Zusha!

Road accidents are a major cause of preventable death and disability globally. The World Health Organization (WHO) estimates that more than 1.25 million people are killed and an additional 20 to 50 million are injured by road accidents each year. If current trends continue, the WHO projects that road accidents will become the 7th leading cause of death globally by 2030. The problem is particularly pronounced in low-and middle-income countries, which the WHO estimates account for about 90% of the world's road traffic fatalities despite having only 54% of the world's vehicles. The road traffic death rate is higher in Africa than in any other region.

What do they do? Road accidents are a leading cause of death and injury globally, and the problem is particularly pronounced in low- and middle-income countries. The Georgetown University Initiative on Innovation, Development, and Evaluation (gui2de)'s Zusha! Road Safety Campaign (from here on, "Zusha!") is a campaign intended to reduce road accidents. Stickers are distributed to public service vehicles encouraging passengers to speak up and urge drivers to drive more safely.

Does it work? We believe there is reasonably strong evidence from two randomized controlled trials (RCTs) conducted in Kenya that Zusha! decreases road accidents. However, we believe that these results have limitations which lead our best guess of the program's effectiveness to be lower than the estimated effects from the RCTs. Evidence from two additional RCTs, in Tanzania and Uganda, is forthcoming. In its scaled up program in Kenya, Zusha! has recently implemented strong monitoring and has found estimated coverage rates of about 20-50% among targeted vehicles. Due to differences in measurement approach, these compliance rates are difficult to compare to the rates measured in the RCTs, but we would guess that they are roughly similar.

What do you get for your dollar? Our analysis suggests that Zusha!'s cost-effectiveness is in a similar range of cost-effectiveness as unconditional cash transfer programs. This analysis depends on a number of difficult judgment calls about moral weights and how to adjust for questions about internal and external validity. Our best guess estimates involve large discounts relative to taking the results of Zusha!'s RCTs at face value.

Is there room for more funding? We believe that Zusha! could use at least an additional $800,000 per year to support implementation of its program in Kenya. We are not aware of any other potential funders for Zusha!, and our best guess is that Zusha! will need to scale down its field staff support for the program and substantially reduce its monitoring if it does not receive additional funds. Zusha! has told us that it would have varying levels of involvement in the program depending on how much additional funding it receives, but that its highest priority use of small amounts of additional funding would be to print and deliver stickers to its partners, which Zusha! would try to encourage to take a larger role in direct implementation and ownership of the program absent external funds.