of transporting passengers in the cargo area of light delivery vehicles (LDVs) also occurs in many countries: one small study in South Africa found that 35% of passengers treated for injury following ejection from the vehicle were children under the age of 18 (and 11% sustained a permanent disability) [111].

Much recent attention has been paid to the high level of traffic injury associated with motorcycles (mostly driven by young men). Problems associated with a lack of adequate body and head protection (given that helmets are uncomfortable in high temperatures and often of sub-standard manufacture), poorly regulated vehicle and driver safety and the preponderance of young male drivers with a taste

for speed, are exacerbated when two, three or more passengers are riding pillion. Phone use when operating a vehicle adds to these hazards [112]. Air pollution from motorcycles is also a growing issue in densely populated urban areas, especially in Asia.

Finally, it is important to note that where gender-disaggregated data are available, road injury patterns show a significant gender dimension, with nearly three quarters (73%) of all road traffic deaths occurring among males under the age of 25 years: they are almost three times as likely to be killed in a road traffic crash as young females [101,113,114]. Unfortunately, in LMICs in Asia and Africa, adequate gender-disaggregated data are still regularly missing from road safety studies. This is likely to be partly a factor of overall poor reportage of road injury by accident victims, their families and carers, the police and hospitals [102]. One review of published and grey literature on road traffic injury in urban sub-Saharan Africa among young people (≤19 years) suggested that boys and young men were twice as likely to be involved as girls and young women [115]. A recent study of primary school pupils in low-income neighbourhoods in Cape Town found that older boys (10–15 years) were most at risk of experiencing a severe pedestrian injury [116]. In India, data for 2014–2016 show that females represented only around 15% of road accident victims [117]. Gender imbalance in RTIs in LMICs, as globally, appears to be associated not only with higher male access to and use of road transport and higher male mobility overall, but also to gender variations in attitude to risk.

#### *6.2. Travel Safety and Security*

Beyond road traffic accidents, travel safety and security is often regarded as primarily an issue affecting females. There is certainly substantial evidence regarding high perceptions of travel danger (from verbal harassment to rape and murder) among girls and young women across the globe. There is also ample evidence of actual harassment of women globally and on a daily basis, with recent statistics suggesting, for instance, that over 70% of women in Karachi had experienced harassment on public transport and 90% in Sri Lanka, while 89% of women in Santiago had either seen or experienced it themselves [83] (pp. 15–16). Participants in a Chennai research study reported 14 years as the mean age at which they first encountered harassment in travel contexts; harassment was worst at night [118]. Jeffrey similarly reported so-called 'eve-teasing' in India [74]. This is rarely reported to the police and, as Anand and Tiwari noted for a Delhi slum [84] and Salon and Gulyani for a Nairobi slum [43], results in women travelling far less than they might otherwise do, thus contributing to their economic and social exclusion.

Lack of reportage means that it is difficult to assess the age-distributed incidence (or impact) of sexual harassment. Women worldwide have reported street harassment even in their 80s [119], so this is not purely an issue for youth. The statistics cited above are for women per se, but young girls may well be at particularly high risk of harassment and are even less likely to report such actions so their situation is often particularly dire. Young girls interviewed in the 24-site study in Ghana, Malawi and South Africa confided (especially to the peer researchers) a range of problems from catcalling and jeering by men to being groped when on public transport and actual rape [14] (pp. 184–186), [120]. Especially in locations with high HIV/AIDS prevalence, rape is clearly life-threatening. Girls' fear of travelling alone often leads them to postpone travel until others can accompany them (travel in groups is usually preferred by them and their parents), to take longer journeys to avoid particular trouble spots or to simply not travel, especially during hours of darkness [14,121] (for urban South Africa). However, it is important to note that boys can also face significant harassment, intimidation and, albeit very rarely, rape as they travel [14,122] (pp. 186–187).

#### **7. Mobile Technology: Interactions between Mobile Technology and Travel among Young People**

Young people tend to be at the forefront in uptake and use of digital technology across the world. Consequently, there is already substantial evidence of their engagement with mobile technology—mobile phones, the internet and other information and communication technologies (ICTs)—in transport contexts, not least as an aid to help address transport poverty. E-learning and mHealth are expanding rapidly, while smart mobility and smart city solutions are now becoming central foci of urban planning research globally. In remote rural areas, the potential for e-connectivity to reduce transport poverty can be particularly powerful [123,124]. In LMICs, where low cost mobile phone handsets and mobile phone networks have expanded dramatically over the last two decades, the implications for travel practices are extremely significant, as a growing literature attests (for example, Porter on the implications for poorer people's mobility [125], Williams et al. 2015 on the Nairobi digital matatu project [126]). When emergencies arise—not least obstetric emergencies among first time and very young mothers (who are at particularly high risk)—mobile-enabled mobility (whereby a phone-call to the nearest health centre brings in an ambulance) can be life-saving [127]. One issue worthy of note, however, is the varying cost of airtime and data. In countries with a highly competitive ICT sector, such as Kenya, airtime and data are relatively cheap, but in others, including South Africa, running a mobile phone, especially a smart phone, is costly. For young people with limited resources, this is an issue of considerable significance, although two studies conducted with African youth indicated that many young people see these costs as a priority over other consumables and often make considerable sacrifices in order to maintain their access [128–130].

The published literature specifically concerned with *youth* use of phones in daily travel contexts (as opposed to migration contexts) is, to date, relatively sparse globally, although there is a large amount of literature on phone practices based around youth culture and social media, adult or partner surveillance, etc. Nonetheless, there is growing evidence in the Global North of young people embedding technology in their everyday lives to better accommodate the uncertainty in activity and travel scheduling, such that it 'lubricates' modern life without fundamentally changing travel behaviours [131]. In the Global South, technology may have more impact on travel behaviour. The extent to which mobile phones can reduce travel is a particularly important question with regard to resource-poor people and environments and to carbon reduction, especially in urban contexts. Qualitative and survey data regarding young people's perception of the extent to which their use of phones had substituted for travel in the previous year, conducted in 24 sites in Africa, suggests that some reductions in travel are occurring, although the precise patterning varies with location [132–134].

In urban South Africa, many short daily journeys conducted by both males and females, especially walking journeys, seem to be being substituted by phone calls with safety as the main reason behind this. There is also evidence of a perceived reduction in longer (more expensive) journeys by motor vehicle as a result of greater mobile phone usage: in this case, the change is probably mostly attributable to the potential for saving money (although safety considerations could come into play too, given the hazards of long distance travel in the continent) [121]. Among urban residents, perceived reductions in long distance, irregular, and short everyday journeys look substantial, but it is important to note that these are only assessments based on respondent reflections about their travel activities over the past year. Whether this a real change, and if so, whether it is one that has reduced pedestrian and motorised traffic flows in the neighbourhoods where the surveys were conducted—and, if so, with what consequences for health and security—would be worthy of further research.

ICT/transport connectivities can be particularly important for women. As noted earlier, many women and girls in LMICs are restricted in their physical travel by male family members who may not only express concern for the vulnerability of womenfolk travelling alone but also distrust the potential that independent female mobility offers for promiscuity. In such contexts, women's access to mobile phones can be seen as a potential (virtual) mobility aid. However, keeping control of a partner's mobile phone communication is now a regular male endeavour in many households (as Burrell observed for rural Uganda [135]). As handset prices drop and phone ownership increases among young women, this is becoming more difficult to maintain, but surveillance of wives' and girlfriends' phone contact lists and calls and use of the phone as a 'digital leash' to check their physical location and travel movements appear to be growing features of many relationships [136,137]. In this context, it is noteworthy that young men in the motor-cycle taxi business and older 'sugar daddy' male

taxi drivers have become notorious in some locations for using their relative wealth built through transport operations to buy phones for their girlfriends [121].

For (mostly male) transport operators, owning a working phone is widely considered essential to running a successful business; this is even the case for bicycle-taxi operators in Malawi [133]. Across Africa, people of all ages keep the numbers of local motorcycle-taxi and taxi drivers on their phones (ibid). For young women in particular, this is often seen not merely as a convenience but as a vital informal safety mechanism [121].

Beyond the transport sector per se, informal use of mobile devices appears to be having some impact on youth entrepreneurship through leapfrogging physical distance and promoting social networking. Qualitative and survey data on phone use for business among young people in 24 African research sites indicate that the phone is used extensively and intensively in small informal businesses. In trade, it is used not only to build relationships with customers and suppliers but also to help with pre-arranging meetings, organising travel, finding staff and for mobile money transfers and ensuring that payments have been made [121]. However, it could be unwise to overrate the phone's potential to promote youth entrepreneurship [138]. In Kibera, one of Nairobi's slum areas, although phones are utilised by young people to ease communication and strengthen existent social ties, this does not necessarily allow them to bypass Kenya's hierarchical class-based society [139].

#### *New Forms of ICT-Enabled Mobility Service*

While mobile phone usage will continue to be interwoven in diverse ways with human corporeal mobility and with physical transport technologies in LMICs, these patterns of interweaving are constantly being re-shaped. A burgeoning array of inventive phone apps, closely tied to growing smartphone use and the development of wireless infrastructure, appears to have particularly significant potential. In Asia, where the ride-hailing app boom is currently massive, smartphones are now available cheaply; advanced fourth-generation services can be accessed for just a few dollars. In Phnom Penh, for instance, at least four services, including one named CamGo, have been launched recently. This is for tuk-tuks, which are cheap but whose popularity was somewhat marred by drivers charging unreasonably high fares or intentionally taking round-about routes to increase the fare. CamGo is reportedly popular with young people because it offers a fixed rate per km and the route takes the shortest distance to the destination, measured by GPS, confirmed before boarding. Other recent examples include Chiang Mai, northern Thailand, where the Indonesian company Grab has launched a ride-hailing service for microbuses, now with 300 registered drivers. Ride-hailing services are also being used to book home deliveries. In India, Jugnoo, a ride-hailing service specializing in motorized tricycles, has partnered with fast-food restaurants such as Kentucky Fried Chicken and Burger King to deliver meals: it reportedly has 15,000 vehicles operating in 35 cities. We can anticipate that young people—both as customers and operators—will lead in the usage of these apps, although the returns from ownership of the vehicles involved may well go mostly to older, more established entrepreneurs [140].

In Africa, Uber and Uber-style apps are now playing a similar role. In South Africa, for instance, Uber has operated in major cities since 2013, although not without considerable hostility from metered taxi companies [141]. Subsequently, in 2017, the South Africa Meter Taxi Association set up their own app, "Yookoo Rider". This benefits customers through the registration of cab drivers, comprehensive driver vetting and criminal checks with fingerprint technology [141].

Uber-style companies now operate in many Africa cities (including for motorcycle taxis in cities like Kampala). With Little Cab, a Kenyan ride-hailing app backed by telecoms operator Safaricom, customers can pay for their ride through Safaricom's mobile money service, M-Pesa, buy discounted airtime during the trip and access free Wi-Fi. It also lets women exclusively request female drivers from 18:00 to 6:00 for safety reasons [142]. Many smaller operations are now attracting young entrepreneurs—for instance, the mobile application, Tag Your Ride, was launched by a young South African university graduate [142]. Young women customers appear to derive very considerable benefits

from these apps, as can women drivers, especially if they are able to build a women-only service. Finally, however, it is necessary to refer back to the potential of phones as a causal factor in transport accidents with potential for impact on all sectors of the population.

#### **8. Concluding Summary and Reflections**

This paper covered diverse aspects of mobility while taking a specific child and youth perspective and drawing on the voices and evidence of young people themselves. It has emphasised how travel experiences, needs and risks are embedded in power relations and vary with gender, age and location (urban versus rural, rich country versus poor country, Asia versus Africa). It has also pointed to the scale and range of uncertainties that so many young people now face as they negotiate daily mobility (or immobility). Neoliberal economic and social changes have been radically transforming young people's experiences of youth and early adulthood across much of the world over the last decade [143], while climate change and growing environmental fragility are beginning to bring further uncertainties to the fore. In this context, it is important to note that while the majority of emphasis in the literature reviewed has been on daily mobility or immobility and travel experiences, the implication of such daily mobility experiences (physical and virtual) for migration decisions (short and long distance, short and long term) needs far stronger attention, particularly in this era of climate change. The linkages between daily mobility experiences and migration decisions will need far closer investigation globally, but especially in the context of conflict, climate change and growing environmental fragility in many LMICs.

The review pointed to other clear research gaps too: in particular, the need for a realignment of research methods and associated practices. Of prime importance is the need for more in-depth research, particularly in Asia. There is a growing body of detailed evidence regarding children and young people's specific transport and mobility needs and experiences in sub-Saharan Africa, often taking an ethnographic approach, but as this review has demonstrated, data remain sparse (and primarily quantitative) in Asian and Middle East and North Africa (MENA) contexts. But whatever the place context, it is important that mixed methods studies and an interdisciplinary approach are adopted in order to capture a fuller understanding of young people's complex transport needs and constraints. To date, there has been a particular sparsity of research using mixed-methods approaches: the 24-site study of daily mobilities among young people 9–18 years in sub-Saharan Africa [14] seems, to date, to be the only extensive study in LMICs that utilised a range of qualitative and quantitative methods. In Asia, mixed methods studies are rare and a majority of research takes a quantitative survey approach that commonly fails to provide adequate understanding of the patterns that emerge. A triangulation of in-depth ethnographic and survey research drawing on a range of disciplinary skills (possibly coupled with action research where interventions are made, and their impact then studied in depth), can be particularly powerful in understanding mobility experiences, behaviours and opportunities for positive change.

Linked to this point, greater engagement with young people themselves in research and planning processes is essential. Community peer-research with young people as a route to more fully understanding their needs and aspirations in the transport field is gaining growing attention. The mixed-method study cited above, which brought together 70 young researchers (11–19 years) in Africa to help build an extensive academic study, demonstrated the value of this approach. Small studies in Asia and Africa further support the importance of directly engaging young people in the research process [12,17]. At the same time, however, there is also need to build stronger recognition among transport professionals of the value of inputs from more vulnerable groups. There is no point in conducting research with young people if the evidence collected is subsequently ignored. Thus, greater effort is required to draw transport professionals more centrally into the research process with vulnerable groups.

Action research incorporating and assessing both transport service and infrastructure interventions could considerably aid exploration of a diversity of issues in both LMIC cities and rural areas. In LMIC cities, this could include working with young people to pilot and monitor interventions associated with road safety and improving potential for active travel: for instance, walking buses and other interventions such as street lighting and dedicated pedestrian and cycle lanes, as well as safe travel skills training for young women. Given the growing obesity problems among middle-class children in LMICs, particular attention also needs to be paid to improving their active travel to school. Meanwhile, for young people who may have never attended school and thus never had access to any road safety curriculum, piloting of non-school based road safety training interventions could bring great benefit—notably for the many involved in dangerous roadside hawking on busy city streets. In LMIC rural areas, there would be similar value in exploring the potential of walking buses, cycling and cycle maintenance/repair training, especially for girls, dedicated contract transport, and other interventions to improve girls' journey to school and to work. In both urban and rural contexts, new approaches to transport subsidy need exploring (and piloting) that do not result in excluding young people from transport (as has occurred when operators on busy routes have to choose between paying and non-paying customers). Subsidy is contentious in the transport services arena but could significantly improve the mobility opportunities and life chances of pupils, unemployed youth and young workers in urban and rural contexts.

Moving more centrally into the employment sphere, the transport/mobility elements that help shape youth employment, job search, entrepreneurship and unemployment experiences have, as yet, been insufficiently researched. This needs urgent attention across LMIC peri-urban sites, in particular where so many poorer households are located—and not least with specific reference to young women. More research is also needed around mobility aspects of out-of-school activities associated with recreation and social network building, which will be important for overall well-being but also may aid youth employment opportunities. Linked to this, more attention will be required to relationality across age groups (especially the linkages between expanded older people and youth cohorts) and the mobility implications that may extend well beyond work and employment.

Another area for further attention is how mobile technology is reshaping travel practices in low income contexts in the Global South (but also with likely relevance to some poor Global North communities). This includes the potential of mobile technology to reduce motorised transport usage and the extent to which young people may experience negative elements of exploitation or surveillance through digital technology. Mobile technology now helps young people to extend their networks across the world and has potential to support distance management in both emergency and everyday travel contexts and in rural and urban places. The potential for apps (including those developed by young people themselves) to reshape the transport arena globally is very exciting and opens up a potentially dramatic new phase of development. However, the extent to which less powerful groups in society, especially young people, are able to benefit in the longer term while evading potential threats of exploitation (for instance in the gig economy) or the wider surveillance and control also posed by increasingly smart technological innovation is uncertain; the evolving scene will merit careful observation.

Finally, it is important to look beyond the transport sector if we are to make significant improvements in young people's travel experiences and opportunities. Regarding LMICs, far greater attention is needed to youth transport issues from development practitioners working in other sectors outside transport, particularly education, youth employment, ICT and energy (although recent moves in the health sector to incorporate both transport and ICT considerations in their analyses are very encouraging). This will require more sustained efforts among transport practitioners and researchers to reach cross-sectorally and engage productively with those sectors if youth opportunities that are so central to achieving progress across the SDGs are to be fully realised.

**Author Contributions:** Writing—original draft, G.P.; writing—review and editing, J.T. **Funding:** This research was funded by the UK Department for International Development. **Acknowledgments:** This research was funded by UK AID through the UK Department for International Development under the High Volume Transport Applied Research Programme, managed by IMC Worldwide. However, some of the material referenced in the paper was drawn from a series of original field research studies on youth mobility (and associated publications) led by the first author and funded in whole or in part by the Department of International Development from 2000 in sub-Saharan Africa. (Studies 2006–2010 and 2012–2015, were jointly funded by UK DFID and the UK Economic and Social Research Council).

**Conflicts of Interest:** The authors declare no conflict of interest.

#### **References**


© 2019 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).

## *Review* **Road Safety in Low-Income Countries: State of Knowledge and Future Directions**

**Shahram Heydari 1,\*, Adrian Hickford 1, Rich McIlroy 1, Je**ff **Turner <sup>2</sup> and Abdulgafoor M. Bachani <sup>3</sup>**


Received: 26 September 2019; Accepted: 4 November 2019; Published: 7 November 2019

**Abstract:** Road safety in low-income countries (LICs) remains a major concern. Given the expected increase in traffic exposure due to the relatively rapid motorisation of transport in LICs, it is imperative to better understand the underlying mechanisms of road safety. This in turn will allow for planning cost-effective road safety improvement programs in a timely manner. With the general aim of improving road safety in LICs, this paper discusses the state of knowledge and proposes a number of future research directions developed from literature reviews and expert elicitation. Our study takes a holistic approach based on the Safe Systems framework and the framework for the UN Decade of Action for Road Safety. We focused mostly on examining the problem from traffic engineering and safety policy standpoints, but also touched upon other sectors, including public health and social sciences. We identified ten focus areas relating to (i) under-reporting; (ii) global best practices; (iii) vulnerable groups; (iv) disabilities; (v) road crash costing; (vi) vehicle safety; (vii) proactive approaches; (viii) data challenges; (ix) social/behavioural aspects; and (x) capacity building. Based on our findings, future research ought to focus on improvement of data systems, understanding the impact of and addressing non-fatal injuries, improving estimates on the economic burden, implementation research to scale up programs and transfer learnings, as well as capacity development. Our recommendations, which relate to both empirical and methodological frontiers, would lead to noteworthy improvements in the way road safety data collection and research is conducted in the context of LICs.

**Keywords:** road safety; low-income countries; under-reporting; best practices; vulnerable groups; injury severity; road crash costing; crash data; capacity building

#### **1. Introduction**

Road safety is a major global health issue since large proportions of unintentional injuries are caused by traffic-related crashes. According to the Global Health Observatory, 1.35 million fatalities occur on the world's roads each year [1]. In general, although traffic-related injuries and fatalities have seen a decreasing trend during the past two decades, this reduction has not been as significant as expected [2]. This is despite several improvements in motor vehicle safety standards and features, road safety policies, and road design [2]. In fact, road transport still poses a substantial risk to human health in many regions around the world.

The problem is especially critical in low-income countries (LICs), due to several persisting shortcomings in road safety standards, vehicle safety and maintenance, and in the design and implementation of policies and safe transportation infrastructure. Figure 1 displays national wealth versus road death rate based on data provided by the WHO [1]. Research is thus needed to better understand the underlying mechanisms of road safety in LICs. This will help guide road safety policies and strategies, with the aim of reducing traffic-related injuries and fatalities. Note that we refer to LMICs to indicate low- and lower-middle income countries, while LICs refer specifically to low-income countries, as shown in Figure 1.

**Figure 1.** Comparing road traffic death rates with national wealth [1].

There are global initiatives that have sought to address such issues, many of which are coordinated through the Global Plan for the Decade of Action for Road Safety 2011–2020 [3], developed by the United Nations Road Safety Collaboration (UNRSC). Examples include the Global Road Safety Partnership (GRSP) [4], the World Bank's Global Road Safety Facility [5], the Bloomberg Philanthropies Initiative for Global Road Safety [6], and the Road Safety in 10 Countries Project [7]. These global efforts have generally focused on the practical implementation of policies and standards to improve road safety in the developing world [8].

Given these developments in the field, and the fact that we are nearing the end of the UN Decade of Action for Road Safety [3], it is important to take stock of where we are, what the state of the field is, and determine what research will be important in the future to make further progress. In line with this approach, our study aims to take a holistic approach investigating different lines of research under the broad topic of road safety in LICs with the aim of (i) analysing and summarising the current state of knowledge; and (ii) proposing a number of future research directions. We have used the Safe Systems framework and the framework for the UN Decade of Action on Road Safety to identify the domains of focus for this work [9,10]. There is a focus on the understanding of road safety engineering issues while also reaching out to other sectors.

The paper is structured as follows: Section 2 discusses our methodology. Section 3 discusses our findings and is centred on an overview of current (available) research focusing on the main road safety issues in LICs. In Section 4, we report on the results of a survey of experts in road safety in LICs. Section 5 discusses implications and our proposed future directions, where there are several opportunities for improvements, both empirically and methodologically. We conclude with a summary in Section 6.

#### **2. Materials and Methods**

#### *2.1. Review Framework*

This article explores the state of knowledge of road safety in LICs based on a review of literature and consultation with experts in the field. The review panel was formed by an international collaboration of the Transportation Research Group at the University of Southampton (United Kingdom) and Johns Hopkins International Injury Research Unit at Johns Hopkins University (USA). With respect to quantitative results, the literature search was carried out according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines [11] as explained in Section 2.3. Non-quantitative results were identified through online searches as described in Section 2.3. Expert consultation is described in Section 2.4.

#### *2.2. Research Questions*

Our research questions were as follows:


#### *2.3. Search Strategy, Selection of Studies, and Eligibility Criteria*

We extracted the search terms from published studies (journal/conference articles and reports published by international organisations) in a preliminary search. For the review, while there was no search restriction on the publication date, articles published before 1990 were only considered for inclusion if the number of relevant results was particularly low. The search strategy aimed to limit the search to LICs by combining search results from a list of names of LICs with other relevant keywords applicable to other search topics such as vehicles and crashes, road safety measures, vehicle safety measures or vulnerable road user groups. Articles had to be peer-reviewed and published in English. Articles were screened by title and abstract for relevance, and appropriate bibliographies were also scanned for further relevant articles or reports. The search resulted in over 7000 potential articles to be screened across all the topics under consideration.

Quantitative results were specifically sought for under-reporting, and the literature search for that topic was carried out according to PRISMA guidelines, using electronic databases such as Web of Science, Scopus, PUBMED, TRID, BMC, and EMBASE. Search strings were generated by combining the list of LIC named countries and other relevant search terms such as underreport, under-report, and capture-recapture (a methodology used to address under-reporting). To be included, articles had to be related to a formal assessment of under-reporting. As the number of eligible papers in LICs was relatively few, there was no restriction on whether the assessment was for injury/fatality counts, nor any restriction on date. This in-depth search yielded many papers related to under-reporting as well as the other topics of road safety, both as part of the search results, and from bibliographies within relevant articles and reports. In this regard, further details are discussed in Section 3.1.

With respect to other topics, further relevant articles or reports, published by international organisations, were identified through online searches using appropriate keywords for each of the topics, and from discussions with experts and stakeholders. Search strings were generated by combining the list of LIC named countries, and other relevant search terms; e.g., low-income OR road accident OR traffic accident OR road crash OR traffic crash). Table 1 gives examples of the search strategy developed for this study (the example displayed having been used for searching Scopus). The strategy aims to limit the search to LICs (see Scopus #1), and then limit the search according to the desired topics of vehicles and crashes (see Scopus #2), road safety measures (see Scopus #3), vehicle safety measures (see Scopus #4), or vulnerable road user groups (see Scopus #5). For example, from a total of 69,448 studies relating to LICs, 454 studies were found to be relevant to road crashes in LICs (see Table 1).


#### *2.4. Expert and Stakeholder Consultations*

In the process of synthesizing findings from the literature review and identifying areas for further inquiry, we informally consulted with ten road safety experts from academia and international road safety organizations, including local experts from Bangladesh, Nepal, Uganda, Ghana, and Kenya. We asked a smaller number of experts (n = 6), who have had extensive experience working on road safety in LICs and are well versed with the global road safety landscape, to respond to a survey to provide further input on findings from the literature review. These consultations and surveys aided in the synthesis and prioritization of important areas of focus for future road safety in LICs. This questionnaire was based on three main themes regarding road safety in LICs: (i) main topics of concern; (ii) policy-making and implementation; and (iii) capacity development for road safety. Basically, with respect to each theme, respondents were asked to answer "what needs to be done, and how it can be achieved?" Before undertaking this part of our research, we obtained an approval from the University of Southampton Faculty of Engineering and Physical Sciences Ethics Committee on 03/05/2019 (ERGO II 48744). The outcomes from the survey and other discussions also provided context for topics for which there was a gap in the literature. These consultations contributed to the future research agenda set out in Section 5. Our consultation results are discussed in Section 4.

#### **3. State of Knowledge**

This section discusses our findings with respect to pertinent previous studies.

#### *3.1. Under-Reporting of Road Crashes in LICs*

Accurate knowledge of road crashes and their causes can help provide robust motives for the investment of appropriate and effective road safety interventions, and is especially important where such funds are limited [12]. Police road traffic crash data has been the traditional source of such information, although the accuracy of such data is questionable since all countries suffer from some level of under-reporting. The WHO provide estimates of the numbers of fatalities in each country, using negative binomial modelling based on the actual number of reported fatalities [1]. According to their estimates, the average number of road fatalities correctly reported to official sources is likely to be higher for higher income countries, with an average of 88% of road fatalities correctly reported in high-income countries (HICs) and 77% in middle-income countries (MICs). However, this reporting accuracy is significantly lower in LMICs (52%) and LICs (17%).

There are several underlying reasons why under-reporting may occur. A poor understanding regarding the benefits of complete and accurate road crash records means those involved may avoid contacting the police [13], preferring to negotiate with the driver [14,15]. A poorly resourced, capacity-limited police force is likely to focus on those crashes that involve more injuries, fatalities or property damage [13,16,17]. Also, the legal requirement to report road crashes to the police varies from country to country [18]. In built-up areas, victims are likely to be taken to a nearby hospital by relatives or bystanders before any police officers can attend the crash scene [13,14,17]. In rural areas, relatives and neighbours of crash victims may be deterred from travelling to hospitals due to cost implications [14]. There are further limitations due to the reliance on paper records, rather than on the types of electronic recording systems in place in higher income countries [18], especially if such original paperwork is required for subsequent judicial hearings [19].

Numerous studies have investigated how to improve the quality and accuracy of road crash data, particularly through combining police records with hospital records of patients admitted as a result of road crashes. These studies have mainly taken place in the developed world, for example in France [20–23], elsewhere in Europe [24–30], the United States [31,32], Australia and New Zealand [33–38], and China and Japan [39,40].

With respect to quantitative results relating to under-reporting, we found only four studies in LICs (from an initial list of 983 potential articles) that provide a quantitative assessment of the level of under-reporting, comparing police data with those of hospital records (see the PRISMA flow diagram in Figure 2). The four studies were all from LICs in Africa (Ethiopia, Uganda, Malawi, and Mali). Table 2 shows the location, study period, methodologies and metrics used, highlighting the inconsistencies in study designs. The study in Ethiopia [14] focuses on a 264 km stretch of two-way, two-lane road, on which traffic volumes vary from an average of 17,000–20,000 vehicles per day on the 64 km stretch near Addis Ababa, to around 3000–3500 vehicles per day on the remaining 200 km as the road approaches Hawassa. The other studies focus on regional areas (adopting a zone- or macro-level approach), considering the records at police offices and hospitals within a certain region.

**Figure 2.** PRISMA flow diagram for under-reporting literature search.

The only consistent element to these four studies is the analysis methodology used: the capture-recapture method. The 'Capture-recapture' method is perhaps the most widely used method to rectify inaccuracies in road crash reporting [41]. Originally developed for use in estimating the biometrics of animal populations and subsequently applied to human populations and the injury field as discussed for example in (as discussed for example in [42]), the method involves estimating the number of cases in a defined population using multiple sources of information (e.g., linked databases), assuming that each source alone may under-count the population. While it is a useful (and relatively low-cost) tool for road crash investigators, especially in LICs where under-reporting is frequent, there are certain caveats to understand regarding its use due to population movements and dependence of data sources [43]. However, movement of population has been identified as a minor issue, for example, due to the relatively short timescales between police attending a crash scene and casualties visiting hospital [14,20], or the relative lack of migration within a study region [44]. The four studies identified here all aimed to address any bias introduced by a lack of independence by using a stratified capture-recapture technique to identify those factors that were associated with dependency of the data sources. Yet, whether stratification is satisfactory remains uncertain and the problem may not be fully addressed.

Given the limitations associated with capture-recapture methods, other techniques have been used to estimate the levels of under-reporting. Regression analysis is useful if the two-source approach used in capture-recapture is not appropriate or feasible [1,33]. A modified Poisson regression has been used in France [21], and similar approaches have been used in India [15], the United States [32], and Australia [38]. The impact of under-reporting on crash severity models has also been investigated [45–47]. However, as previously noted, all four quantitative papers in LICs use capture-recapture.


**Table 2.** Summary characteristics of selected studies.

The key findings of the studies reported in Table 2 are summarised in Table 3 according to the metric used and sources of data (police and/or hospital). In order to compare results of the four African studies while accounting for uncertainty, the relative accuracy of each data source was calculated in terms of confidence intervals (see Table 3). The accuracy rate is obtained by considering the main metric used in a particular study (e.g., number of fatalities, or injuries per 100,000 vehicle km), and comparing police and hospital results with those generated by the capture-recapture method. These results reveal some consistent patterns. Police records tend to account for more fatalities than hospital records, while hospitals tend to have more complete records of road crashes and injuries. However, neither set of records has a complete record of the numbers of fatalities or injuries. In general, the uncertainties around estimates relating to fatalities are larger than those obtained for injuries and crashes. The study conducted by Abegaz et al. [14], which adopts a micro-level approach, focusing on a specific roadway rather than a region, has the smallest confidence intervals. The results from Ethiopia and Mali indicate that the police records contain around 60% of the total fatalities, and hospital records seem to account for between 40% and 60% of injuries or road crash numbers.


**Table 3.** Accuracy rates of police and hospital records for four LICs (with associated confidence intervals).

#### *3.2. Lessons Learned from Global 'Best Practice' and Its Applicability to LICs*

We believe it is important to draw on the experience of successful road safety campaigns around the world. For example, Wegman [49] identifies Spain in particular as an exemplar of success in road safety practice, as the number of fatalities there has decreased by over 70% between 2000 and 2013, with neighbours Portugal close behind.

According to the Spanish Government's Traffic Directorate report on their road safety strategy [50], Spain's improved safety level in the 2000's stemmed from their adoption of the European Road Safety Strategy in 2000, followed by the increased use of in-car safety systems, the increased use of helmets

(from 73% to 99%), the increased use of seat belts (from 70% to 91%), and reduced risks from slower average speeds (reduced by 2 km/h) and a downward trend in drink-driving (the percentage of drivers who died when over the limit of 0.3 g/L fell from 35% to 29%).

The Spanish experience is one example of how a cohesive national road safety strategy may result in significant reductions in road crashes. However, as a developed country, the challenges and issues involved in improving road safety are likely to be different from those in LICs [51]. While infrastructure improvements and appropriate legislation are, to a relatively large extent, common themes appropriate to all road networks, road user behaviour may vary from one country to another. This is why one should take into account that cultural differences may lead to variation in road user behaviour in different jurisdictions. For example, the same engineering intervention may result in unequal road safety improvements even if all other factors such as traffic exposure and roadway characteristics are similar. However, we speculate that, while such variation in road user behaviour would affect the magnitude of effectiveness, it would not deter the effect of such engineering interventions entirely. Therefore, lessons can be learnt from successful interventions in developed countries. For example, the Safer Africa project [52] aims to utilise knowledge and expertise from successful European road safety projects to implement effective road safety and traffic management interventions in African countries.

In order to attempt to affect road safety positively in LICs and LMICs, 2011–2020 has been designated the World Health Organization's (WHO) 'Decade of Action for Road Safety', seeking to save millions of lives by building road safety management capacity, improving the safety of road infrastructure, further developing the safety of vehicles, enhancing the behaviour of road users and improving the post-crash response. A number of previous studies have carried out reviews of road safety interventions in LICs and LMICs, some of which are shown in Table 4 and discussed in more detail below.

Gupta et al. [53] focused on regulatory and road engineering interventions for preventing road traffic injuries and fatalities among non-motorised and motorised two-wheel (i.e., vulnerable) road users. Of the twenty-five studies in their review, only two were LIC-based. Esperato et al. [54] aimed to evaluate the cost and health impacts of road safety interventions in LMICs, identifying thirteen studies which met their criteria, none of which were based in LICs. Staton et al.'s focus [55] was to determine quantitative impacts of road safety interventions including legislation, enforcement and education campaigns. Of the eighteen studies identified, three were in LICs. Bonnet et al. [56] identified twenty-three articles relating to road safety interventions in Africa; eight were set in LICs. These studies highlight the relative dearth in quantity and quality of research output that relate specifically to the impact of road safety interventions in LICs.

With respect to best practices in LICs, the experience of Ethiopia could be mentioned, where media campaigns coupled with targeted research studies have provided a more complete picture of the impact of road safety legislation [6,57–59]. A summary of these and other research into policy interventions in LMICs is given below under the broad themes of education, enforcement and engineering.




#### 3.2.1. Education

Educating the populace, and children in particular, about road safety and good road user behaviour can help to reduce the number and severity of crashes, particularly when used as part of a wider package of interventions [56,61,63]. For example, storybook narratives have been used in Pakistan to improve children's knowledge and attitudes towards road safety, and the relatively low-cost storybooks provided an effective and early strategy towards promoting behavioural change, particularly how to behave at the road side and when crossing. For instance, results indicated that while questions regarding where it is safe to cross were answered correctly by just over 50% of the children, this increased to over 90% correctly answering two months after the initial intervention. However, it was acknowledged that there may be a need for regular road safety education to further ensure that students retain traffic safety messages in the longer term [60], and for any impact to be effective, such measures ought to be coupled with legislative and enforcement measures [55].

Communities and families also have considerable potential to influence the young and road safety programmes need to be developed in support of formal school programmes [64]. In the wider community, research has focused on the impact of televised road safety messaging [65], which was found to be largely effective at promoting lower alcohol consumption when driving, although the language used in the messages was considered a potential barrier in a country with multiple languages spoken. In Tanzania, an education programme was developed based on an assessment of local road crashes, including targeting motorcyclists [62].

The transferral of road safety education practices from developed to developing countries can be difficult due to variations in education systems, teaching methods, traffic regulations and exposure to risk. Road safety education and awareness have been identified as the interventions which are most adapted to LICs [56]. Thus, road safety practitioners should aim to research and develop bespoke teaching methods and materials in the country in which they will be used [64].

#### 3.2.2. Enforcement

Improving road safety through enforcement of revised legislation can also help promote road safety, particularly in the five key risk factors identified in the Global Plan for the Decade of Action for Road Safety (speed, drink driving, not wearing motorcycle helmets, not wearing seat belts, and not using child restraints in cars) [3], manuals for each of which have been published by WHO [72]. The drink-driving manual has been further developed into an assessment framework to help understand how LICs and LMICs can better adopt the guidelines [71]. Further examples of research in this area include a study in Addis Ababa in Ethiopia, where joint media and enforcement campaigns have reduced drink driving by 50% [57]. In terms of legislation, Addis Ababa has developed its first ever road safety strategy and implementation plan, and established an inter-agency road safety council chaired by the Deputy Mayor and is considering setting up a road safety fund [6]. Wider road safety policy interventions in Ethiopia were investigated using interrupted time series [59]; the revised road safety policy banned the use of mobile phones while driving, made helmet and seat belt use mandatory, and increased levels of enforcement of excessive speeding, drunk driving and carrying dangerous loads. This was found to have helped reduce motor vehicle crashes by around 19% and associated fatalities by 12% in the year following the intervention; however, the overall crash rate was still very high [57].

Helmet use, for both bicycles and motorcycles, is low throughout LICs. A study in Malawi observed zero bicyclists wearing a helmet over a four-day study period [70]. In Kenya, the low prevalence of motorcycle helmet use remained unchanged, with around 30% of motorcycle riders correctly using helmets following the introduction of a traffic amendment bill in 2012, highlighting the need for a multi-faceted strategy that includes media campaigns and widespread enforcement in addition to legislative change for improving helmet use [66]. The authors reached a similar conclusion after studying the prevalence and attitudes towards drink driving in Cambodia, as Bachani et al. [67] concluded that a multi-pronged and coordinated approach would be needed

to effectively address this issue, including social marketing and public education campaigns, and enhanced enforcement measures.

Wismans et al. [73] provide a summary of the WHO report [74] focusing on Asian countries, highlighting that while the interventions suggested have been adopted in many countries, LICs (notably Afghanistan and Nepal) tend to be lacking in such interventions.

#### 3.2.3. Engineering

There is a lack of studies specifically assessing the impact of engineering interventions in LMICs [53], and those that are available have mixed results. Gupta et al. [53] report that the results of the three before-and-after engineering-based studies included in their review show that while fatalities declined, the number of casualties more than doubled. Other more recent research in Ethiopia has focused on reducing traffic-related pedestrian injuries at roundabouts by modelling the effects of different features of the approaches, such as the presence of guard railing and location of pedestrian crossings. The results which emerged from a crash prediction model and development of safety performance functions suggested that the number of crashes involving pedestrians was 50% higher near public transport terminals, where the spatial intensity of pedestrian-vehicle conflicts is high. A change in gradient of the approach of 1% could result in 12% increase in pedestrian crashes, as visibility is reduced and speeds are affected. However, there is less risk of pedestrian crashes where appropriate crossing facilities are provided. For instance, roundabout approaches with central refuges had 44% fewer pedestrian crashes than those without such facilities [58]. However, provision of pedestrian facilities does not imply compliant use. In Ghana, 65% of pedestrians using a zebra crossing displayed some aspect of risky behaviour such as talking, eating or drinking, using telephones, and wearing headphones [75].

The WHO's annual 'Global Status Report on Road Safety' provides an overview of progress that has been achieved in important areas such as legislation, vehicle standards and access to post-crash care. The 2018 report [1] notes that progress has not, however, occurred at a pace fast enough to compensate for the rising population and the rapid motorisation of transport taking place in many parts of the world. At this rate, they note, the Sustainable Development Goals (SDG) target 3.6 to halve road traffic deaths by 2020 will not be met.

#### *3.3. Vulnerable Groups and Gender Disaggregation*

The travel behaviour of vulnerable groups, such as the disabled, women and children, can be adversely affected by road safety issues, particularly in LICs. The injury profile of road traffic crashes in LICs differs in important ways from the profile seen in developed countries. Pedestrians, cyclists and passengers on multi-passenger transport (buses, trucks and minibuses) are at particular risk of injury. For instance, Nantulya and Reich [76,77] note that pedestrians, cyclists and passengers in buses and trucks account for around 90% of the casualties in countries in low- and middle-income regions, as opposed to high-income regions where drivers constitute the majority of victims. This large proportion of vulnerable road users in road crash statistics in LICs may be explained by a traffic mix of incompatible users, where pedestrians, cyclists and motorcyclist are forced to share road space with cars and trucks, especially where communities live within the vicinity of roads, where there is a lack of pavement along large urban streets [78], and where children are particularly vulnerable to increasing levels of motorisation [79].

Despite the prominence of vulnerable road users in LICs, they are still largely ignored in the planning, design and operation of roads [1]. Around three-quarters of the casualties and fatalities in LICs are men [80,81], and this may reflect gender disparities in access to economic opportunities and in exposure to road traffic injury risks as drivers and passengers [77]. Unfortunately, the published summary data of injury numbers is seldom disaggregated to look at patterns in factors such as gender [82]. However, as more countries are conducting household surveys, in addition to regular population censuses, more countries can now produce data disaggregated by sex for basic indicators on population, families, health, education and work [83]. Nevertheless, even when such information is collected, it is often not tabulated and disseminated to allow for meaningful gender analysis [83].

Men and women typically adopt different journey patterns, which will differentially change their exposure to risk of involvement in road crashes [82,84]. Uteng [85] suggests that there are a number of factors influencing women's mobility in the developing world, including social and cultural norms in a patriarchal system and transport infrastructure planning and design. Typically, women are less likely to make long journeys or use slower modes, and may not use busy roads as frequently as men, thus crash statistics for men and women will tend to show different patterns [85]. The predominant mode of transport for women in rural Africa, for instance, is walking [86], while men get access and priority for the use of private vehicles [85]. When women use motorised transport, it is likely to be public transport and they are often subject to other risks while travelling [86]. While these gender differences in the use of transport is greatest in rural settings [87], in urban areas, women have less access to either individual or public means of transport than men, due to both economic and social reasons, and are hence dependent on walking or using undesirable and potentially unsafe forms of public transport [88].

In their review of 73 studies of road traffic injuries in developing countries, Odero et al. [80] note that "no study in this review attempted to investigate specific potential factors that would explain the observed gender differences. Such a study is desirable and would need to assess and correct for levels of exposure by gender." Thus, the available literature on gender disaggregation in road crashes specifically relating to LICs is sparse, indicating a clear gap in the knowledge base, and this is a topic which could merit the use of social research mechanisms such as behavioural and attitudinal surveys of these vulnerable groups, especially focussing on countries which have recently improved frequency of and access to household survey data. Car-centric transport policies coupled with increased urbanisation could lead to greater inequity in mobility [85], and further study needs to be made on how such policies affect mobility from a gender-based perspective.

#### *3.4. Disabilities Due to Road Crashes*

Disability due to road traffic crashes and injuries is a significant proportion of the burden in low-income settings, where appropriate and timely medical care is not usually available for victims. Rehabilitation care systems are sorely lacking in LICs [89,90]. It is estimated that for every road traffic death, there are an additional 20–50 more people who are injured, and often face disability [91]. According to the World Health Organization [91], around 85% of all global road deaths, 90% of the disability-adjusted life years (DALYs) lost due to crashes, and 96% of all children killed worldwide as a result of road traffic injuries occur in low-income and middle-income countries. However, definite data on the number of people who survive road crashes but live with disabilities are almost non-existent [92].

Some indicative data is available as highlighted in the WHO's report on Global Road Safety 2018 [1]. There are data available for 29 of the 175 countries listed in that report, giving details of post-crash response, which provides an estimated value for the percentage of road crash victims with permanent disability. Of these 29 countries, four are classified as LICs and four as LMICs. The range of estimates for the four LICs is quite wide, with an estimated 47% of road crash victims having permanent disabilities in Togo and 40% in the Democratic Republic of Congo, while estimates for Zimbabwe (7%) and Uganda (3%) are much lower. The range is less stark for the LMICs, with an estimate of 19% of road crash victims in Sudan, and 15% in Cambodia suffering from permanent disabilities, compared with 2.4% in Bangladesh and 1% in Palestine (West Bank and Gaza). Of the upper-middle and high-income countries for which data is provided, this metric is highest in Brazil (24%) and Romania (21%), and lowest in Qatar and France (both 1%). There are no reasons offered within that report on why these data should be so disparate, and there is no obvious pattern linking the health care availability and these disability rates.

Zafar et al. [93] carried out secondary analysis of the results of four nationally representative cluster randomized surveys in LICs (Nepal and Uganda in 2014, Rwanda in 2011 and Sierra Leone in 2012) as part of the Surgeons Overseas Assessment of Surgical Needs, which collected information regarding demographics, injury characteristics, anatomic location of injury, healthcare seeking behaviour, and disability from injury. The authors found that among the four LICs, involvement in a road crash was reported by 1.8%–2.6% of the population. These accounted for about 12.9% of all injuries. 'Major disability' was reported by an average of 38.5% of those suffering an injury as a result of a road crash. Respondents from Sierra Leone (49.3%) and Uganda (46%) were most likely to report a disability, whereas those from Rwanda (32.8%) and Nepal (21.1%) were less likely. Patterns of injury varied between countries; however, head and extremity injuries remained the most common.

One potential problem comparing the studies above is that of inconsistent definitions. For instance, the international road safety community has not yet settled on a precise definition of 'serious' injury resulting from a road traffic crash [94]. Injury severity in some developed countries has been assessed by means of the maximum abbreviated injury scale (MAIS), i.e., the maximum score of a six-point scale ranging from 1 (minor injury) to 6 (fatal injury) [95]. However, there is no agreement on which of the central MAIS levels should be used to define serious road injuries as a policy indicator. In the Netherlands, for instance, MAIS 2+ is used to indicate a serious road crash [94], while the International Road Traffic and Accident Database (IRTAD), proposes an injury score of MAIS 3+ to define a seriously injured road casualty [12].

A number of studies (see for example [96–101]) provide means to monitor the prevalence of disabilities among populations, but it should be noted that improved health care and vehicle safety does not necessarily imply that there will be fewer disabled people as a result of road traffic crashes. If healthcare and acute care services improve in LICs and in-vehicle protection devices (e.g., airbags) become more prevalent, there are likely to be fewer fatalities resulting from crashes. However, the implication is that more people will survive with non-fatal but extensive injuries, resulting in higher numbers of disabled people [102], implying a greater need in the future for long-term care and rehabilitation facilities for those who survive road crashes, but are permanently disabled. There are obvious cost implications associated with this [96].

#### *3.5. Economic Burden of Road Crashes*

Since road crash cost estimates are difficult to obtain, there are few studies that specifically focus on road crash costing or cost-effectiveness of interventions in LICs [103]. A recent summary of the economic costs of RTIs included in the Disease Control Priorities project suggests that these costs could range between 1%–2% of a country's GNP [92]. Delays in implementing road safety measures could also impact severely on a nation's wealth and its population's wellbeing [104]. While estimates on the total costs of RTIs vary based on the methodological approaches used, one large 21-country study estimated the global cost of RTIs at US\$518 billion [92,105]. Another recent analysis of the economic impact of road traffic injuries led by the World Bank's Global Road Safety Facility found that if countries were able to halve mortality and morbidity due to road traffic injuries and sustain that over 24 years, they could realize significant increases in their GDP—between 7% and 22% [106].

In addition to the above costs, it is important to note that RTIs result in a significant societal burden as well, information about which is important for evidence-based policy making. However, there is a paucity in information in the global literature about the societal costs of RTIs, especially in LMICs, and more studies are needed. This information would provide insight into the consequences of crashes for the economy and social welfare. In fact, road crash costs can be used as a comparator with other policy areas, to help decision-makers prioritise investments. While epidemiological data for crash-related disability from LICs is scarce, the costs of prolonged care, loss of income and consequences for injured parents and their dependents impose financial pressures on families, threatening sustainable livelihoods [107]. Also, the burden of care for long-term illness and disability may fall disproportionately on women and girls [108]. That said, the tangible costs such as lost productivity (indirect cost) and medical costs (direct costs) can be estimated in economic terms more easily compared to the intangible costs such as pain and suffering [109]. However, regardless of

difficulties in estimating road crash costs, accounting for economic costs of crashes is necessary to inform policy makers in prioritising and choosing the most effective countermeasures. Three main approaches used in estimating the cost of road crashes [109] are (i) the human capital approach, in which mainly tangible injury costs to individuals are aggregated at societal, regional and national levels; (ii) the willingness-to-pay approach, which derives a value of pain and suffering based on the preferred amounts that people would be prepared to pay to live in a world where risks are reduced; and (iii) the general equilibrium approach, which uses simulation models to estimate costs from a broader macroeconomic perspective, although this is, as yet, untested for injury cost modelling [92]. The human capital approach has been the most common approach used in LMICs, due to the relative simplicity and structured nature of the approach [109].

#### *3.6. Vehicle Safety Standards and Dumping of Old Vehicles*

An emerging problem for road safety in LICs is the issue of vehicle safety and technologies. While there is a dearth of literature focusing on this issue in LICs, as part of this project, we have been working to liaise with stakeholders in considering lessons learnt from the developed world in this area to understand this issue further. These stakeholders include experts from the Global New Car Assessment Programme (NCAP), and regional car assessment programs.

With respect to emerging vehicle safety features in LICs (e.g., air bags, crash avoidance systems, etc.), one should take into account risk compensation issues. A number of studies have investigated risk compensation issues mostly in the developed world [110–113]. As discussed by Winston et al. [110], road users may become less vigilant about road safety due to innovations that are designed to improve safety. For example, drivers may trade off improved safety for speedier trips [110]. With the expected change in vehicle fleet (and their safety features) in LICs, it is important to understand how the experience of developed countries in this regard could lend itself to LICs. This also highlights the importance of publicity campaigns to raise awareness among road users in LICs with respect to vehicle safety features. This is particularly necessary to educate and train drivers at the very beginning steps of moving towards advanced vehicle safety features in LICs.

With respect to dumping old vehicles in LICs, the issue has been raised by a number of organisations and research studies, which mostly focus on the environmental impact [114]. The mainly old vehicle fleet in LICs does not meet some of the basic safety standards set in developed countries, increasing the propensity of crashes. This may be exacerbated by vehicle modification, poor maintenance standards, inappropriate use (e.g., overloading) and lack of safety enforcement. In addition, when a crash occurs, drivers and passengers would sustain more severe injuries, for example, due to lack of airbags. To our knowledge, scientific studies that investigate safety implications of exporting old vehicles to LICs are non-existent. Policies may be needed to prevent developed countries from dumping vehicles of a certain age or category in LICs and to encourage scrappage in LICs (e.g., cash for clunkers).

#### *3.7. Proactive Approaches to Road Safety*

Traditional methods that help detect, prioritise and treat high crash-risk sites have been based solely on prior crash history [115]. However, crash data quality in LICs tends to be poor, at limited numbers of sites, and with high rates of under-reporting. Studies of observed unsafe road user behaviour in LMICs do exist, e.g., [116,117], but manual data collection is time consuming and costly. To overcome these constraints, it may be possible to use new forms of data collection techniques such as video data or remote sensors, and storage and manipulation techniques involving 'big data' to allow for a proactive road safety approach that can address safety deficiencies before crashes occur [118]. For instance, assessing global databases could help identify country-specific determinants of road safety [119]. More locally, it is possible to monitor and analyse road users' trajectories and identify conflicts and near misses [120]. A proactive approach to road safety should ideally complement traditional, reactive methods [121], allowing us to design improvement programs (publicity campaigns,

engineering interventions, etc.) before crashes happen. However, applying such approaches in LICs may not be straightforward, due to cost and resource constraints.

#### *3.8. Limited Data Conditions, Omitted Variables Problem, and Unobserved Heterogeneity*

A series of well-known issues often encountered in road safety analysis are related to data limitations of various types. Crash data may be limited in terms of sample size or the number of risk (contributing) factors available in the data resulting in limited data conditions, the omitted variables problem, and unobserved heterogeneity [122–124]. Note that risk factors are needed to explain the safety of a site (highway segment, jurisdiction, etc.).

When a crash data set is not large enough, the maximum likelihood estimation is prone to bias; therefore, the model estimates are biased. This problem can be addressed by employing Bayesian methods in which prior knowledge can be included in the analysis in the form of the prior distribution, leading to enhanced statistical inferences. In this regard, for instance, Heydari et al. [124] showed how it is possible to obtain reliable statistical models for crash data characterised by a small sample size. With respect to the omission of risk factors, road safety literature discusses that, when important variables that have significant explanatory power are missing from the data, road safety inferences could be misleading [122].

Unobserved heterogeneity is related to the omitted variables problem and leads to spurious road safety inferences as indicated in the crash literature [2]. Several risk factors that affect road safety at a site (intersection, road segment, neighbourhood, etc.) are often missing (being unknown or unmeasured) in crash databases, causing the unobserved heterogeneity problem. A large body of literature discusses how to overcome this problem in order to obtain reliable estimates [2,125]. However, most studies that address the abovementioned issues are conducted in the developed world. Advanced statistical methods can mitigate unobserved heterogeneity and omitted variables problems [123], and such methods should be applicable to data sets in LICs, but their use in such contexts has so far been limited.

#### *3.9. Reaching out to Other Sectors—Social and Behavioural Aspects*

Road safety education and awareness campaigns in high-income settings are often based on changing people's attitudes. Change someone's attitudes, and they will change their behaviour. This may not, however, work across all cultural contexts. For example, previous research has suggested the link between attitudes and behaviours (in a road safety context) to be weaker in Sub-Saharan African countries than in high-income European countries [126,127]. In a study across six countries, McIlroy et al. [128] found that in Kenya, road safety attitudes predicted self-reported pedestrian behaviours to a significantly lesser extent than in the UK. This cannot, however, be explained by national income or road safety statistics. Across the six countries included in their investigation, McIlroy et al. found no patterns in this respect. This strongly points to the need to conduct preliminary research in the country of interest before applying road safety interventions. Every setting has unique characteristics, and interventions should be designed with this in mind.

Culture is a significant factor in this regard. This has been explored by a variety of researchers, with mixed results. In a study of West African taxi drivers, Kouabenan [129] examined religious, mystical, and fatalistic beliefs. Road crashes were attributed more to external factors (such as poor road maintenance and the absence of pedestrian infrastructure) than to driver behaviours (such as the breaking of road laws or carelessness). Additionally, such beliefs were linked with a disregard for safety measures. A strong belief in luck, fate, or destiny, was linked with a perceived lack of need for things such as helmets or seatbelts. Similar findings have since been reported by Dixey [130], Peltzer [131], Omari and Baron-Epel [132], and Maghsoudi et al. [133]. Additionally, not only are stronger beliefs in fate or destiny related to lower engagement in self-protective behaviours, but also with active engagement in risky behaviours. Results to this effect have been found in a variety of settings, including South Africa [134], Turkey and Iran [135,136], and Cameroon [137].

Results are not, however, clear-cut. In a study in Turkey, Yıldırım [138] found religiosity to have a positive effect on self-reported traffic behaviours. Those reporting stronger religious beliefs also reported making fewer risk-taking behaviours. Similarly, McIlroy et al. [139], found stronger beliefs in the influence of God over one's life to be related to safer attitudes and pedestrian behaviours in Kenya and Bangladesh. Note that the opposite pattern was found in China, Thailand, the UK, and Vietnam. Once again, research conducted in the setting of interest is crucial for successful intervention design and implementation.

Road transport is a highly complex sociotechnical system, with influence from a wide variety of individuals and organisations at varying levels of system abstraction [140]. Although it is the end user that carries the weight of the road traffic injury and fatality burden, it is generally not the end user that makes safety intervention decisions [141]. Yet it is this group that generally shoulders the blame [142]. This is not unique to low- and middle-income countries; however, change is beginning to be seen in some high-income countries with acceptance of the 'safe system' or 'vision zero' philosophy. The approach's primary central tenet is the idea that the end user is fallible, and that the system should be designed in a way to reduce the likelihood of crashes and reduce the consequences of crashes that happen. Crucially, blame is not placed solely on the end user, rather it is shared among system actors [143]. Although this way of thinking is gaining traction in the Europe, North America, and Australia, there is as yet a complete lack of systems-level research in low-income settings [144]. To reiterate the sociotechnical perspective, road safety is not the domain of one actor or group of actors alone, but it is the concern of many entities, at many levels of the system, from the end user to the policy maker [140].

#### *3.10. Current Capacity for Research and Practice*

Capacity for research and practice in the field of road safety is one of the key issues impeding progress in this area in the context of LICs. This is a recurrent theme in all global and regional reports published to date on road safety [1,8,91,92]. Capacity is needed for research as well as planning and implementation of appropriate safety improvement programmes, and any work being done in such settings ought to embed capacity development into it [145,146], as well as consider how to overcome institutional barriers [147].

Initiatives such as the Road Traffic Injuries Research Network [148] and the UNECE programmes in developing countries, in partnership with ECLAC (Latin America and Caribbean region) and ESCAP (Asia and the Pacific region) [149] have aimed to reduce the burden of road crashes in developing countries by identifying and promoting effective, evidenced-based interventions and supporting research capacity building in road safety research in LMICs. Building on the experience gained from such initiatives, there is a need to develop formal training programs that are readily accessible by individuals residing in LMICs. Based on the literature review and through liaising with experts and stakeholders, we have identified two main areas where improving capacity is most needed.

I Limited trained human resources: Many LICs around the world lack adequate human resources in the various areas necessary for effective action on road safety—research, program planning and implementation, as well as monitoring and evaluation [92,149]. One main reason for this is the lack of formal training programs in these settings that are specifically targeted towards the skills necessary for effective and appropriate action on an issue as complex and multi-sectoral as road safety [150]. This limits the amount and type of research conducted locally. For example, road safety studies that focus on data derived from LICs are extremely under-represented in peer-reviewed publications [145], and when they exist, they are often far away from advanced methodological techniques adopted in studies conducted in the developed world. To this end, it is important to train practitioners and researchers residing in LICs in the different areas necessary to effect programmatic change, such as road safety management, research on risk factors for road safety, evaluation of interventions, etc. Incorporating some of these capacity building activities

in ongoing engagements and initiatives in LMICs will also have the added benefit of enhancing collaboration between HIC and LMIC researchers and practitioners.

II Lack of data: As set out in Sections 3.1, 3.3, and 3.4, another gap identified in LICs is the limited amount of disaggregated data available for understanding the safety condition and monitoring safety improvement programs when implemented. Capacity development efforts for road safety in LMICs ought to focus on improving data systems such that there is valid, reliable, and timely data available to not only assess the safety condition, but also serve as a basis for assessing the effectiveness of programs or interventions implemented.

#### **4. Expert Consultation Results**

As described in Section 2.4, six road safety experts, with extensive experience in road safety in LICs, participated in our survey. They provided insight into those topics that were most important to consider for future research in LICs. Two main topics emerged as the most important issues: (i) data collection and management techniques and (ii) governance and legislation. The range of sub-topics and proposed solutions are reported in Table 5. The outcomes from the survey and other discussions also provided context for topics for which literature is unlikely to be available, but which helps provide the background to the future research agenda set out in Section 5.


**Table 5.** Expert elicitation results showing important topics for future road safety.

Respondents agreed that the complexities of road safety implementation meant that there are unlikely to be any 'quick wins', although investigating how governance could be improved and held more accountable could initiate action to improve the impact of road safety interventions in the short term. Further responses suggested that the effective use of increased resources and awareness of global best practice could help provide rapid insight into the priority issues, particularly with respect to the safety of vulnerable road users and the expected growth of traffic in developing countries. Additionally, reviewing current practices could help inform government and other stakeholders of the key issues in their specific location, and highlight where current governance mechanisms can be improved, with the aim of achieving greater political and funding commitments from decision-makers, resulting in better legislation and enforcement.

#### **5. Discussion: Implications and Future Directions**

This section provides a discussion of our findings and their implications grouped in seven major areas. A number of topics emerged from our analysis of the State of Knowledge review above combined with discussions with experts and stakeholders, which can help form a future research agenda. These topics relate to both empirical and methodological frontiers; therefore, they will lead to noteworthy improvements in the way road safety research will be conducted in the context of LICs. Note that topics discussed below are inter-related; nevertheless, their theoretical and empirical weights vary from one topic to another.

#### *5.1. Under-Reporting of Crashes*

This is a major issue in LICs; research is needed not only to understand causes of under-reporting but also to develop methodological approaches that can better address the issue. The use of capture-recapture techniques has been shown to be a useful tool to estimate the levels of under-reporting in low-income countries, and as such could be used when authorities wish to understand the true nature of road traffic crash rates in their country. To better address the under-reporting problem, alternative statistical methods that overcome the limitations of the capture-recapture approach (discussed in Section 3.1) should be examined and/or developed. It is also advisable to carry out a review of police and hospital data availability in LICs and LMICs, in order to understand better the nature of the types of data generally available. Following such a review, a general 'toolkit' could be developed offering guidance and methodologies for the analysis of under-reporting in LICs and LMICs. Such guidance could incorporate minimum data requirements, software tools and reporting templates in order to standardise such reporting in all LICs and LMICs in the future.

#### *5.2. Tra*ffi*c Injuries Sustained in the Crash*

Understanding the causes, severities, long-term implications, and costs to society of disabilities resulting from road crashes could help refine road safety policies in LICs and improve impact analysis of road safety interventions. There are inconsistencies in the metrics and methods used to assess injury severities (as discussed in Section 3.4), and further work could seek to build on any review of road safety and healthcare data recording systems suggested in Section 5.1 (under-reporting), and aim to assess the most appropriate metrics for LICs to use in analyses of disabilities. Further research could help to develop methodologies for road safety and healthcare practitioners in LICs to understand not only the trends associated with disabilities resulting from road crashes but also their impact on society and the economy. It may be appropriate to focus such future research on vulnerable groups. Also, a surprising gap in previous road safety research conducted in LICs relates to the lack of studies that aim at analysing and understanding differing injury-severity levels properly. That is, how different factors increase or decrease the likelihood of injury-severity sustained by road users. Such analyses are common in the developed world and help draw a complete picture, allowing decision makers to design cost-effective countermeasures to reduce injuries once a crash occurs. In this regard, further research is thus needed in LICs.

#### *5.3. Road Crash Costing*

There are limitations in the methods used to apply cost estimates to road crashes in LMICs [151] and in LICs in particular. Wesson et al. [152] carried out a review of economic evaluations in LMICs, finding only three studies that assessed the costs of road safety interventions, and six studies that were cost-effectiveness analyses. Only one of these papers referred specifically to LICs [153]. Similarly, Banstola and Mytton [103] only found five studies assessing cost-effectiveness in LMICs, with only two interventions showing moderate evidence of being cost-effective. More recently, Mukama et al. [154] assessed the costs of unintentional injuries to children in a Ugandan slum, noting that costs associated with road traffic crashes are higher than those for incidents occurring at a school, due to the severe nature of most road traffic injuries requiring specialised care and hence higher treatment costs. This lack of LIC-based research indicates that further research is needed to identify relevant methods of road crash cost estimations or cost-benefit analyses of road safety interventions applicable in those settings.

#### *5.4. Characterisations of the Vehicle Fleet*

With respect to the vehicle safety features and risk compensation concerns discussed in Section 3.6, further research is needed to better understand risk compensation issues in LICs to be able to take advantage of emerging safety innovations more fully. In addition, it is important to explore issues surrounding the second hand vehicle market and how countries that are heavily reliant on imported second-hand vehicles can regulate more appropriately, as well as vehicle technologies. In this regard, scientific research is needed to quantify road safety implications of dumping old vehicles in LICs.

#### *5.5. Challenges of Data Collection and Analysis*

As set out in Section 3, and identified by the expert survey, many of the issues pertinent to this study relate to the challenges of data collection, management and analysis. While it may be possible to draw on experiences of global good practice, it may also be relevant to develop specific methods and analysis techniques that apply in the LIC-context. The following sections discuss these issues in greater detail.

#### 5.5.1. Expected Increase in Traffic Volume and Its Implications

Previous research indicates that as a country's economy grows and traffic volume (and consequently exposure) increases, road safety deteriorates. However, the relationship is not linear and varies from one jurisdiction to another [155,156]. It is important to quantify the rate of deterioration in road safety as traffic exposure increases; and consequently, investigate how we can reduce this rate. For example, using advanced statistical methods, a study conducted by Heydari et al. [157] shows how with the same set of variables available in the data one can understand variation in crash frequency as traffic exposure increases. This is important since an increase in traffic volume in LICs seems inevitable in the near future. Further research is thus needed to understand the relationship between road safety and traffic exposure in LICs. To this end, a series of safety performance functions should be developed for different road infrastructures in LICs, similar to those developed in the Highway Safety Manual 2010 [158]. Note that safety performance functions are the main ingredient for the six-step safety management process described in the Highway Safety Manual [158]. They are used to quantify road safety, to understand factors affecting safety, and to identify hazardous locations that should then be prioritised for safety improvement programs.

#### 5.5.2. Accounting for Data-Related Limitations and Unobserved Heterogeneity

As previously discussed, in LICs, crash data tends to be lacking or when it exists, it is often limited, in terms of sample size limitations and/or the lack of risk factors available in the data. Therefore, issues discussed in Section 3.8 are often more prevalent and frequent in LICs compared to the developed world. The number of road safety studies conducted in LICs is limited, and rarely do those studies

employ rigorous road safety and statistical techniques to address the aforementioned issues properly. One aspect of future research should be to continue work in this area by developing statistical methods, especially those applicable to LIC-contexts, and help provide robust analyses of road safety data.

#### 5.5.3. Feasibility of Proactive Approaches to Road Safety in LICs

Although we recognise challenges for implementing proactive road safety approaches in LICs, it is important to investigate how this could help mitigate crash risk propensities in LICs. Building on the successful experience of developed countries in implementing such approaches, while considering resource and cost constraints applicable to LIC-contexts, it would be possible to adapt proactive methods in LICs to optimise their benefits with a minimum cost. Initially, this could be treated as a range of feasibility studies to extend the knowledge base to LICs. Perhaps, it would be possible to focus on monitoring a limited number of road infrastructures and based on that provide valuable insights, which in turn allow for designing tailored safety improvements transferable to other similar locations within each jurisdiction. To summarise, proactive safety approaches should be considered in the future if a major improvement in road safety in LICs is expected to be achieved.

#### 5.5.4. Alternative Approaches to Obtain Data

With respect to data issues and limitations encountered by LICs, which also relates to limited capacity in these countries, a valuable and cost-effective approach could be based on using street imagery, for example, available in Google street view or shared on social networks. Previous research has successfully taken advantage of street imagery, for example, to identify travel patterns [159]. Estimating travel patterns and/or traffic exposure by different modes of transport and/or road user types could be promising when such information is not available (e.g., when data are not collected through traditional data collection techniques). Also, automatic data collection, for example, using traffic analyser sensors has been shown to provide valuable data that allows the analyst to conduct road safety studies [160,161]. This is particularly important given the expected increase in traffic exposure in LICs since traffic exposure is known as a major determinant of road safety. Therefore, it would be interesting to investigate how this could be employed to collect relevant data and improve safety in LICs.

#### *5.6. Social and Behavioural Approaches to Road Safety*

As described in Section 3.2, the majority of road safety research is performed in high-income countries; hence, the majority of methods are biased towards these settings. As such, there is a strong requirement for research methods developed in low-income settings. This can also be said for road safety interventions. Given differences in cultures, attitudes, and behaviour constraints, it may not be the case that what has worked in Europe or America will also work in LICs. As such, interventions should be designed preferably based on research conducted in the country in which the intervention is to be implemented. Therefore, there is a clear need for more in-depth research on the social and behavioural factors that influence road safety in low-income settings. There is also a strong need to embed sociotechnical systems thinking in crash analyses, and in road transport policy, planning, and construction. This is beginning to happen in high-income countries; however, LICs are being left behind in this respect. As such, a concerted effort to apply contemporary sociotechnical systems methods to the analysis of road transport in LICs is needed. The design of road safety interventions should be based on a good understanding of the context of application and a consideration of all the factors that influence outcomes. Neither of these points are typically addressed in LICs; as such, they represent important topics for research.

#### *5.7. How to Build Sustainable Capacity E*ff*ectively and in a Timely Manner?*

Two of the future road safety challenges identified by the WHO [10] are 'Building Capacity' and 'Strengthening Data Collection', and effective training programmes could help improve both of these aspects of road safety. As discussed in Section 3.10, limited trained human resources and a lack of data are two areas where capacity building is most warranted. Although some previous studies have investigated related issues in LICs, there is a need to continue work in this area in order to systematically identify and/or define the most cost-effective and sustainable strategies that can be in place in a timely fashion.

#### **6. Summary**

The general objective of our research was to help improve road safety in LICs, identifying and targeting the most important problems encountered by these countries and defining critical future research directions that help enhance safety effectively given the expected increase in traffic exposure in LICs. Following recent developments in the field, including the UN Decade of Action for Road Safety (2010–2020), this article contributes to the literature by reviewing the state of knowledge and recommending a future research agenda for further improvements. Our study reveals where some of the major knowledge gaps exist for those topics that have been part of the research arena for some time. To this end, not only have we conducted a literature review, but we have also liaised with international organisations, local authorities, experts and professionals, particularly where the body of literature does not exist. Thus, we have identified some of the most critical road safety concerns in LICs; consequently, we have suggested some areas of future research that could be considered to inform an agenda for future action.

Specifically, we identified ten focus areas: (i) under-reporting of road crashes in LICs; (ii) lessons learned from global best practices; (iii) vulnerable groups and gender disaggregation; (iv) disabilities due to road crashes; (v) economic burden of road crashes; (vi) vehicle safety standards and the dumping of old vehicles; (vii) proactive approaches to road safety; (viii) limited data conditions, omitted variables and unobserved heterogeneity; (ix) reaching out to other sectors, considering social and behavioural aspects; and (x) capacity limitations of road safety research. Based on our analyses, we conclude that road safety is inherently a multi-sectoral issue, where interventions will need to involve multiple strategies and stakeholders. The most successful programmes globally have been those that have integrated systems of legislation, regulation and enforcement, combining robust data collection and management systems, economic evaluation systems to inform investment decisions, significant technical and enforcement capacity, and a substantial knowledge base of the social, medical and behavioural implications of road safety interventions.

Seven major research directions were identified based on the above-mentioned focus areas. In summary, in terms of policy recommendations, given the poor resources and lack of capacity for data management available in LICs, improving the quality of data in these countries would be one of the initial steps to make any improvements, either through investing in capacity for analysis and research, or through the development of modern techniques of data collection. Raising public awareness of the importance of accurate data and the reporting of road crashes is another central issue that should be considered by governments. We also suggest investigations into data analysis techniques considering both the statistical foundations upon which such analyses are built, and the use of proactive measures to prioritise investments, all carried out with a focus on existing cost and resource limitations in LICs, and using evidence-based techniques to promote effective changes. Combining expert insights and experiences with research from LICs, LMICs, and developed countries should provide the basis for a robust approach and a future research agenda that will help improve road safety in LICs.

**Author Contributions:** S.H., A.H., J.T., and A.M.B. were involved in drawing the conceptual plan of the paper. S.H. and A.H. wrote the first draft of the manuscript. R.M. wrote the sections relating to social and behavioural aspects. A.M.B. and J.T. provided valuable inputs on the content of the article.

**Funding:** This research was funded by the UK Department for International Development.

**Acknowledgments:** This research was funded by UK AID through the UK Department for International Development under the High Volume Transport Applied Research Programme, managed by IMC Worldwide. The authors are grateful to the panel of experts, who participated in the survey, and anonymous reviewers for their valuable comments.

**Conflicts of Interest:** The authors declare no conflict of interest.

#### **References**


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