integrated strategic framework for the prevention of ...acknowledgments. i would like to extend my...

Integrated Strategic Framework for

the Prevention of Injury and

Violence in South Africa

2012–2016

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This publication was developed with financial support from Task Order 2 of the USAID (United States Agency for International

Development) Health Policy Initiative. It was funded by the USAID under Contract No. GPO-I-01-05-00040-00. HIV-related

activities of the initiative are supported by the President’s Emergency Plan for AIDS Relief. Task Order 2 is implemented by

Futures Group International. The views expressed in this publication do not necessarily reflect the views of the U.S. Agency for

International Development or the United States Government.

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Integrated Strategic Framework for the

Prevention of Injury and Violence

in South Africa

2012–2016

July 2012

Pretoria, South Africa

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I. List of Tables, Figures and Boxes...............................................................................................ii

II. Foreword.................................................................................................................................iii

III. Acknowledgements..................................................................................................................iv

IV. Acronyms.................................................................................................................................v

V. Glossary..................................................................................................................................viii

VI. Opening Note To The Reader.....................................................................................................xi

VII. Executive Summary................................................................................................................xiii

1. INTRODUCTION........................................................................................................................1 Mandate, Rationale And Context..................................................................................1 International, Continental And South African Contexts..................................................2 How The Strategic Framework Was Developed............................................................3 Drawing Out Areas For Action......................................................................................5

2. BURDEN OF INJURIES..............................................................................................................7 Impact Of Injuries......................................................................................................10

3. APPROACH, KEY CONCEPTS AND PRINCIPLES.......................................................................12

4. THE STRATEGIC FRAMEWORK................................................................................................15 Vision.......................................................................................................................16 Purpose....................................................................................................................16 An Intersectoral Action Plan: Priority Areas For Action.................................................16 Priority Area 1: Reduce Injuries By Targeting Cross-Cutting Risk Factors.....................17 Priority Area 2: Reduce Risks Specific To Different Injury Priorities..............................26 Priority Area 3: Faciltate Supportive Institutional And Organisational Environments............................................................................................................38

5. CONCLUSION..........................................................................................................................45

6. SELECTED REFERENCES........................................................................................................46

Table of Contents

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List of tables

Table 1: Poverty and socio-economic inequality...................................................................................17Table 2: Poor infrastructure and service delivery..................................................................................19Table 3: Gender inequality and dominant masculinity norms................................................................21Table 4: Alcohol and drug abuse..........................................................................................................24Table 5.1 Injuries and male interpersonal violence...............................................................................26Table 5.2 Injuries and intimate partner violence...................................................................................27Table 5.3 Injuries and child abuse.......................................................................................................27Table 6: Traffic injury............................................................................................................................30Table 7: Suicide ..................................................................................................................................33Table 8.1: Unintentional injuries due to burns.......................................................................................35Table 8.2: Unintentional injuries due to drowning.................................................................................35Table 8.3: Unintentional injuries due to falls.........................................................................................36Table 8.4: Unintentional injuries due to poisoning.................................................................................36Table 9: Effective leadership by lead agencies......................................................................................38Table 10: Intersectoral collaboration ....................................................................................................40Table 11: Information collection for injury prevention planning and decision making.............................42

List of figures

Figure 1: Selected international, continental and South African policy initiatives that prioritise injury prevention......................................................................................................3Figure 2: The generation of injury prevention recommendations............................................................4Figure 3: Leading types of injury mortality in South Africa......................................................................7Figure 4: South Africa’s DALYs compared to other WHO regions.............................................................9Figure 5. Public health approach: Four interconnected phases linking data to action............................12Figure 6: Ecological model with risk factors for intentional injury.........................................................13Figure 7: Integrated Strategic Framework for the Prevention of Injury and Violence in South Africa, 2012–2016 .................................................................................................15

List of boxes

Box 1: Extent of premature non-natural injury mortality and morbidity in South Africa...........................8Box 2: Injury consequences ................................................................................................................10Box 3: The public health approach to injury prevention.........................................................................12Box 4: Organising intervention activities...............................................................................................14

List of Tables, Figures and Boxes

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Foreword

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AcknowledgmentsI would like to extend my appreciation to all those who contributed to the development of the Integrated Strategic Framework

for the Prevention of Injury and Violence in South Africa, 2012–2016. My special thanks go to Professor Melvyn Freeman

(National Department of Health) and Dr Shaidah Asmall (USAID and former Chief of Party, Futures Group) for their pivotal role in

spear-heading this initiative.

My gratitude is also extended to the following individuals and agencies for their substantial conceptual and technical

contributions, in particular, Professors Mohamed Seedat, Ashley van Niekerk and Kopano Ratele, and the MRC-UNISA Safety

and Peace Promotion Research Unit (SAPPRU) team, which included Ms Taryn Amos, Ms Najuwa Arendse, Ms Chernelle

Lambert, Professor Sandy Lazarus, Ms Sarah Mackenzie, Ms Kharnita Mohamed, Ms Guillermina Ritacco, Ms Shahnaaz Suffla,

Mr Anesh Sukhai, Ms Neziswe Titi and Ms Susanne Tonsing. This includes Ms Eurica Palmer and Ms Zuzelle Pretorius of the

Futures Group.

In addition, I would also like to thank Professor Rachel Jewkes (Medical Research Council, Gender and Health Research Unit),

Professor Lourens Schlebusch (University of KwaZulu-Natal), Dr Alpa Somaiya (Medical Research Council) and Dr Wendy

Watson (Translog) for their significant inputs.

Finally, my warm thanks go to members of the National Steering Committee for their considered contributions to the

development of the Strategic Framework, including Ms Maria Mabena, Mr Fezile Kate, Ms Mpho Phayane and Neil Naidoo

(Correctional Services); Ms Joyce Maluleka (Department of Justice and Constitutional Development); Ms Connie Nxumao,

Mr J.M. Mbonani and Mr Steven Maselele (Department of Social Development); Daniel Mabulane and Ms Hajira Masheso

(Department of Sport and Recreation South Africa); Ms Pakiso Netshidzivhani, Dr Nonhlanhla Dlamini, Mr J. Mokonto, Charles

Theu and Ms Rebecca Motlatla (Department of Health); Col S. Singh (South African Police Service); Mr M.E. Sithole and Mrs

Letsholonyane (Department of Human Settlements); Rev T.J. Vundla, Mr Nomsa Mtshweni and Ms Thandi Moya (Department of

Transport); Sydney Mashiloane and Nonhlanhla Bhengu (Women, Children and People with Disabilities); Dr Andrè Kudlinski, Ms

Lindiwe Mavundla and Neilendra Maikoo (Department of Trade and Industry); Dr V. Mabudusha, Ms M.E. Ruiters, Ms K. Tselane

and R. Lengolo (Department of Labour); Wendy Mapira (Economic Development Department); Siseko Gwavu (Department

of Public Works); Patrick Nethengwe and Tilly Manamela (South African Police Services); and Ms Nozipho Xulu-Mabumo

(Department of Basic Education).

Other contributing partners include National and Provincial Departments, academics, and civil society organisations. The

Department of Health would like to express its appreciation to them all.

PRECIOUS MATSOSO

DIRECTOR-GENERAL OF HEALTH

July 2012

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AIDS Acquired Immune Deficiency Syndrome

AARTO Administrative Adjudication of Road Traffic Offences

CASE Community Action towards a Safer Environment

CBO Community-Based Organisation

CGE Commission of Gender Equality

DALY Disability Adjusted Life Year

DBE Department of Basic Education

DCOGTA Department of Cooperative Governance and Traditional Affairs

DCS Department of Correctional Services

DPLG Department of Provincial and Local Government

EDD Economic Development Department

DoH Department of Health

DHS Department of Human Settlements

DoJ&CD Department of Justice and Constitutional Development

DOL Department of Labour

DSD Department of Social Development

SRSA Department of Sport and Recreation South Africa

DOT Department of Transport

Acronyms

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DTI Department of Trade and Industry

DPW Department of Public Works

DWCPD Department of Women, Children and People with Disabilities

EPWP Expanded Public Works Programme

GCIS Government Communication and Information System

HIV Human Immunodeficiency Virus

MDGs United Nations Millennium Development Goals

MRC Medical Research Council

MSR Men at the Side of the Road Initiative

NEPAD New Partnership for Africa’s Development

NPO Non-Profit Organisation

NPA National Prosecuting Authority

NIMSS National Injury Mortality Surveillance System

NYDA National Youth Development Agency

PTSD Post-Traumatic Stress Disorder

RTCIs Road traffic crashes and injuries

RTMC Road Traffic Management Corporation

SA South Africa

SALGA South African Local Government Association

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SANCA South African National Council on Alcoholism and Drug Dependence

SAPPRU Safety and Peace Promotion Research Unit

SAPS South African Police Service

UNISA University of South Africa

WHO World Health Organization

WRVH World Report on Violence and Health

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GlossaryTerm Definition

Injury

An injury is the physical damage that results when a human body is suddenly subjected to

energy in amounts that exceed the threshold of physiological tolerance. It is conventional to

classify injuries by their cause, i.e. as intentional (deliberately inflicted) or unintentional (1).

Intentional injury or violence

Intentional injury or violence is defined in the World Report on Violence and Health (WRVH) as

‘the intentional use of physical force or power, threatened or actual, against oneself, another

person, or against a group or community that either results in or has a high likelihood of resulting

in injury, death, psychological harm, maldevelopment, or deprivation.’ Intentional injuries can be

further classified according to the people involved in the event, i.e. self-inflicted, interpersonal

(injuries inflicted by one person against an intimate partner, child or elderly person) and collective

violence (1).

Self-directed violence or suicide

Self-directed violence or suicide is violence in which the perpetrator and the victim are the same

individual (1).

Interpersonal violence

Interpersonal violence is violence between individuals. Interpersonal violence is subdivided

into family, intimate partner and community violence. The former category includes child

maltreatment, intimate partner violence and elder abuse; while the latter is broken down into

acquaintance and stranger violence, and includes youth violence, assault by strangers, violence

related to property crimes, and violence in workplaces and other institutions (1).

Child abuse or maltreatment

Child abuse or maltreatment constitutes all forms of physical and/or emotional ill-treatment,

sexual abuse, neglect or negligent treatment, or commercial or other exploitation, resulting in the

actual or potential harm to a child’s health, survival, development, or dignity in the context of a

relationship of responsibility, trust or power (1).

Unintentional injury

Unintentional injuries are classified according to their causal mechanism (i.e. how they occurred),

with most common sub-categories including road traffic injuries, falls, burns and scalds,

drowning and poisonings (2).

Road traffic injury

A road traffic crash is defined as ‘a collision or incident that may or may not lead to injury,

occurring on a public road and involving at least one moving vehicle.’ Road traffic injuries are

defined as ‘fatal or non-fatal injuries incurred as a result of a road traffic crash’ (3). Death

incurred within 30 days of a road traffic crash is considered to be a road traffic fatality (4).

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Drowning Drowning is the process of experiencing respiratory impairment from submersion/immersion

in liquid. Drowning outcomes are classified as death, morbidity or no morbidity (5).

Burns

A burn occurs when some or all of the different layers of skin cells are destroyed by a

hot liquid (scald), a hot solid (contact burns) or a flame (flame burns). Skin injuries due to

ultraviolet radiation, radioactivity, electricity or chemicals, as well as respiratory damage

resulting from smoke inhalation, are also considered to be burns (6).

Poisons

Poisoning refers to an injury that can result from being exposed to an exogenous substance

that causes cellular injury or death. Poisons can be inhaled, ingested, injected or absorbed.

Poisoning can also occur in utero (7).

Falls The World Health Organization Global Report on Falls Prevention (2007) defines a fall as

when a body inadvertently comes to rest on the ground, floor or lower level (8).

Injury prevention

The WHO defines injury prevention as the actions or interventions that prevent an injury

event or violent act from happening by rendering it impossible or less likely to occur. Injury

control refers to actions aimed at reducing injuries or the consequences of injuries once they

have occurred.

Primary, secondary and tertiary prevention

Injury prevention interventions may be organised according to three levels of action:

• Primary prevention: The prevention of injury before its occurrence.

• Secondary: The immediate responses once an injury has occurred. These include pre-

hospital care, emergency medical care for physical trauma and shelter services for, for

example, abused women and children.

• Tertiary: This focuses on rehabilitation and reconciliation. Services may include individual

and family counselling.

Universal, selected and indicated interventions

Prevention may also target specific vulnerable and identified groups:

• Universal interventions: Targeted at the general population or groups without consideration

for any specific risk groups. These may include, for example, public campaigns sensitising

entire communities to safe pedestrian behaviour when crossing roads, or, for example,

conflict resolution training for all high school children or public campaigns that sensitise

entire communities to the magnitude of injury.

• Selected interventions: Targeted at groups shown to be at specific risk for injury, for

example, home visitation for marginalised families with young children at risk for household

injury, and those that require parenting support.

• Indicated interventions: Aimed at groups who have already been exposed to injury either as

perpetrators or survivors. This may include gender sensitisation training for perpetrators of

intimate partner violence.

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Morbidity

Morbidity is an incidence of ill health. It is measured in various ways, often by the probability

that a randomly selected individual in a population at some date and location will become

seriously ill over some period of time (9).

Mortality

Mortality is the incidence of death in a population. It is measured in various ways, often by

the probability that a randomly selected individual in a population at some date and location

will die in some period of time (9).

Downstream or proximal risk factor

A downstream or proximal risk factor is a risk factor that represents an immediate

vulnerability for a particular condition or event. Sometimes downstream risk factors

precipitate an event. For example, an intensely stressful life experience, such as a divorce or

loss of a job, is a downstream risk factor for a suicide attempt (10).

Upstream or distal risk factor

An upstream or distal risk factor is a risk factor that represents underlying social and

infrastructural vulnerabilities for a particular condition or event. An upstream risk factor does

not predict that the condition or event is about to happen, but rather that a person may be at

risk for the condition at some time in the future (10).

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Opening Note to the ReaderThe Integrated Strategic Framework for the Prevention of Injury and Violence in South Africa, 2012–2016 has been developed

to coordinate the prioritisation of programmes that will help prevent injuries and promote safety. This Framework is a strategic

and co-ordinated endeavour to change key social, environmental and behavioural factors that contribute to the causation

of injuries. The Strategic Framework highlights evidence-led recommendations for Government Departments to develop

operational plans that utilise proven injury prevention interventions. The Framework draws on the public health perspective,

which has been successfully applied across settings to integrate the efforts of multiple sectors in the implementation of

evidence-led injury prevention strategies.

The Framework highlights the most common injury types current in South Africa, i.e. interpersonal violence, traffic injuries,

suicide and to a lesser extent, unintentional injuries (other than those by traffic crashes). This Strategic Framework uses

the term injury to refer to both intentional and unintentional injury. Sometimes the word ‘injury’ is used alongside the

term ‘violence’ to both highlight the major contribution of violence to South Africa’s burden of disease and to point to the

psychological, emotional and social dimensions of violence. While the Framework targets the prevention of risk factors specific

to the priority injuries, it also emphasises the control of common or cross-cutting injury determinants and the promotion of

supportive institutional factors. The focus on these common determinants and institutional enablers allows for an impact that

extends beyond a single injury type, towards a number of types, with consequent benefits across Government Departments.

The Strategic Framework also focuses on the prevention of injuries before they occur. The Framework focuses upon primary

(i.e. on pre-injury circumstances), secondary (i.e. on conditions specific to the injury event) and selected tertiary prevention (or

rehabilitative) priorities.

The Framework recognises that the needs and opportunities differ between Departments and therefore offers specific injury

prevention objectives, with the requisite flexibility to allow for the individual or collective uptake by Departments of injury

prevention opportunities. This Integrated Strategic Framework thus requires the formation of strong partnerships, both

between Government Departments and with other external stakeholders. It provides a framework for partners in the injury

prevention and safety promotion sector to collaborate on common service delivery activities to achieve the areas for action

listed in the Framework.

The implementation of the Strategic Framework is coordinated by the Department of Health, which manages the

consequences of all injuries. Health, however, does not hold the sole mandate for the prevention of those injuries. There are

safety issues led by other agencies, such as road safety, crime prevention, and infrastructure and product safety, on which the

Department of Health is a partner, and has much to offer in terms of injury data and analysis, models of practice, and access

to those vulnerable to injury.

This Integrated Strategic Framework offers a platform from which Government departments can implement priority injury

prevention and safety promotion programmes. The Framework specifies strategic objectives, each with specific outcomes,

recommended strategies, specific interventions and a lead Department(s). Specific injury prevention implementation plans

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will be developed separately by departments, or integrated into existing plans. Some of these interventions are already in place

across various Government departments and have therefore been incorporated as part of this integrated strategy.

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Executive SummaryWhen compared to countries that produce injury data, South Africa has one of the highest levels of death and disability from

injury in the world. The injury death rate in the country of 158 per 100 000 is twice the global average of 86,9 per 100 000

population and higher than the African average of 139,5 per 100 000. The high South African injury death rates are primarily

driven by intentional injuries due to interpersonal violence (46% of all injury deaths) and road traffic injuries (26%), followed by

suicide (9%), fires (7%), drowning (2%), falls (2%) and poisoning (1%).

Injury is defined as the physical damage that results when a human body is suddenly subjected to energy in amounts that

exceed the threshold of physiological tolerance. Injury is commonly grouped into intentional and unintentional injury. Intentional

injury collectively refers to injuries that are due to interpersonal violence (injuries inflicted by one person against an intimate

partner, child or elderly person), suicidal or self-inflicted harm, and collective violence. Unintentional injury includes injuries

due to fires and scalds, drowning, poisoning, falls, and traffic crashes, although the latter, because of its widespread nature

is referred to separately. Injuries may result in profound psychological, social and economic consequences for the affected

individuals and their families. The causation of injury is multi-factorial and typically involves a complex chain that combines the

interaction of both upstream and downstream factors, which include individual, interpersonal, community and societal factors.

In recognition of the unprecedented burden of mortality, disability and suffering arising from injuries in South Africa, and the

need for a co-ordinated inter-sectoral response, the Directors-General of the Human Development Cluster mandated the

National Department of Health to convene a high-level task team to develop a Strategic Framework for Injury Prevention.

The development of the Strategic Framework involved complex and multiple processes including a comprehensive desktop

review and analysis of injury prevention evidence; in-depth discussions with a National Steering Committee; a situational

analysis, consultation and dialogue with experts in injury prevention; and consultations with the technical advisors within lead

Government ministries and departments.

Based on Outcome 3 of Government’s strategic priorities, that ‘all South Africans are and feel safe’, the vision of this Integrated

Strategic Framework for the Prevention of Injury in South Africa is for a safe and peaceful South Africa that is free from injury

and suffering, and is conducive to physical, mental and social well-being. Building on the recent policy-related initiatives from

Government ministries and departments, the Strategic Framework highlights the issues central to achieving ‘a better life for all

South Africans’. The Framework offers sound, empirically based recommendations for Government departments to carve out

injury prevention interventions. The Framework stresses that the prevention of injury, for which there is no single silver bullet,

necessitates a concerted and coordinated, inter-sectoral evidence-led response.

The Framework aims to bring together Government Departments to strengthen the implementation of empirically developed

injury prevention interventions. It places the emphasis on preventing injury before it occurs. Research has shown that certain

interventions can prevent injuries, with some countries demonstrating up to a 50% reduction in their injury mortality rates over

a 10–20 year period.

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This Framework signals a strategic evidence-led and co-ordinated endeavour to changing the social, behavioural and

environmental factors that cause injuries. As such, the Strategic Framework places the accent on three key action areas.

Following these key action areas, the Framework has 12 strategic objectives as outlined in the figure below.

KEY ACTION AREAS(1)

Reduce injuries by targeting priority cross cutting risk

factors

Objective 1

Promote selected poverty alleviation measures targeting groups at risk for

injuries

Objective 5

Facilitate comprehensive

measures to prevent violence-related

injuries and contain associated severity

Objective 9

Promote effective leadership across

lead agencies

Objective 2

Promote selected health, road

and residential infrastructure and services to reduce

the risks for injuries and contain injury

severity

Objective 6


measures to reduce road traffic-related

injuries and associated severity

Objective 10

Promote inter-sectoral

collaboration within Government and with civil society

Objective 3

Facilitate equitable gender relationships

and norms

Objective 7


measures to reduce suicide-

related injuries and associated severity

Objective 11

Facilitate the collection and

use of empirical information for planning,

implementation and evaluation

Objective 4

Reduce alcohol and drug abuse

Objective 8


measures to prevent and reduce the

severity of injuries arising from falls, burns, poisonings and water related

incidents

Objective 12

Promote effective and equitable

resource allocation and utilisation for

the implementation of evidence-led interventions

(2) Reduce risks specific to the

different injury priorities

(3) Facilitate supportive

institutional and organisational environments

(1) PRIORITY CROSS -CUTTING

RISK FACTORS

(2) RISKS SPECIFIC TO THE DIFFERENT INJURY PRIORITIES

(3) SUPPORTIVE INSTITUTIONAL

AND ORGANISATIONAL ENVIRONMENTS

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The Strategic Framework identifies different combinations of primary, secondary and tertiary interventions that are directed

at each objective. Primary interventions refer to those that prevent an injury before it occurs. Secondary interventions refer

to the immediate responses once an injury has occurred. For instance, emergency medical care for physical trauma is meant

to mitigate injury severity. Tertiary interventions focus on rehabilitation and reconciliation, and include individual and family

counselling. These interventions are based on proven or promising practices and are connected to measurable outcomes,

and should be coordinated by one or more departments or lead agencies. Each of the 12 strategic objectives has at least one

outcome.

Some of these interventions are already in place across various Government departments and institutions, and have therefore

been incorporated as part of this integrated strategy. The Strategic Framework thus serves as an evidence-based platform

for Government departments to develop implementation and action plans. Finally, the Strategic Framework focuses on injury

prevention for the 2012–2016 period. Over this period, it is expected that the combination of interventions will prompt

further annual decreases in homicide (of 7–10%), child homicide rates (of 7–10%) and traffic mortality (of 10–15%). Rape

and sexual assault screening systems face particular challenges; system improvements are prioritised to ensure reliable

information systems are developed within the 2012–2016 period.

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1

1. INTRODUCTIONThere is an unprecedented burden of morbidity and mortality arising from injuries in the country. The injury death rate in the

country of 158 per 100 000 is twice the global average of 86,9 per 100 000 population and higher than the African average of

139.5 per 100 000 (11). The World Health Organization has defined injury as the physical damage that results when a human

body is suddenly subjected to energy in amounts that exceed the threshold of physiological tolerance. Injury is commonly

classified as either intentional or unintentional. Intentional injury collectively refers to injuries that are due to interpersonal

violence (injuries inflicted by one person against an intimate partner, child or elderly person), suicidal or self-inflicted harm and

collective violence. Unintentional injury includes injuries due to fires and scalds, drowning, falls, poisoning and traffic crashes.

However, due to their widespread nature traffic injury is often referred to separately. Injuries are also described in terms of the

settings in which they occur, with most injuries occurring in the home, on roads, in public spaces and in high-risk occupational

settings. Injuries may result in profound psychological, social and economic consequences for the affected individuals, families,

communities and societies.

MANDATE, RATIONALE AND CONTEXT

Despite South Africa’s unprecedented levels of injury mortality and morbidity, the country’s prevention responses tend to be

characterised by insufficient inter-sectoral collaboration, fragmentation, inadequate co-ordination, inappropriate resource

allocation, and insufficient adoption of evidence in planning, implementing and monitoring interventions. In recognition of this,

the National Department of Health (DOH) presented a case in August 2009 to the Directors-General of the Human Development

Cluster for the development of a national strategy for preventing injuries. The National DOH presented the prevention of

injuries as a public health priority and a multi-sectoral issue requiring strategic and focused actions from different Government

departments. In response, the Directors-General of the Human Development Cluster mandated the National DOH to convene

a high-level task team to develop a national Strategic Framework for the Prevention of Injury in South Africa. The task team,

comprising the DOH, the Futures Group and the MRC-UNISA Safety and Peace Promotion Research Unit (SAPPRU), took its

guidance from a National Steering Committee that provided critical oversight on the Framework.

The rationale for this Strategic Framework therefore arises out of recognising the gaps in the country’s prevention responses

and the widespread injury mortality and morbidity, associated physical disabilities and psychological suffering, and the urgent

need for a co-ordinated and seamlessly functioning evidence-led national strategy. Therefore, in order to provide substance for

its rationale, the Framework draws on the experiences of a number of countries. These experiences indicate that injuries are

not random, but predictable events that are preventable, and that national injury prevention policies can and do work.

Over the past 10–20 years, many industrialised countries have reduced their injury death rates, some by as much as one-

half. These reductions can be attributed to concerted and sustained injury prevention efforts, often instigated by Government

as part of a national strategy or programme.

The Strategic Framework aims to enable the consolidation of both existing and proposed prevention and control measures,

facilitate inter-sectoral linkages, promote a focus on all priority risk groups and environments, and encourage evidence-led

planning and implementation practices.

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2

Following this rationale and international experiences, the Strategic Framework aims to enable the consolidation of both

existing and proposed prevention and control measures, facilitate inter-sectoral linkages, promote a focus on all priority risk

groups and environments, and encourage evidence-led planning and implementation practices.

The broad strategy to prevent injuries is informed by key international, African and South African instruments, and finds

resonance with a rationale grounded in South African social and health priorities.

International, African and South African contexts

Several international declarations and platforms for action have explicitly prioritised injury prevention efforts. These include,

but are not limited to, the United Nations Convention on the Rights of the Child (1989), the Beijing Platform for Action (1995),

the United Nations Millennium Development Goals (2000), and more recently, the United Nations Decade of Action for Road

Safety (2010). These policy-related initiatives have important implications for national safety promotion agendas. For example,

the UN Millennium Development Goals (MDGs), set in 2000, commit to reducing child mortality. In addition, the MDGs focus

on important social drivers of injury prevention, including maternal health, poverty alleviation, universal primary education and

gender equality. Likewise, the UN Decade of Action for Road Safety emphasises global road safety efforts, focusing on road

safety management, provision of safer road environments for mass mobility, safer vehicles, safer road users and efficient

post-crash response systems.

The South African Government has endorsed both the MDGs and the UN Decade of Action for Road Safety. Furthermore,

Government has committed itself to safety promotion-related continental initiatives arising out of the Organisation of African

Unity (OAU)/African Union (AU), such as the African Charter on the Rights and Welfare of the Child (ACRWC) and the New

Partnership for Africa’s Development (NEPAD). The ACRWC, for example, seeks to ensure the rights of children to the best

attainable state of mental and physical health (ACRWC, 1999). NEPAD highlights poverty eradication or alleviation, gender

mainstreaming and empowerment of women (12).

By signing up to these agreements, South Africa has indicated its support of the principles contained therein (2). These

commitments resonate with the Government’s current Programme of Action (2009–2014), the South African Presidency’s

12 key outcomes, and a range of specific legislative mechanisms to promote specific safety promotion issues (Figure 1). The

South African Programme of Action (2009–2014) and Presidency’s 12 key outcomes undertake to, amongst others, promote

safety, reduce selected injury risk factors, and create structural and institutional enablers for a better life.

Over the past 10–20 years, many industrialised countries have reduced their injury death rates, some by as much as one-

half. These reductions can be attributed to concerted and sustained injury prevention efforts, often instigated by Government

as part of a national strategy or programme. National strategies have been especially effective in reducing injuries in countries

such as Australia, Canada and France (2, 12). Many emerging economies, such as South Africa, have also begun investing in

research and programming towards developing the local evidence base.

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3

The South African Programme of Action (2009–2014) and Presidency’s 12 key outcomes undertake to, amongst others,

promote safety, reduce selected injury risk factors, and create structural and institutional enablers for a better life.

Figure 1. Selected international, continental and South African policy initiatives that prioritise injury prevention

Strategic Framework for the Prevention of Injury in South

Africa

African Charter on the Rights and Welfare of the Child (ACRWC) • Article 14: Health

and Health services to all children

• Article 16: Protection against child abuse and torture

• Article 18: Protection of family

• Article 27: Sexual exploitation

African policy-‐related initiatives

• New Partnership for Africa’s Development (NEPAD)

• Develop infrastructure

• Support human resources development

• Promote Governance

• Ensure capacity building

South African policy-‐related initiatives

SA Presidency: 12 key outcomes

• Long and healthy life

• All people in SA are and feel safe

• Better and safer South Africa, Africa and world

SA Government Programme of Action (2009–2014) • Improve

health profile of all South Africans

• Intensify fight against crime and corruption

International policy-‐related initiatives

The UN Millennium Development Goals

• Reduce child

mortality • Improve maternal

health

The UN Make Roads Safe –Decade of Action Campaign • Road safety

management • Safer roads and

mobility • Safer vehicles • Safer road users • Post-‐crash

response

Strategic Framework for the Prevention of Injury in South Africa

International policy- relatedinitiatives

New Partnership for Africa’s Development (NEPAD)

• Develop infrastructure

• Support human resources development

• Promote Governance

• Ensure capacity building

The UN Millennium Development Goals

• Reduce child mortality

• Improve maternal health

African policy- relatedinitiatives

SA Presidency: 12 key outcomes

• Long and healthy life

• All people in SA are and feel safe

• Better and safer South Africa, Africa and world

The UN Make Roads Safe –Decade of Action Campaign

• Road safety management

• Safer roads and mobility

• Safer vehicles

• Safer road users

• Post-crash response

South African policy-related initiatives

SA Government Programme of Action (2009–2014)

• Improve health profile of all South Africans

• Intensify fight against crime and corruption

African Charter on the Rights and Welfare of the Child (ACRWC)

• Article 14: Health and Health services to all children

• Article 16: Protection against child abuse and torture

• Article 18: Protection of family

• Article 27: Sexual exploitation

HOW THE STRATEGIC FRAMEWORK WAS DEVELOPED

While the public health approach and associated principles guided the organising logic, see Section 3, the Framework was

developed through a process that included a comprehensive desktop review and analysis of injury prevention evidence, in-

depth engagement with a National Steering Committee, a situational analysis of existing prevention responses, consultation

and dialogue with experts in injury prevention, and consultations with the technical advisors to lead Government ministries and

departments. Figure 2 below illustrates the key foci, outcomes and recommendations that emerged from each component of

the process of building the Framework.

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Figure 2. The generation of injury prevention recommendations

Desktop review and analysis of

evidence

National Steering Committee consultations

Situational analysis

Stakeholder consultations

Departmental technical liaison

• Strategic guidance • Identification of Government programmes

• Prioritisation of evidence-‐led interventions

• Sourcing of documentation

• Existing South African policies and prevention programmes

• Review of existing prevention responses and identification of gaps

• Expert opinions: • Priority areas for strategic framework

• What works • Service delivery gaps and priorities)

i) Magnitude: 15 900 homicides, 13 800 road fatalities, 66 200 sexual offenses, 7 500 suicides ii) Cross-‐ cutting factors: e.g. gender inequality and dominant masculinity, alcohol and drugs • Injury specific factors: e.g. to traffic injury: speeding, seatbelt use iii) Interventions: e.g. for male violence prevention: responsible fatherhood interventions; conflict resolution skills

• Review of factors to enable Framework implementation, including:

• Intervention suitability • Resources • Capacity

• Strategic guidance: endorsed Framework vision, and oversight to development processes

• Government programmes: e.g. DOH Brother for Life Programme; SAPS and DOJ&CD Victim Empowerment Programme

• Interventions: promotion of evidence-‐led interventions for integration into Government initiatives

• Priority Framework areas: cross cutting risk factors; injury type specific risk factors; and systemic or institutional enablers

• What works: evidence -‐led programmes, within public health approach to implementation

• Service delivery gaps: emphasis on institutional arrangements, e.g. integration of police, judges in existing gender violence prevention legislation

• South African policies: e.g. for child abuse prevention: the Children’s Act; Safety Regulations for Schools

• SA Programmes: e.g. for violence prevention: SRSA’s ‘Sport for Peace’ Programme

• Existing responses: identified 71 policy-‐related documents, 35 existing programmes

Process Scope and focus Outcomes and recommendations

STRATEGIC FRAMEW

ORK

• Magnitude and main types of injury • Cross-‐cutting and injury-‐specific risk

and protective factors • Consequences and impact of injury • South African evidence-‐led

prevention interventions • International evidence-‐led

prevention interventions

• Departmental implementation plans that focus on:

• Outcome(s) • Strategies • Interventions • Action steps • Lead agency and main responsibilities • Partner agencies and main responsibilities • Resource implications

• Magnitude: 15 900 homicides, 13 800 road fatalities, 66 200 sexual offenses, 7 500 suicides• Cross- cutting factors: e.g. gender inequality and dominant masculinity, alcohol and drugs• Injury specific factors: e.g. to traffic injury: speeding, seatbelt use• Interventions: e.g. for male violence prevention: responsible fatherhood interventions; conflict resolution skills

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The desktop review, which included the analysis of both international and national publications, focused on the magnitude

and manifestations of injury, contributing risk and protective factors, societal drivers and cross-cutting influences, the

consequences of the injury burden, and evidence-led responses to injury . The National Steering Committee , constituting

a multi-sectoral body, provided strategic guidance to the project team, assisted the prioritisation of evidence-led practices,

helped identify existing Government key programmes and initiatives, and helped source Government and departmental

documentation for the situational analysis. The situational analysis involved identifying existing departmental policies and

programmes intended to directly or indirectly prevent injuries, and a review of existing legislative acts, amendments, policies,

white papers, green papers, notices, and programme-related documents. The analysis yielded a total of 71 policy-related

documents and 35 existing programmes within lead Government departments. Stakeholder consultations , representing the

public, private, NGO, CBO and Governmental sector, contributed towards identifying key gaps with regard to immediate service-

delivery priorities and priority areas for action. Finally, a departmental technical liaison process involved in-depth discussions

with key technical advisors from key Government departments. These in-depth consultations focused on implementation and

associated issues, such as resources, capacity, and suitability, that may either enable or hinder the implementation of the

Framework.

Drawing out key areas for action

This process of consultation helped delineate certain priority injuries and risks as well as areas for action. In summary, the

consultation process and desk top review suggested the following:

1. Prioritise and invest in order to reduce priority cross-cutting risk factors such as poverty and socio-economic

inequality, poor infrastructure and service delivery, gender inequality and dominant masculinity, and alcohol and

drug abuse.

2. Target risks specific to the priority injury types.

3. The main recommended areas of focus for injury prevention are:

• male interpersonal violence

• intimate partner violence

• child abuse

• traffic injuries

• suicide

• unintentional injuries arising from fires and scalds, drowning, poisoning and falls.

1 The review investigated the evidence-base specifically for the prevention of injuries due to male interpersonal violence, intimate partner violence, child abuse,

suicide, traffic, burns, falls, drowning and poisoning. These are documented in An Empirical Case for the Prevention of Injury in South Africa (2011), and available

from the National DOH.2 The Steering Committee comprised senior officials from the Human Development Cluster (Health, Social Development, Education and Transport), the Criminal

Justice Cluster (Police, Justice, Correctional Services and Social Development), and others, including Human Settlements and Trade and Industry. 3 A detailed consultation process involved engagements with subject specialists on child abuse, intimate partner violence, interpersonal male violence, traffic,

leadership priorities, data collection and policy advocacy. There were 12 focus group meetings in Cape Town and Pretoria, with a total of 125 participants

representing 43 organisations.

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4. Promote institutional environments that support prevention.

5. Leverage existing data systems, such as the National Injury Mortality Surveillance System, and encourage

additional non-fatal surveillance systems to guide and monitor the implementation of the Framework.

6. Utilise the Framework as a platform to facilitate departmental injury prevention operational and implementation

plans.

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South Africa has one of the highest levels of death and disability from injuries (14). In 2010, for example, approximately 15 900

homicides (13), 13 800 road fatalities (15), and 66 200 sexual offences were reported (13). Annually, there is an estimated

7 500 suicides (19), while unintentional injury mortality due to fires, drowning, falls and poisoning comprise 12% of all injury

deaths in the country. Injuries are the second largest contributor, after HIV/AIDS, to South Africa’s burden of disease, and

are driven by intentional injuries due to interpersonal violence and road traffic injuries, followed by fires, drowning, falls and

poisoning (see Figure 3).

2. BURDEN OF INJURIES

Figure 3. Leading types of injury mortality in South Africa

Murder affects not only direct victims, but also the parents, community and perpetrator

In Gugulethu in October 2011, a 20-year-old man was accused of

killing a 3-year-old boy. Local authorities reported that the young boy

was brutally murdered and placed in a suitcase. Provincial task team

co-ordinator for the ANC Women’s League pleaded, ‘We are asking our communities to remember that you

must be aware of your neighbour’s child as if she or he is your own.’ The mother of the boy, distraught with

grief, fainted when she found her son’s lifeless body. A community plagued with violence now seeks revenge

and awaits the accused’s trial. This is an example of the high levels of child homicide. The SAPS reported

906 murder cases against children under 18 in 2010/2011 (13). It is hard to quantify the broader impact

of the murder of a child, as it is of any individual. Besides the heartache of the mother and the anger of the

community, this case embodies that murder not only affects the victim whose life is cut short, but also the

parents, public and perpetrator.

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South Africa has one of the highest levels of death and disability from injuries (14). In 2010, for example, approximately 15 900

homicides (13), 13 800 road fatalities (15), and 66 200 sexual offences were reported (13). Annually, there is an estimated

7 500 suicides (19), while unintentional injury mortality due to fires, drowning, falls and poisoning comprise 12% of all injury

deaths in the country. Injuries are the second largest contributor, after HIV/AIDS, to South Africa’s burden of disease, and

are driven by intentional injuries due to interpersonal violence and road traffic injuries, followed by fires, drowning, falls and

poisoning (see Figure 3).

2. BURDEN OF INJURIES

Figure 3. Leading types of injury mortality in South Africa

War0%

Other6.2% Road Traffic Injuries

26.7%

Poisoning1.1%

Falls1.7%

Fires6.9%

Drowning2.3%

Self-inflectedviolence

9%

Interpersonalviolence

46%

Murder affects not only direct victims, but also the parents, community and perpetrator

In Gugulethu in October 2011, a 20-year-old man was accused of

killing a 3-year-old boy. Local authorities reported that the young boy

was brutally murdered and placed in a suitcase. Provincial task team

co-ordinator for the ANC Women’s League pleaded, ‘We are asking our communities to remember that you

must be aware of your neighbour’s child as if she or he is your own.’ The mother of the boy, distraught with

grief, fainted when she found her son’s lifeless body. A community plagued with violence now seeks revenge

and awaits the accused’s trial. This is an example of the high levels of child homicide. The SAPS reported

906 murder cases against children under 18 in 2010/2011 (13). It is hard to quantify the broader impact

of the murder of a child, as it is of any individual. Besides the heartache of the mother and the anger of the

community, this case embodies that murder not only affects the victim whose life is cut short, but also the

parents, public and perpetrator.

[Source (11): Norman, Matzopoulos, Groenewald, & Bradshaw, 2007]

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There have been recent significant decreases in homicide (5,3% per annum), but information on other forms of violence, in

particular forms of gender-based violence, remains unclear or has increased (13). A small increase (<1%) in traffic mortality

was recorded for 2010 (15). These high injury mortality and morbidity rates contribute a disproportionate amount to South

Africa’s injury and overall disease burden. Figure 4 provides an indication of the elevated Disability Adjusted Life Years (DALYs:

a measure of the overall disease burden, expressed as the number of years lost due to ill-health, disability or early death)

sustained by South Africa compared to the African region and other WHO regions. There is also a substantial burden of non-

fatal injuries in South Africa, with an estimated 3,5 million people annually seeking health care from a range of providers,

one-half of which are for treatment for violent injuries and suffering (16, 17). A considerable proportion of this burden is due

to sexual violence.

Box 1: Extent of premature non-natural injury mortality and morbidity in South Africa

South Africa’s injury death rate is driven primarily by injuries due to violence and traffic-related incidents.

• There were an estimated 59 935 injury fatalities in 2000.

• There was an overall injury death rate of 158 per 100 000.

• This death rate is higher than the African average and twice the global average.

• The rates are driven by interpersonal violence, which contributes 46% of all injury deaths in South Africa.

• The road traffic mortality rate of 40 per 100 000 is 26% higher than the aggregate for the African region and

nearly double the global rate.

• The burn mortality rate of 8,5 per 100 000 is greater than the world average of 5 per 100 000, and the African

Region average of 6 per 100 000.

• Injuries occur primarily in homes, roads and public spaces; but also in high-risk occupational settings. In 2001,

there were, for example, 301 mining-related fatalities.

• Over a lifetime, up to 75% of South Africans experience at least one traumatic event.

• Annually, 3,5 million people seek health care for injuries, one-half of which are for the treatment for violence

related injuries.

• There were over 36 000 rapes of women and girls reported to the police in 2010/2011.

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Figure 4. South Africa’s DALYs compared to other WHO regions

[Source (11): Norman, Matzopoulos, Groenewald, & Bradshaw, 2007]

Different types of violence and trauma are interlinkedIn Bloemfontein, in April 2011, a policeman shot his girlfriend and her two children (aged 9 and 5 years), before turning the

gun on himself. This horrific murder-suicide claimed four lives leaving countless more forever affected; especially the two

surviving children who now live without their mother and siblings. ‘This policeman was on medication, anti-depressants,

yet they still let him keep his service weapon’, the biological father of the deceased children said (18). This story is but one

example of the many cases of homicide-suicide (specifically femicide-suicide) in South Africa, which has one of the highest

femicide-suicide rates in the world. A national study on female homicide reported that 8,8 per 100 000 women aged 14

years or older are victims of intimate partner-femicide. 8–11% of all non natural deaths in South Africa are due to suicide,

and for every fatal suicide, there are at least 20 attempted suicides (19). The causes and consequences of femicide-suicide

are inter-related, indicating the relationships between different types of violence and trauma as well as their wide impact.

The case shows, amongst other things, the interconnections between guns, mental health, gender norms, masculinity, family

disruptions and the vulnerability of children in unsafe contexts. Once again, it is hard to calculate the broader impact of the

case.

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IMPACT OF INJURIES

Violence and fear of violence exacerbates health disparities and worsens health outcomes. The 2011 Global Study on

Homicide indicates that young people exposed to violence as a victim or witness are at significantly higher risk for post-

traumatic stress disorder (PTSD), major depressive episodes, and substance abuse and dependence. For example, 77% of

children exposed to a school shooting and 35% of urban youth exposed to community violence develop PTSD, far higher than

that of soldiers deployed to combat areas in the past six years (20%) (20).

The extent of disability and suffering as a result of injuries is extensive. For example, for every fatal motor-vehicle accident,

four crash survivors suffer from brain injuries (21). Many others are hospitalised for less severe but debilitating injuries (22).

There are more than 200 000 traffic crashes in South Africa every year. At a social level, the threat and occurrence of injuries

produce a sense of persisting panic, and undermine social cohesion and the country’s overall socio-economic developmental

trajectory. The burden of injury has a considerable draining effect on the economy, particularly during a recession. Direct

economic costs are evident in the elevated DALYs reported for South Africa, and the resulting medical care and rehabilitation

costs faced by people and the supportive state structures, including the extensive policing (180 000 police staff) and private

security (estimated at 450 000 security staff) required. Other costs pertain, for example, to the acquisition of security

equipment (burglar bars, guard dogs and alarms). The total medical costs for violent injuries is estimated at R4,7 billion (23),

while the total costs of traffic crashes and injuries are estimated at R110 billion to the South African economy (24). The injury-

related costs of alcohol misuse are estimated to be twice the amount received in excise duties for alcohol (25).

Box 2: Injury consequences

• Exposure to violence poses a greater risk for a range of social and health problems, including ischemic heart

disease (2,2 times), cancer (1,9 times), stroke (2,4 times), chronic obstructive lung disease (3,9 times), diabetes

(1,6 times) and hepatitis (2,4 times).

• There are more than 200 000 traffic crashes in South Africa every year. For every road traffic fatality (14 000 in

2010) there is an estimated four crash survivors with brain injuries.

At a social level, the threat and occurrence of injuries produce a sense of persisting panic and undermine social cohesion, and

the country’s overall socio-economic developmental trajectory.

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Side Panel: South Africa’s high number of transport-‐related injuries There are more than 200 000 traffic crashes in South Africa every year, many of which are fatal and which have profound consequences. In August 2011, a 32-‐seater bus was used to transport 58 school children to school in Knysna. The driver of the bus lost control, sending the bus plunging into a dam. The driver and 14 school children were killed; the remaining 44 children were injured. The Minister of Transport Sibusiso Ndebele said in a statement ‘We cannot go on like this. This horrific road crash in Knysna … is yet again an unnecessary loss of lives’ (Error! Reference source not found.).

South Africa’s high number of transport-related injuries

There are more than 200 000 traffic crashes in South Africa

every year, many of which are fatal and which have profound

consequences. In August 2011, a 32-seater bus was used to

transport 58 school children to school in Knysna. The driver of the

bus lost control, sending the bus plunging into a dam. The driver and

14 school children were killed; the remaining 44 children were injured. The Minister of Transport Sibusiso Ndebele said in a

statement ‘We cannot go on like this. This horrific road crash in Knysna … is yet again an unnecessary loss of lives’ (26).

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Following the prevention orientation of the World Health Organization and other international agencies, the Strategic

Framework is informed by the public health perspective. The value of the public health perspective lies in its emphasis on

multi-disciplinary and inter-sectoral action, the modification or elimination of certain causal factors, and scientific logic. The

public health approach is population-based, evidence-based and focused on prevention (see Box 3).

The public health approach provides a four-step logic that proceeds from identifying the extent of the problem and its risk

factors, to identifying and implementing effective prevention interventions (see Figure 5).

3. APPROACH, KEY CONCEPTS AND PRINCIPLES

Figure 5. Public health approach: Four interconnected phases linking data to action

[Source (27): Hammond, Haegerich & Saul, 2009]

Box 3: The public health approach to injury prevention

• Population-based: Targets the safety or health of, and extends better care to, whole populations.

• Multi-disciplinary: Draws on knowledge from many disciplines including medicine, epidemiology, engineering,

sociology, psychology, criminology, education and economics, to promote health and safety.

• Evidence-led: Based on scientific methods, it draws on empirically produced evidence to plan, implement and

evaluate services.

• Inter-sectoral collaboration: It emphasises collective action with cooperative efforts from such diverse sectors as

health, education, social services, justice and policy.

• Prevention: The approach emphasises prevention. Its starting point is that injury events and violent behaviour, and

their consequences, can be prevented and controlled.

Implement Intervention/and Measure Prevention Effectiveness

• Community Intervention/ Demonstration Programs• Training• Public Awaerness

Develop and Test Interventions

• Evaluation Research

Identify Causes

• Risk Factor Identification

Problem Response

Define the Problem

• Data Collection/ Surveilance

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The public health approach typically incorporates an ecological perspective in order to understand the causes of injury. The

ecological perspective, which strongly influences many other public health policies (for example, the WHO World Report

on Violence and Health, 2002), emphasises the importance of focusing on all levels of the system, including individual,

relationship, community and social components. The ecological perspective allows for a holistic understanding of injury

causes and simultaneously enables comprehensive evidence-led prevention actions (see Figure 6).

Within this perspective, the prevention of injury and the promotion of safety occur by:

• implementing evidence-based interventions

• targeting individuals and their multiple environments

• co-ordinating intervention efforts

• collaboration among identified stakeholders across sectors.

Such interventions have in general been conceptualised according to a range of key principles. Interventions may be focused

on different points along the injury continuum (pre-event, event and post-event), different groups (universal, selected or

indicated), and various strategies (environmental, engineering, education, enforcement and evaluation). These are outlined in

Box 4.

[Source (1): Butchart, Phinney, Check & Villaveces, 2004]

Figure 6. Ecological model with risk factors for intentional injury

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Box 4: Organising intervention activities

• Primary, secondary and tertiary prevention

Primary prevention focuses on preventing injury before it occurs (pre-event). This is a priority for South Africa because of the

relative lack of such measures. Secondary prevention includes the immediate responses once an injury has occurred (event).

These include pre-hospital care, emergency medical care for physical trauma and shelter services. Tertiary prevention focuses

on rehabilitation and reconciliation, with related services including individual and family counselling (post event).

• Universal, selected and indicated groups

Interventions may be directed at the general population or specifically affected sub-sets. Universal interventions target the

general population without considering any specific risk groups. These may include, for example, public campaigns directed at

entire communities for safe pedestrian behaviour when crossing roads, the magnitude of injuries, or conflict resolution training

for all high school children. Selected interventions are those that target groups shown to be specifically at risk of injury, for

example, home visits for marginalised families with young children at risk of household injury. Indicated interventions are

aimed at groups who have already been exposed to injury, either as perpetrators or survivors. These interventions may include

gender sensitisation training for perpetrators of intimate partner violence (2).

• Strategies

Environmental modifications focus on modifying the physical environment, for example, separating transport pathways for

vehicles and vulnerable road users. Engineering is directed at enhancing the safety of equipment, for example, stoves.

Education involves the provision of training and information to improve safety. Enforcement focuses on all interventions that

enforce safety legislation. Evaluation provides information to determine injury priorities and which prevention interventions

work.

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4. THE STRATEGIC FRAMEWORK

Figure 7: Integrated Strategic Framework for the Prevention of Injury and Violence

in South Africa, 2012–2016

KEY ACTION AREAS

PURPOSE

VISION

Integrated Strategic Framework for the Prevention of Injury and Violence in South Africa, 2012-2016

(1) Reduce injuries by targeting

priority cross cutting risk factors

To promote injury prevention and safety through focused actions that reduce injuries by targeting:

1. priority cross-cutting risk factors2. risks specific to the different injury priorities

3. supportive institutional and organisational environments.

A safe and peaceful South Africa, conducive to physical, mental and social well-being

Objective 1


injuries

Objective 5




Objective 9


lead agencies

Objective 2




severity

Objective 6




Objective 10



Objective 3


and norms

Objective 7




Objective 11




Objective 4


Objective 8




incidents

Objective 12




(2) Reduce risks specific to the

different injury priorities

(3)Facilitate supportive

institutional and organisational environments





RISK FACTORS

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VISION

A safe and peaceful South Africa that is conducive to physical, mental and social well-being

This vision:

• arises from the recognition that injury is a major contributor to premature death, disability, and harm

• emphasises preventing injuries before they occur

• emphasises changing the social, behavioural and environmental factors that cause injury

• makes science integral to identifying effective policies and programmes

• integrates the efforts of diverse scientific disciplines, organisations and communities

• implies that the combined participation of Government and all South Africans is essential for successful and

sustained prevention efforts at all levels of society.

PURPOSE

To promote injury prevention and safety through focused actions that reduce injuries by targeting:

• priority cross-cutting risk factors

• risks specific to the different injury priorities

• supportive institutional and organisational environments.

AN INTER-SECTORAL ACTION PLAN: PRIORITY AREAS FOR ACTION

The Strategic Framework, following its purpose, is directed at three major action areas:

1. Reducing priority cross-cutting injury risk factors, namely those factors that affect more than one injury type

2. Reducing risks specific to the different injury types

3. Facilitating supportive institutional and organisational environments

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Evidence relevant to Objective 1

Socio-economic inequalities are strong positive predictors of rates of injury, including homicides and major assaults, and

traffic and burn fatalities. After income inequality, unemployment, particularly male youth unemployment, is a consistent

correlate of these injuries. In South Africa, over one-quarter of the population are unemployed, and the richest 10% of

households earn nearly 40 times more than the poorest 50% (see Table 1 below).

Objective 1 proposes the promotion of selected poverty alleviation measures targeting groups at risk for injury. The main

outcome of this objective is prioritised targeted job creation, particularly among groups that report high rates of injury.

This includes single parent households and youth. The lead agency would be the Economic Development Department, with

participating agencies such as the Department of Labour, Department of Provincial and Local Government, South African Local

Government Association and Treasury.

PRIORITY AREA 1: REDUCE INJURIES BY TARGETING PRIORITY CROSS-CUTTING RISK FACTORS

As indicated in the graphic below, Priority Area 1 has four objectives, all of which are intended to reduce the risk for and

impact of injuries.

Table 1: Poverty and socio-economic inequality

Objective 1


injuries

Objective 2




severity

Objective 3


and norms

Objective 4



RISK FACTORS

Extent and evidence of contribution to injury

CCo-occurring Factors SA strategies Key recommendations Recommended service delivery priorities

• 25,7% of population unemployed

• Richest 10% of households earn 40 times more than poorest 50%

• 22% of population below the R283/month poverty line

• High proportion of burns, traffic and violent injury in low-income settings

• Underdeveloped infrastructure

• Poor housing conditions; overcrowding

• Unemployment

• Expanded Public Works Programme (EPWP)

• Men at the Side of the Road Initiative (MSR)

• Prioritise targeted job creation, i.e. most vulnerable to injury

• Introduce targeted skills development and employment strategy for priority unemployed groups

• Sustainable work opportunities and assistance to vulnerable households, e.g. unemployed single parent households

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Infrastructural barriers to effective service delivery in South Africa include cost and affordability issues, affordable transport,

access to facilities, and the quality of services (28). Communities with the most impoverished housing, roads and community

structures suffer particular social and economic disadvantages (29). Cost, accessibility and quality of South Africa’s health

infrastructure, in particular, are directly related to injury mortality and severity. Trauma care in South Africa, with the exception

of a few areas of excellence, has been reported as being largely poorly planned, coordinated and resourced (30). Inequalities

are further manifested by quality of trauma care. For example, over 60% of Priority 1 calls are responded to within 15 minutes

in Cape Town by the Metro EMS, while in the Eastern Cape, one service responded to only 3,3% of all calls within one hour

(31).

Objective 1

Promote selected poverty alleviation measures targeting groups at risk for injuries

Outcome

Strategy1

Intervention

Lead agency: Partners

Examples

a) Prioritised targeted job opportunities

• Targeted skills development and employment strategy for priority unemployed groups

• Develop/implement targeted skills development and employment interventions for single parent households and youth in high injury settings

EDD: DPW, DPLG/ SALGA, Treasury

South Africa Men at the Side of the Road Initiative http://www.msr.org.za/ International Baltimore Empowerment Zone: 1994-‐2004 http://www.ebmc.org/home/documents/EBMC%20Job%20Creation0905.pdf

• Sustainable work opportunities and assistance to vulnerable households and communities

• Scale up dedicated work opportunities and assistance to vulnerable households and high injury communities

EDD: DPLG/ SALGA, DPW

South Africa Expanded Public Works Programme (EPWP) International KATA -‐Konbit ak Tèt Ansanm http://www.usaid.gov/ht/docs/ps/kata_fact_sheet_final.pdf

1 Prevention interventions are colour coded according to the primary, secondary, tertiary prevention (see Glossary on p. vi), or multiple emphases of the recommended prevention, as follows: Primary Secondary Tertiary A combination of two or

more types

Objective 1


Outcome

Strategy1

Intervention


Examples











more types

Objective 1


Outcome

Strategy1

Intervention


Examples











more types

Objective 1


Outcome

Strategy1

Intervention


Examples











more types

1The Framework would require Government to engage business, broader civil society sectors including NGOs, and CBOs, the tertiary education sector, and

research institutions for successful and co-ordinated implementation.

2Prevention interventions are colour coded according to the primary, secondary, tertiary prevention (see Glossary on p. vi), or multiple emphases of the

recommended prevention, as follows:

Objective 1


Outcome

Strategy1

Intervention


Examples











more types

1.1 South AfricaMen at the Side of the Road Initiative http://www.msr.org.za/InternationalBaltimore Empowerment Zone: 1994-2004http://www.ebmc.org/home/documents/EBMC%20Job%20Creation0905.pdf

South AfricaExpanded Public Works Programme (EPWP)InternationalKATA -Konbit ak Tèt Ansanmhttp://www.usaid.gov/ht/docs/ps/kata_fact_sheet_final.pdf

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Objective 2 proposes the promotion of selected general and health-specific infrastructure and services to reduce the risks for

injuries and contain injury severity.

The main outcomes of this objective are to:

(1) enhance health infrastructure and services to promote safety

(2) enhance neighbourhood, home and transport infrastructure so that it is conducive to greater safety.

The lead agency for the first outcome would be the Department of Health, with participating agencies including Treasury,

and for the second outcome, it would be the Department of Public Works, with participating agencies including Treasury,

the Department of Transport, Department of Provincial and Local Government, and the South African Local Government

Association.

Table 2. Poor infrastructure and service delivery



• Trauma care, with few exceptions, poorly planned, coordinated and resourced

• Significant indication of ‘preventable’ mortality

• Delays of quality care because of multiple health system transfers contribute to higher, more severe injuries

• Uneven distribution of resources and skills

• Low rates of public medical practitioner and hospital beds

• Strengthen sub-district health management teams capacity for service delivery

• Increase resources to infrastructure and services to promote safety

• Enhance monitoring and evaluation

• Appropriate clinical and referral protocols

• Prioritise development of quality health infrastructure

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Objective 2

Promote selected health, road and residential infrastructure and services to reduce the risks for injuries and contain injury severity

Outcome

Strategy

Intervention


Examples

2.1 Enhanced health infrastructure and services that promote safety

i) Improve EMS access to injury prone areas

ii) Implement dedicated national emergency number and system

DOH South Africa Medical Emergency Transport and Rescue (METRO) http://www.westerncape.gov.za/eng/directories/services/11498/6299 International 9-‐1-‐1 Services http://transition.fcc.gov/pshs/services/911-‐services/

• Adjust ambulance and paramedic provision and training to prioritise high injury catchment areas

DOH: Treasury

South Africa ‘The Golden Hour’ – Trauma And Acute Care http://www.transport.gov.za/library/docs/raf/s12-‐29.pdf International Trauma care quality improvement http://www.who.int/violence_injury_prevention/capacitybuilding/courses/trauma_quality/en/index.html

• Review and develop trauma referral protocols and guidelines for first paramedics at scene

DOH: Treasury

South Africa ‘The Golden Hour’ – Trauma And Acute Care http://www.transport.gov.za/library/docs/raf/s12-‐29.pdf International Trauma care system planning and management http://www.who.int/violence_injury_prevention/capacitybuilding/courses/trauma_care/en/index.html

2.2 Neighbourhood, home and transport infrastructure conducive to greater safety

• Prioritise electrification for injury prone areas

• Identification and provision of electrification infrastructure and services in high-‐injury neighbourhoods and recreational settings

DPW: DPLG/ SALGA, Treasury

South Africa Eskom rural development http://financialresults.co.za/2011/eskom_ar2011/eskom_foundation2011/rural_development.php International Rural Electrification Corporation Limited http://recindia.nic.in/

Dedicated pathways and lanes for vulnerable road users

• Identification and development of road user transport corridors and services

DPW: DOT

South Africa Empowerment Impact Assessment (EmpIA) http://www.nra.co.za/live/content.php?Item_ID=43 International Safety of vulnerable road users http://www.oecd.org/dataoecd/24/4/2103492.pdf.

Objective 2


Outcome

Strategy

Intervention


Examples






DOH: Treasury



DOH: Treasury









DPW: DOT


Objective 2


Outcome

Strategy

Intervention


Examples






DOH: Treasury



DOH: Treasury









DPW: DOT


Objective 2


Outcome

Strategy

Intervention


Examples






DOH: Treasury



DOH: Treasury









DPW: DOT


• Improve EMS access to injury prone areas

• Implement dedicated national emergency number and system

South AfricaMedical Emergency Transport and Rescue (METRO)http://www.westerncape.gov.za/eng/directories/services/11498/6299International9-1-1 Serviceshttp://transition.fcc.gov/pshs/services/911-services/

South Africa‘The Golden Hour’ – Trauma And Acute Carehttp://www.transport.gov.za/library/docs/raf/s12-29.pdfInternationalTrauma care quality improvementhttp://www.who.int/violence_injury_prevention/capacitybuilding/courses/trauma_quality/en/index.html

South Africa‘The Golden Hour’ – Trauma And Acute Carehttp://www.transport.gov.za/library/docs/raf/s12-29.pdfInternationalTrauma care system planning and managementhttp://www.who.int/violence_injury_prevention/capacitybuilding/courses/trauma_care/en/index.html

South AfricaEskom rural developmenthttp://financialresults.co.za/2011/eskom_ar2011/eskom_foundation2011/rural_development.phpInternationalRural Electrification Corporation Limitedhttp://recindia.nic.in/

South AfricaEmpowerment Impact Assessment (EmpIA)http://www.nra.co.za/live/content.php?Item_ID=43InternationalSafety of vulnerable road usershttp://www.oecd.org/dataoecd/24/4/2103492.pdf.

•

•

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21

Evidence relevant to indicated Objective 3

Gender inequality is a strong positive predictor of injury, especially fatal injuries due to violence, traffic crashes, burns and

drowning. A dominant feature of the patterns of fatal injury is that the overwhelming majority of victims are men. Both men

and women are victims of violence, with 25% of adult women reporting physical violence at some point in their lives. Young

men are the overwhelming majority of perpetrators. The vulnerability of men to sustaining injuries and their involvement in

causing injuries is attributed to the dominant constructions of masculinity, which are based on a gender hierarchy. See Table 3

Objective 3 focuses on the facilitation of equitable gender relationships and norms to reduce the impact of gender inequality

and dominant masculinity norms on injury.


(1) promote cultural and social norms that support gender equality and positive masculinity

(2) strengthen safe and nurturing relationships between children and caregivers.

The lead agencies involved would be, for the first outcome, the Department of Social Development and Department of Women,

Children and People with Disabilities, and for the second outcome, the Departments of Social Development, Health and Basic

Education. Participating agencies include the Commission of Gender Equality, the Department of Justice and Constitutional

Development, and the South African Police Service.

Table 3. Gender inequality and dominant masculinity norms



• Majority of fatal injuries due to violence, traffic crashes, burns and drowning to young men

• Lifetime prevalence of 25% among adult women

• 40% of men disclose having been physically violent to a partner

• Patriarchal norms

• Poverty and unemployment

• Absence of fathers in child rearing

• Violence to affirm identity as males

• Normalisation of aggression

• The Domestic Violence Act No. 1 16 of 1998

• Sexual Offences and Related Matters Act

• Maternal Child and Women’s Health Policy

• Gender policy statement: Balancing the scale of justice through gender equality 1999

• Programmes: Brothers for Life

• Promoting cultural and social norms that support gender equality and positive masculinity

• Strengthen safe and nurturing relationships between children and caregivers

• Strengthen national policies and legislation aimed at improving status of women

• Establish communication strategy to promote human rights and gender equality

• Implement evidence-led programmes that address gender stereotypes and promote gender equality and positive masculinity

• Strengthen evidence-led programmes and services for families at risk, to enhance parenting skills and promote positive fatherhood

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22

Objective 3

Facilitate equitable gender relationships and norms

Outcome Strategy Intervention Lead agency:

Partners

Examples

3.1 Strengthened cultural

and social norms that

support gender equality

and positive masculinity

• Strengthen national

policies and legislation

aimed at improving the

status of women.

• Inter-Ministerial Committee

to review, promote and monitor

the implementation of national

policies and legislation

DWCPD/ GCIS:

Commission of

Gender Equality

(CGE), DOH, NPA

South Africa

Promotion of Equality

and Prevention of Unfair

Discrimination Act http://www.

acts.co.za/prom_of_equality/

whnjs.htm

International

Gender equality in Australia’s

aid programme – why and how

(2007)

http://www.ausaid.gov.au/

publications/pdf/gender_policy.

pdf

• Establish a communication

strategy, including

leadership messages to

promote human rights and

social norms that support

gender equality within an

equal, gendered

perspective

• Inter-Ministerial Committee to

develop, implement and

monitor communication

strategy

DSD/

DOJ&CD: CGE

South Africa

Commission for Gender Equality

http://www.cge.org.za/

International

Regional Framework for Action

on Injury and Violence Prevention

2008-2013

http://www.wpro.who.int/

internet/resources.ashx/MNH/

injuries_prevention/2008/Regio

nal+Framework+for+Action+V

IP2008-13.pdf

• Establish a communication

strategy, including

leadership messages to

promote social norms that

support masculinity

• Inter-Ministerial Committee to

develop, implement and

monitor communication

strategy

DSD:

CGE

South Africa

Sonke Gender Justice

http://www.genderjustice.org.za/

International

Gender and Access to Health

Services Study

http://www.dh.gov.uk/en/

Publicationsandstatistics/

Publications/

PublicationsPolicyAndGuidance/

DH_092042

• Develop and implement

evidence-led programmes

that address gender

stereotypes and promote

gender equality

• Implement evidence-led

programmes, prioritise

communities with highest injury

rates in each province

DSD:

CGE, DPLG, SAPS

South Africa

Stepping Stones (DOH-MRC)

International

Mentors in Violence Prevention

http://www.jacksonkatz.com/

mvp.html

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23

3.2 Safe and nurturing

relationships between

children and caregivers

• Expand and strengthen

ECD services for children

in low-income and

high-risk families and

communities

• Expand ECD registration in

high-injury communities

• Develop/implement compulsory

safety training for ECD

practitioners

DBE:

DSD, DOH, SAPS

South Africa

The Aware Parenting Institute

http://www.awareparenting.com/

southafrica.htm

International

Positive Parenting Programme

www.triplep.net/

• Strengthen and implement


and services for families

at risk



communities with highest injury

rates in each province;

prioritise young, unemployed

and single caregiver families

DSD:

DOH, SAPS

South Africa

The Aware Parenting Institute

http://www.awareparenting.com/

southafrica.htm

International

Positive Parenting Programme

www.triplep.net/

• Develop and implement


and services that enhance

parenting skills and

promote positive

fatherhood



communities with highest

injury rates

DSD:

DOH, SAPS

South Africa

CASE

http://www.case.za.org/contact.

html

International

Programme H

http://www.promundo.org.br/en/

• Strengthen PHC at facility

level and through

community health worker

support to screen, refer

and support families

at risk of injury; and

promote safe and

nurturing relationships

• Implement PHC in communities

with highest injury rates;

prioritise young, unemployed

and single caregiver families

DOH South Africa

South African Gender-based

Violence and Health Initiative

http://www.mrc.ac.za/gender/

sagbvhi.htm

International

Safer communities – Action Plan

to reduce Community violence

and sexual violence, New Zealand

2004


Alcohol, and in some parts of the country, drug abuse, are strongly associated with homicide, intimate partner violence, rape,

the abuse of children, road fatalities and other unintentional injuries such as burns and drowning. There is a deeply embedded

relationship between alcohol and injuries, with South African studies reporting two-thirds of injured patients with blood alcohol

levels above the legal (i.e. for driving) limit (32). Since 2003/2004, drug-related crime has increased by 123,0%, while driving

under the influence has increased by 148,4% (13). Thus, victims are often intoxicated, and those who are drunk often become

violent, cause death on the roads, or place themselves at risk for other injuries such as burns and drowning. This consequent

exposure to injury may in turn result in post-traumatic stress disorder, which increases the risk of further substance abuse.

South Africa has a high per capita alcohol consumption level per drinker.

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24

Objective 4 places the accent on the reduction of alcohol and drug abuse.

The main outcomes of this objective are consistent with recent South Africa legislation, and are to:

(1) harmonise legislation and policy

(2) strengthen community-based mental health and after-care services, especially in high-risk settings.

The lead agencies involved would, for the first outcome, be the Inter-Ministerial Committee on Alcohol and Substance

Abuse, and for the second outcome, the Departments of Health and Social Development. Participating agencies include

the Department of Transport, the South African Police Service, the Department of Health, and the Department of Sport and

Recreation South Africa.

Table 4. Alcohol and drug abuse

Objective 4


Outcome

Strategy

Intervention


Examples

4.1 Harmonised legislation and policy

i) Coordinate strategy to reduce the harmful use of alcohol, across all provinces

ii) Implement and monitor master plan/strategy across provinces

Inter-‐Ministerial Committee on Alcohol and Substance Abuse:

DTI, DSD DOT, SAPS, DOH

South Africa Second Biennial Substance Abuse Summit Resolutions, 2011 (DSD); International WHO, Draft global strategy to reduce the harmful use of alcohol (February, 2010)

4.2 Strengthened mental health and after-‐care services

iii) Implement and strengthen community-‐based mental health and after-‐care services, especially in high-‐risk settings

iv) Develop and expand community-‐based mental health after-‐care services in communities with the highest alcohol abuse and injury rates

DOH/DSD: SRSA, SAPS

South Africa SANCA Sinethemba Programme http://www.sancawc.co.za/uploads/files/File/sinethembareport2010.pdf International Midwestern Prevention Project http://www.promisingpractices.net/program.asp?programid=72

Objective 4


Outcome

Strategy

Intervention


Examples










DOH/DSD: SRSA, SAPS




• 2010/2011: increase of 10,2% in drug-related crime

• 2010/2011: increase of 4,5% in driving under influence of alcohol or drugs

• Strong correlation with injury

• Poverty

• Unemployment

• Widespread trauma

• 75% of South Africans experience at least one traumatic event during lifetime

• Prevention of and Treatment for Substance Abuse Act 2008

• Strategic framework on crime and drugs for Southern Africa, 2003

• National Drug Master Plan, 2012-2016

• Road Traffic Safety Management Plan for 2015

• Programmes: Arrive Alive

• Strengthen and enforce legislation and policy

• Strengthen mental health and rehabilitation services

• Implement the Second Biennial Substance Abuse Summit Resolutions, 2011 (DSD)

• Implement and strengthen community-based mental health and after care services, especially in high-risk settings.

••

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25

Objective 4


Outcome

Strategy

Intervention


Examples










DOH/DSD: SRSA, SAPS


http://www.sancawc.co.za/uploads/files/File/sinethembareport2010.pdf

••

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26

Priority Area 2 has four objectives, as indicated below, all of which are intended to reduce the risk, occurrence and impact of

priority injury types.


Men are over-represented as both perpetrators and victims of serious violence in South Africa. Mortality due to male

interpersonal violence is highest in the age group 15–29 years, with 12 880 male homicides reported in 2007, the majority

caused by firearms and sharp objects. In addition, up to 156 505 male prisoners were incarcerated in 2010, many for violent

crimes (see Table 5.1).

Objective 5




Objective 6




Objective 7




Objective 8




incidents


Downstream Factors

• Job loss

• Conflicts

• Dominant masculinity

• Substance abuse

• Weapons

• Gang violence

Extent

• 12 880 male homicides (age: 15–29; 2007)

• 156 505 male prisoners (as of 10/2010) (of total of 160 026)

SA stratergies

• National Youth Policy 2009–2014

• National Youth Development Agency (NYDA)

• Prevention of and Treatment for Substance Abuse Act 2008

• Brothers for Life Campaign

Key upstream factors

• Poverty

• Unemployment

• Inadequate housing

• Communities with reduced social capital

• Gender roles/ masculinities

Gaps

• Limited policies

• Limited interventions specific to young males

Recommended Service delivery priorities

• Mobilisation of men networks

• Targeted employment opportunities

• Responsible fatherhood interventions

• Conflict resolution skills

• Reintegration programmes in jails

• Reduce alcohol & drug availability/use

Table 5.1 Injuries and male interpersonal violence

PRIORITY AREA 2: REDUCE RISKS SPECIFIC TO THE DIFFERENT INJURY PRIORITIES

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27

Intimate partner violence is a widespread and persistent problem in South Africa, with 2 594 murders of women in

2010/2011. Many women are killed by their partners (33). SAPS reports that 66 196 sexual offences were committed against

women in 2010/2011 (13). Experts indicate that this is in all likelihood an underestimate of the true extent, which is estimated

to be 9 times greater (34) (see Table 5.2).

Table 5.2 Injuries and intimate partner violence

Child abuse is widespread in South Africa. In 2010, 906 murders and over 28 000 sexual offenses to children were reported

to the police. While child murders are declining, cases of sexual offences reported against children are increasing (see Table

5.3).

Downstream Factors

Downstream Factors

• Job loss

• Partner substance abuse

• Relationship conflicts

• Family job loss

• Family substance abuse

• Large number of children

• Young maternal age

Extent

Extent

• 1 349 women murdered by partner (1999)

• 2 594 cases of murder reported against women 18 years and older in 2010/2011

• SAPS 2010/2011: 66 196 sexual offences against women 18 years and older

• 906 murder cases reported against children under 18 in 2010/2011

• SAPS 2010/2011: 28 128 sexual offences against children under 18

SA stratergies

SA stratergies

• Domestic Violence Act 1998 (e.g. protection orders)

• Sexual Offences and Related Matters Act 2007

• Maternal, Child and Women’s Health Policy

• Victim empowerment centres

• Children’s Act

• School Safety regulations

• School sexual violence and harassment prevention guidelines

• Child Protection and Support Services Programme



• Poverty

• Communities with reduced social capital

• Inadequate housing

• Gender inequity

• Lack of education

• History of child sexual abuse and substance abuse

• Poverty

• Communities with reduced social capital Inadequate housing and community spaces

• Low family cohesion

• Child: premature birth, handicaps

Gaps

Gaps

• Multi-sectoral approach

• Targeted mental health services

• Coordinated response



• Mobilisation of women networks

• Integrated police, health and legal system responses

• Training of police, prosecutors, judges in legislation

• Strengthen screening, investigation and monitoring

• Mental health services

• Strengthen social service resources for child protection

• Family and child care interventions

• Housing and community spaces

• Reduce alcohol & drug availability/use

• Treatment and rehabilitation for addicts

Table 5.3 Injuries and child abuse

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Intimate partner violence is a widespread and persistent problem in South Africa, with 2 594 murders of women in

2010/2011. Many women are killed by their partners (33). SAPS reports that 66 196 sexual offences were committed against

women in 2010/2011 (13). Experts indicate that this is in all likelihood an underestimate of the true extent, which is estimated

to be 9 times greater (34) (see Table 5.2).

Objective 5

Facilitate comprehensive measures to prevent violence-related injuries and contain associated severity


Partners

Examples

5.1 Strengthened life

skills development

in children and

adolescents

• Identify and prioritise

schools that report a

high rate of violence,

to provide evidence-led

school-based violence

prevention programmes

• Implement evidence-

based violence

prevention programmes

in communities with the

highest violent injury

rates

DBE:

SAPS, SRSA,

NYDA

South Africa

CSVR Youth Violence Prevention Programme

http://www.csvr.org.za/

International

Violence Intervention Program (VIP)

http://www.umm.edu/shocktrauma/special_

programs/violence_prevention_program_vip.htm

• Strengthen Life

Orientation Module

• Review Life Orientation

Module and enhance

safety promotion

components

DBE

NYDA

South Africa

Planning, quality assessment and monitoring and

evaluation Branch: DBE

http://www.education.gov.za/TheDBE/

DBEStructure/BranchP/tabid/365/Default.aspx

International

The Healthy Kids Resilience and Youth

Development Module (RYDM)

http://web.me.com/michaelfurlong/HKIED/

Welcome_files/Furlong-RYDM%20Paper_CSP.pdf

• Enhance training of

social work, police,

justice officials and

health-care

professionals to support

victims of intimate

partner violence, and

child, youth and adult

victims of sexual

violence

• Implement training

for the identification,

intervention and referral

of intimate partner

violence, and child, youth

and adult victims of

sexual violence

DOH:

SAPS, DOJ&CD

South Africa

The Primary Health Care Package for South Africa

– a set of norms and standards

http://www.doh.gov.za/docs/policy/norms/full-

norms.html

International

National Consensus Guidelines on Identifying and

Responding to Domestic Violence Victimization

In Health Care Settings – US

http://www.futureswithoutviolence.org/userfiles/

file/Consensus.pdf

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29


An estimated 13 800 South Africans were reported to have been killed in road traffic crashes in 2010/2011, with most

victims being passengers and pedestrians (15). Over 200 000 injuries are estimated to occur each year (35).

Key upstream factors to road traffic crashes and injuries (RTCIs) include lack of safe walking and play areas; excessive

travel exposure endured by road users, especially in historically disadvantaged areas; high numbers of children travelling

as pedestrians in low income areas; and low levels of enforcement. The downstream factors that heighten the risk of RTCIs

are predominantly related to driver behaviour, including driving under the influence of alcohol, inappropriate and excessive

speeds, not wearing seatbelts and other restraints, aggressive road behaviours, and fatigue.

5.2 Reduced access to

firearms and weapons

• Scale up the

implementation and

enforcement of the

Firearms Control Act

of 2000

• Enforce provisions of

Act: licensing, purchase

policies, and ban on

carrying firearms in

public

SAPS: DOJ&CD,

NPA

South Africa

Firearm Control Act 2000 SAPS

http://www.westerncape.gov.za/Text/2003/

firearms_control_act_60_of_2000.pdf

International

Firearms Act (S.C. 1995, c. 39), Canada

http://laws.justice.gc.ca/eng/acts/F-11.6/

5.3 Enhanced victim

identification screening,

care and support

programmes

• Strengthen and scale up

access to child-

protection services and

screening programmes

in high-risk areas

• Scale up access to

child-protection services

and screening

programmes in

communities with the

highest violence rates

DSD South Africa/International

Inter-agency Child Protection Information

Management System (IMS)

http://childprotectionims.org/service.php?

C=admin&M=downloadLoginDocument&fil

e=8126%40Evaluation+of+IA+CP+IMS+-

+Final+Report+English.pdf

International

Global Monitoring

for Child Protection

http://www.childinfo.org/files/Global_Monitoring_

for_CP_brochure.pdf

• Strengthen and

increase access to

mental health care and

victim empowerment

programmes, including

comprehensive rape

care services

• Scale up access to

mental health care and

victim empowerment

programmes, including

comprehensive rape care

services, in communities

with the highest violence

rates

DOH/DSD South Africa

A Facilitation and Training programme to

implement the Victim Empowerment Programme

in Six stations of the South African Police Service

http://www.ipt.co.za/veprep.asp

International

Liverpool VCT, Care and Treatment (LVCT) – Post

Rape Care (PRC)

http://www.endvawnow.org/uploads/browser/

files/programme_profile_and_highlights.pdf

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Objective 6 places the focus on the facilitation of comprehensive measures to reduce road traffic-related injuries and

associated severity.


(1) target environmental speed reduction strategies

(2) prioritise driver licensing legislation and policy

(3) optimise enforcement of high-risk driving behaviours.

The lead agency for all three outcomes is the Department of Transport, in conjunction with the Department of Human

Settlements for the first outcome. Participating agencies include the South African Police.

Table 6. Traffic injury

Downstream Factors

• Alcohol

• Speeding

• Seatbelt compliance

• Aggressive road behaviours

• Driver fatigue

Extent

• 13 800 fatalities (2010/11)

• Drivers: 3 983

• Passengers: 5 205

• Pedestrians: 4 614

• Age group 5–34 (2007/8): 4 397 (29.5%)

• 219 978 injuries (2007/8)

SA stratergies

• SA Road Safety Strategy 2011–2020

• National Transport Master Plan 2050

• Public Transport Strategy

• Others: Arrive Alive, Scholar patrol, Bus Rapid Transport System, Demerit System, Taxi recapitalisation


• Infrastructure: Lack of pedestrian walkways, child play areas

• Excessive travel time: historical spatial disparities

• Child pedestrians in low-income areas

• Low levels of law enforcement

Gaps

• Pedestrian infrastructure

• Poor enforcement

• M&E for existing programmes


• Strengthen Road Safety Management capacity

• Law enforcement programmes (seatbelt use, speeding, substance abuse, aggressive driving)

• Educational campaigns targeting unsafe driver and pedestrian behaviour

• Infrastructure, of roads & for pedestrians

• Separation of pedestrians, two- wheeled, and four- wheeled vehicles

• Affordable and safe public transport

• Post-crash care

• Alcohol control measures

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Objective 6Facilitate comprehensive measures to reduce road traffic-related injuries and associated severity


Partners

Examples

6.1 Environmental

speed reduction

strategies

• Undertake targeted area-wide

traffic calming in high-risk

residential environments using

evidence-led measures

• Identify and implement traffic

calming measures in

communities with the highest

traffic injury rates

DOT/DHS: RTMC South Africa

Speed reduction of adjacent

traffic: safe demarcated

walking pathways, the use of

area-wide traffic schemes

(Bunn, Collier, Frost, Kerr,

Roberts & Wentz, 2003).

International

Global Plan for the Decade

of Action for road safety

2011-2020

http://www.who.int/roadsafety/

decade_of_action/plan/en/

6.2 Driver licensing

legislation and

policy

• Implement a graduated driver

licensing system that requires

young drivers to demonstrate

responsible driving behaviour

before obtaining a final

unrestricted license

• Develop a graduated driver

licensing system

• Pilot and fully implement a

graduated driver licensing

system

DOT:

SAPS, Government

sector

South Africa

Graduated Driver Licensing

System

http://www.saferoads.com/

drivers/drivers_gdl_qa.html

International

Learner Driver Development

Project

http://www.ectransport.gov.

za/index.php?option=com_co

ntent&view=article&id=197:

learner-driver-development-

project&catid=1:latest-news

• Expedite implementation of the

point demerit system for traffic

offences through the AARTO Act

• Implement AARTO DOT:

SAPS, Government

sector

South Africa

AARTO

http://aarto.co.za/

International

Demerit Point System, Ontario

http://www.mto.gov.on.ca/

english/dandv/driver/demerit.

shtml

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6.3 Optimised

enforcement of high

risk driving

behaviours

• Expand screening of alcohol,

speed and seatbelt use among

motorists

• Maintain 1 million stops a month

campaign

DOT: Government

sector

South Africa

Rolling Enforcement Plan,

RTMC

http://www.arrivealive.

co.za/documents/Rolling_

Enforcement_Plan_2009.pdf

International

Alcohol interlock programmes,

Sobriety Checkpoints http://

www.rta.nsw.gov.au/

roadsafety/alcoholdrugs/

interlock/index.html

• Expand the use of automated

enforcement systems, e.g. using

camera technology for speeding

• Expand use of automated

enforcement systems in road

systems with highest traffic

offense/injury rates

DOT: Government

sector

South Africa

Suggested Criteria for the

use of Fixed Speed Timing

Camera Equipment For Law

Enforcement Purposes

International

Automatic speed enforcement,

Road safety: impact of new

technologies, 2003

• Strengthen inter-departmental

protocols between DOT, SAPS

and Criminal Justice for the

efficient and timeous

prosecution of offenders

• Review inter-departmental

protocols and implement

recommendations

DOT: Government

sector

South Africa

Road Traffic Management

Corporation http://www.rtmc.

co.za/RTMC/Default.jsp

International

Traffic Management New

Zealand

http://www.

trafficmanagementnz.co.nz/

• Implement harm-reduction

programmes targeting drink

driving

• Provinces/ municipalities

to implement harm reduction

programmes

DOT: Government

sector

South Africa

Arrive Alive Campaign

http://www.arrivealive.co.za/

International

MADD Campaign to eliminate

drunk driving

http://www.madd.org/drunk-

driving/campaign/


Up to 7 500 South Africans commit suicide annually and approximately 151 600 engage in non-fatal suicidal behaviour (19).

Most suicides occur among males (80%) and most are aged from 25–34 years. Prevention priorities and strategies are listed

in Table 7.

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Objective 7 calls for the facilitation of comprehensive measures to reduce suicide-related injuries and associated severity.

The main outcomes (and lead departments) of this objective are to:

(1) build resilience and life skills in children and adolescents (Department of Basic Education)

(2) improve screening/early detection (Departments of Health and Basic Education)

(3) improve access to mental health services (Departments of Health and Social Development).

Participating agencies include the Department of Sport and Recreation South Africa.

Table 7. Suicide

Downstream Factors

• Poor problem- solving ability

• Adolescence and early adulthood

• Mood disorders

• Alcohol and drug abuse

• Exposure to diseases: chronic, injuries, cancer, HIV/AIDS

• Family environment

Extent

• 7 500 suicides annually

• 151 600 non-fatal suicidal behaviour

• Highest in age group 25–34: ±33%

• Predominantly males: ±80%

SA stratergies

• Mental Health Care Act

• Guidelines on child and youth mental health and life skills

• Programmes: Depression and Anxiety Group, Life Line, Mental Health Information Centre


• Poverty

• Unemployment

• Disillusionment with social changes

• Glorification by media

Gaps

• Action plans for implementation of policies

• Public awareness

• Media control poor

• M&E insufficient


• National data and screening

• Social and mental health services

• Evidence-led interventions for high- risk groups, including high school programmes, suicide toll-free line

• Employment opportunities to youth and the poor

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Unintentional injuries due to fires and scalding, drowning, falls and poisoning constitute a significant proportion of injury

mortality in South Africa. The risk factors range from the individual to community and societal-level risk factors, including

age and gender, alcohol intoxication, household spatial arrangements and hazards exposure, and persisting poverty. There

are a number of proven and promising interventions aimed at fires and scalding burns, drowning, falls and poisoning injury

prevention, used at an international and national level, include environmental, engineering, educational and enforcement

interventions. Specific strategies are listed in Table 8 below.

Objective 7

Facilitate comprehensive measures to reduce suicide-related injuries and associated severity

Outcome Strategy Intervention Lead agency: Partners

Examples

7.1 Enhanced

resilience and life

skills in children and

adolescents

• Incorporate resilience

module within Life

Orientation FET (10–12)

• Adjust and implement

Life Orientation FET

(10–12): Development

of Self in Society Module

within all schools

nationally

DBE South Africa

Planning, quality assessment and monitoring

and evaluation Branch: DBE

http://www.education.gov.za/TheDBE/

DBEStructure/BranchP/tabid/365/Default.

aspx

International

The Healthy Kids Resilience and Youth

Development Module (RYDM)

http://web.me.com/michaelfurlong/

HKIED/Welcome_files/Furlong-RYDM%20

Paper_CSP.pdf

7.2 Screening/ early

detection

• Implement school-based

interventions to identify

and refer learners at risk

for suicide

• Implement school-based

interventions at Grade

R, 8 and 11 to identify

learners at risk for

suicide and refer them to

appropriate mental health

services

DOH/DBE South Africa

Bishops – Suicide Prevention Policy

http://www.bishops.org.za/policies/Pastoral/

suicide.pdf

International

National Suicide Prevention

Strategy for England 2002

7.3 Improved access to

mental health

services

• Implement and strengthen

community-based mental

health services, especially

in high-risk settings

• Develop and expand

community-based mental

health primary, secondary

and tertiary prevention

services in communities

with highest suicide rates

DOH/DSD: SRSA South Africa

Cape Mental Health

http://www.capementalhealth.co.za/index.

International

Community Mental Health Services Block

Grant program

http://store.samhsa.gov/shin/content//

SMA10-4610/SMA10-4610.pdf

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Table 8.1: Unintentional injuries due to burns

Table 8.2: Unintentional injuries due to drowning



• Low socio- economic status

• House layout and materials

• Previously disadvantaged population

• Unfenced water and swimming areas

Injury type

Injury type

Burns

Drowning

SA stratergies

SA stratergies

Downstream factors

Downstream factors

• Paraffin stove legislation

• Banning of fireworks

• Electrification

• Learn to Swim Program (Swimming South Africa

• Use of paraffin home equipment

• Alcohol

• Inadequate child supervision

• Alcohol intoxication

• Not wearing life jackets, esp. male boaters

• Lack of parental supervision

Extent

Extent

• 4 000 deaths

• 1 300 children

• 2.3% of all injury deaths

• Males between 15 and 19 years

• 56% of cases involve children under 15 years

Gaps

Gaps

• Safe specifications for housing policy

• Hot water cylinder specifications

• Child garment policy

• M&E

• Drowning prevention & water safety policies & legislation

Recommended Service delivery

priorities


priorities

• Paraffin stove distribution/ enforcement

• Safe Housing Policy

• Child clothing standards

• M&E of existing initiatives

• Enforcement regarding life jacket use & alcohol use while boating

• Warnings and deterrents at unsafe bodies of water

• M&E of existing initiatives

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Table 8.3: Unintentional injuries due to falls

Table 8.4: Unintentional injuries due to poisoning

Objective 8 involves the facilitation of comprehensive measures to prevent and reduce the severity of injuries arising from

falls, burns, poisonings and water related incidents.

The main outcomes (and lead Departments) of this objective are to:

(1) develop/refine policy for safe home and recreational spaces (Department of Human Settlements, and Department of

Cooperative Governance and Traditional Affairs)

(2) subsidise safe home and recreational equipment (Department of Trade and Industry).



• Substandard housing

• Unemployment

• Poverty

• Ongoing use of lead and other risky products

• Unsafe packaging, labelling, locations & containers

Injury type

Injury type

Falls

Poisoning

SA stratergies

SA stratergies

Downstream factors

Downstream factors

• Limited

• Child-resistant lids on paraffin bottles

• Phase out of leaded petrol

• Legislation to control the use of lead in paint

• Socialisation and role expectations for boys

• Inadequate supervision

• Alcohol use

• Unsafe home/ institutional environment

• Unsafe home environments

• Limited child supervision

• Parental unemployment

Extent

Extent

• Children, especially boys under 15 years

• Elderly

• 1.1% of injury mortality

• 40 000–60 000 children suffer paraffin poisoning

Gaps

Gaps

• Research

• Legislation for children’s recreation

• Limited South African prevention interventions

• Absence of a national blood lead surveillance system & of blood lead screening programmes


priorities


priorities

• Planning and urban design

• Playgrounds of adequate safety standards

• Education to caregivers and parents

• Exercise programmes for elderly

• Mandatory safety standards

• Education campaigns

• Surveillance systems

• Source control legislation

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Objective 8

Facilitate comprehensive measures to prevent and reduce the severity of injuries arising from falls, burns, poisonings

and water-related incidents


Examples

8.1 Strengthened

policy for safe home

and recreational

spaces

• Review and strengthen the

safety specifications in the

Housing Policy

• Commission

enhancements of

safety specifications in

the Housing Policy, e.g.

specifications to enhance

overall security features

such as door locks, hot

water geysers

DHS: DTI South Africa

National Building Regulations

https://www.sabs.co.za/content/uploads/

files/SANS10400%28colour_and_

looseleaf%29.pdf

International

Good, Green, Safe and Affordable Housing –

Housing Praxis for Urban Sustainability, EU

http://urbact.eu/fileadmin/Projects/HOPUS/

outputs_media/hopus_booklet__02.pdf

• Develop and strengthen

safety specifications that

govern recreational

spaces in high-risk

settings

• Develop and strengthen

safety specifications that

govern recreational

spaces in high-risk

settings

DHS/ DCOGTA South Africa

Summary Guidelines and Standards for the

Planning of Social Facilities and Recreational

Spaces in Metropolitan Areas

http://www.csir.co.za/Built_environment/

docs/Guidelines_facilities_oct.pdf

International

Planning Policy Guidance 17: Planning for

open space, sport and recreation, UK

http://www.communities.gov.uk/documents/

planningandbuilding/pdf/ppg17.pdf

8.2 Subsidised safe

home and recreational

equipment

• Subsidise SABS approved

essential home equipment

for high-risk areas

• Implement subsidy

formula for SABS

approved essential home

equipment for high-risk

areas, including

appliances such as

stoves, hot water

cylinders and fire alarms

DTI South Africa

Compulsory specifications for non-pressure

paraffin stoves and heaters

http://www.nrcs.org.za/siteimgs/vc/VC9089.

pdf

International

Renewable Energy Bonus Scheme—Solar

Hot Water Rebate, Australia

http://www.climatechange.gov.au/

government/programs-and-rebates/solar-

hot-water.aspx

• Scale up enforcement of

the safety standards for

the distribution and

storage of paraffin

• Scale up monitoring

and enforcement of

safety standards for the

distribution and storage

of paraffin in

communities with highest

paraffin usage

DTI South Africa

Compulsory specifications for non-pressure

paraffin stoves and heaters Standards Act

http://www.nrcs.org.za/siteimgs/vc/VC9089.

pdf

International

BS 2049:1985 Specification for paraffin

lighting appliances for domestic use, UK

http://shop.bsigroup.com/ProductDetail/?p

id=000000000030175490

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Priority Area 3 has four objectives, all of which are intended to reduce the risk for injuries.


The main function of the leadership or lead agency responsible for injury prevention is to co-ordinate the input of those

involved to ensure policy and intervention implementation (2). South Africa and other countries have found it helpful to

establish multi-sectoral steering committees to share overall responsibility for policy development and implementation.

Rotating the responsibility of hosting and chairing meetings is also a good way of ensuring that each stakeholder has a role

and therefore a stake in the implementation of the policy. To work well, a multi-sectoral committee should have well-defined

working procedures and a clear plan for its implementation (2, 36). The following international examples illustrate how that

leadership is best institutionalised through relevant co-ordinating structures. South African examples of this are the National

AIDS Council and the Tobacco Control Council, while the Boras Safety Promotion Council is a good international example.

PRIORITY AREA 3: FACILITATE SUPPORTIVE INSTITUTIONAL AND ORGANISATIONAL ENVIRONMENTS

Objective 9


lead agencies

Current status and impact

• Strategic Framework (SF) will allow coordination of violence and injury prevention at high level

• Leadership spread across Departments

Objective 10



Current supportive factors

• Communication strategy between role-players

• Demarcation of roles and responsibilities

Objective 11




SA strategies

• Shared vision of the Strategic Framework mission

• Strategic Framework recognises critical inter-sectoral contributions of all stakeholders

Objective 12




Gaps/Recommendations

• High-level leadership to foster political commitment

• Institutionalisation of Strategic Framework objectives in departments

Recommended service delivery priorities

• National Steering Committee to monitor implementation of Strategic Framework

• Mandate Departments or other agencies to lead specific objectives of the Strategic Framework

• Departments to fund from existing budgets; Treasury to supplement



Table 9. Effective leadership by lead agencies

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39

Objective 9 promotes effective leadership across lead agencies. The main outcome of this goal is the effective implementation

of the injury prevention strategy through effective leadership. The National DOH is a key agency in providing leadership,

with examples from Australia and New Zealand showing that when a Health Department coordinates and provides an

administrative hub for the overall implementation strategy, the Strategic Framework is likely to succeed. Each participating

department would take responsibility for implementing Objective 9 amongst its own structures.


Given the range of causes of and solutions to injury problems, stakeholders in any prevention effort should represent many

sectors and disciplines. All agencies, whether they have a leadership role or not, will need to contribute to the success of the

injury prevention strategy. This has been demonstrated across previous successful international injury prevention interventions

(2). Both Government departments and civil society partners are typically required to:

• create greater awareness of injury issues in their realm of influence

• demonstrate greater involvement in partnerships that promote effective injury prevention and safety promotion

strategies

• participate in opportunities to capacitate themselves to prevent injuries, for example, by training at undergraduate

and graduate levels, ongoing job skills development, networking, and building information resources

• devote a greater portion of their business plans and budgets to injury prevention and safety promotion.

Objective 9

Promote effective leadership across lead agencies


Examples

9.1 Effective

implementation of

the injury prevention

strategy through

effective leadership

• Identify leadership to

foster political

commitment for the

implementation of the

Strategic Framework

• Mandate National

Steering Committee to

monitor and review the

implementation of the

Strategic Framework

Directors-General

of the Human

Development

Cluster: All

participating

departments

South Africa

HIV/AIDS/STD Strategic Plan for South Africa

2007-2011

International

The National Injury Prevention and Safety

Promotion Plan: 2004–2014 – Canberra

• Mandate Departments

or other agencies to

take responsibility for

the specific goals of the

Strategic Framework

Directors-General

of the Human

Development

Cluster: All

participating

departments

South Africa

National Road Safety Strategy

2011-2020

International

New Zealand Injury Prevention Strategy

2008–2011 Implementation

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All agencies, whether they have a leadership role or not, will need to contribute to the success of the injury prevention

strategy. This has been demonstrated in previous successful international injury prevention intervention.

Objective 10 calls for the promotion of inter-sectoral collaboration to enable injury prevention. The main outcome of this

objective is to promote inter-sectoral collaboration within government and with civil society. Each department participating in

the Strategic Framework would take the responsibility for implementing Objective 10 amongst its own structures.

Table 10: Intersectoral collaboration


• Violence prevention a historic responsibility of the Criminal Justice System

• Traffic injury prevention located primarily in the Department of Transport

• Many priorities already shared across Departments

• Mandate broadened with Strategic Framework


• Multiple understandings of injury prevention

• Some inter-sectoral collaboration between lead agencies in injury prevention

• Recognition of centrality of common socio-economic contributors

SA strategies

• Overall Presidency Outcomes: All spheres of Government work together to reduce poverty, underdevelopment, and marginalisation of communities

• Government mandate for injury prevention: All departments to work together


• Agreements with departments on Strategic Framework objectives, outcomes, interventions and specific actions

• Lack of effective communication strategies among lead agencies

• Levels of prevention prioritisation vary across departments


• Departments to elect internal entity to lead process and communicate with other partners

• Departments to communicate specific responsibilities to members and to other partners

• Departments to manage their role in the initiative, set internal timeframes, carry out responsibilities, and monitor and evaluate

• Departments to maintain continuous, long-term participation and provide feedback to collaborative initiative and its leadership

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Accurate, reliable data arising from optimal data systems is an essential component of initiatives targeted at sustainably

reducing injury morbidity and mortality (2). By using quality data and its analysis, programmes can appropriately anticipate

and respond to changes in injury patterns, exposure to risks and population trends. In South Africa, the National Injury

Mortality Surveillance System (NIMSS) provides the most detailed source of information on the ‘who’, ‘what’, ‘when’, ‘where’

and ‘how’ of fatal injuries, providing a strategic, operational and research platform for a range of Government ministries and

other stakeholders across the country. The key challenges to effective data collection and dissemination are managing the

vested interests of multiple stakeholders that contribute to the data and inconsistencies with surveillance data across sources

(i.e. SAPS and NIMSS). There are also limited quality evaluations of existing prevention interventions. The main gap that needs

to be addressed is that there are no linkages between various data systems. Data systems may be rendered more effective

through the automation of collection and report-generation mechanisms, as illustrated by systems used in Sweden and the

United States.

Objective 10

Promote inter-sectoral collaboration within government and with civil society


Examples

10.1 Inter-sectoral

collaboration between

departments

• Formalise agreements

with departments

and agencies on goals,

outcomes, interventions

and specific actions

recommended by the

Strategic Framework

• Departments and

agencies to elect an

internal entity to lead the

process and

communicate with other

partners

All lead departments South Africa


2007-2011

International

The National Injury Prevention and Safety

Promotion Plan: 2004–2014 – Canberra

• Departments and

agencies to

communicate their

specific responsibilities

to members and to other

partners


National Road Safety Strategy

2011-2020

International

Ontario Injury Prevention Strategy 2007

• Departments and

agencies to effectively

manage their role in

the initiative, set internal

timeframes, carry out

responsibilities, and

monitor and evaluate



2007-2011

International

New Zealand Injury Prevention Strategy

2008–2011 Implementation

• Departments and

agencies to maintain

continuous, long-term

participation in and

provide feedback to the

collaborative initiative

and its leadership



2007-2011

International

Actions for a safer Europe, Strategy

document of the Working Party on Accidents

and Injuries for 2005–2008

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The key challenges to effective data collection and dissemination are managing the vested interests of multiple stakeholders

that contribute to the data and inconsistencies with surveillance data across sources (i.e. SAPS and NIMSS). There are also

limited quality evaluations of existing prevention interventions.

Objective 11 promotes integrated information collection for injury prevention planning and decision making. The main

outcome of this objective is to promote a national integrated injury information system. These systems may build on the

NIMSS currently co-ordinated by SAPPRU. The outcome can also be extended to incorporate the automation of selected data

collection, analytic and dissemination components, and serve as a basis for the introduction of non-fatal injury data systems,

as used in countries such as Uganda and Sweden. The lead agencies involved would be the Department of Health, South

African Police Service and the Department of Transport.

Objective 11

Facilitate integrated information collection for injury prevention planning and decision making


Partners

Examples

11.1 National Integrated Injury

Information System

• Establish an integrated

national injury information

system to monitor and

evaluate existing initiatives

and programmes

• Inter-departmental group

to identify stakeholders

and implement effective

joint information

management system

DOH, SAPS, DOT:

EDD,DHS,DCS,

DOT, DSD, DPW,

DOL, DTI, DBE

South Africa

National Injury Mortality

Surveillance System (DOH and

SAPPRU)

International

National Vital Statistics System

http://www.cdc.gov/nchs/

nvss.htm

Table 11. Information collection for injury prevention planning and decision making


• Vested interests of multiple stakeholders

• Inconsistencies with surveillance data across sources

• Limited quality evaluation of interventions


• Existing systems although mostly manually collected data

• Development of automated technologies in provinces

SA strategies

• Sector-specific systems

• Mostly manual data collection


• Establish national integrated injury information system

• Expansion of automated capture and reporting web- based surveillance systems


• Appoint inter- departmental group to implement joint injury information management system using existing information systems

• Standardise monitoring and evaluation protocols, including information requirements for Strategic Framework interventions

• Strategy to ensure ongoing national dissemination of existing and new injury information

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There is a significant body of high quality, science based evidence on strategies and interventions that have a demonstrated

prevention effect on injury (36). This evidence indicates that the effective implementation of initiatives requires adequate

provision of the required resources. Research needs to be conducted to provide evidence to support the most effective

implementation of prevention interventions. To ensure the interventions are sustainable, they are to be field-tested for the

South African context and carefully planned, with adequate resources allocated to priority programmes. It is expected that

resources will need to be well-managed and utilised in an effective and equitable manner to ensure ongoing political and

social support.

Objective 12

Promote effective and equitable resource allocation and utilisation for the implementation of evidence-led interventions


Partners

Examples

12.1 Effective and equitable

resource allocation and utilisation

for the implementation of

evidence-led interventions

• Formalise resource

allocation strategy

and utilise monitoring

and evaluation system

for implementation of

evidence-led

interventions

Departments and

agencies to elect

an internal entity to

resource allocation

strategy and monitor

all movements

All lead

departments

South Africa

Health Systems Trust resource

allocation review

http://www.hst.org.za/sites/default/files/

res_allo.pdf

International

UNAIDS – Budget and resource

allocation matrix

http://www.unaids.org/en/media/

unaids/contentassets/documents/

document/2011/ubraf/Appendix4_

Budget_ResultsAllocationMatrix1_

12042011.pdf

• Inter-departmental group to

standardise and implement

monitoring and evaluation

protocols for existing

initiatives and programmes

DOH, SAPS, DOT:

EDD,DHS,DCS,DOT,

DSD, DPW, DOL, DTI,

DBE

South Africa

Monitoring and Evaluation

branches for lead departments

International

New Zealand Injury Prevention

Strategy 2008 – 2011

Implementation

• Inter-departmental group

to develop strategy to

ensure national

dissemination of

information

DOH, SAPS, DOT:

EDD,DHS,DCS,DOT,

DSD, DPW, DOL, DTI,

DBE

South Africa

Research Information

Management System (RIMS)

http://www.uj.ac.za/EN/

Research/RIMS/Pages/home.

aspx

International

Public Health

Data Standards Consortium

http://www.phdsc.org/default.

asp

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Departments and agencies

to effectively manage their

role in the initiative, set

internal timeframes, carry out

responsibilities, and monitor

and evaluate implementation

of evidence-led interventions

All lead

departments

South Africa

Monitoring and Evaluation

branches for lead departments

International

New Zealand Injury Prevention

Strategy 2008–2011

Implementation

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5. CONCLUSIONThe Strategic Framework aspires to a vision of a safe and peaceful South Africa, free from injuries and their associated

suffering, and conducive to physical, mental and social well-being. The Strategic Framework emphasises the prevention of

injury before it occurs, making science integral to the identification of effective policies and programmes, and integrating

the efforts of Government, diverse scientific disciplines, organisations and communities. This is in recognition of injuries as a

major contributor to premature death and disability. The Strategic Framework signals a shift in the way our society addresses

injury, from a focus limited to reacting to an event to a focus on changing the social, behavioural and environmental factors

that cause these injuries. The Strategic Framework emphasises the combined efforts of Government and all South Africans

that are required for sustained effort at all levels of society to successfully address this complex and deeply rooted problem.

This Strategic Framework provides a platform for departments to develop implementation operational plans that highlight each

department’s contribution to injury prevention. The operational plans will also make visible areas of collaboration between

departments and other stakeholders. The implementation plans will, for each relevant objective, specify the main outcome(s),

strategies, specific interventions, annualised action steps, main partners, and partner responsibilities for 2012–2016, to

ensure the effective operationalisation of the Integrated Strategic Framework for the Prevention of Injury and Violence in South

Africa, 2012–2016.

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