Public transport and health outcomes in rural sub-Saharan Africa - A synthesis of professional opinion

Much of the recent transport focus in rural sub-Saharan Africa (SSA) has been on road building and upgrading as opposed to the provision of public transport. The literature reveals evidence of significant negative public health outcomes associated with crashes and pollution attributable to rural transport. We report the results of a synthesis of professional opinion obtained from in-person interviews and an internet survey on health issues related to the provision of public transport in rural SSA. Field interviews were conducted as semi-structured dialogues with some 40 transportation and public health professionals in the capital cities of Ethiopia, Ghana and Kenya. Additionally, 86 responses to an Internet survey were received from 38 African countries. Poor mechanical conditions of vehicles and risky driving behaviours were reported to be an important source of injury from rural road crashes. The factors contributing to unsafe rural public transport were attributable to economic barriers to proper operation. Although there was some mismatch among the survey and interview results and the literature, public transport was shown to be an important potential source of air pollution exposure. The overwhelming conclusion is the lack of true understanding of the health impacts of rural air pollution in relation to basic needs for provision of safe mobility. The findings reflect the awareness of various professional communities and emphasise the complexity of the relationship between rural public transport and public health. Transport and health relationships in places such as rural sub-Saharan Africa are further complicated by the fact that there is such significant potential for positive health outcomes attributable to transport through enhanced access to healthcare, education, commerce, etc. Systematic epidemiological research is needed to fully understand the trade-offs between rural mobility and its impacts to public health in rural sub-Saharan Africa.