India Together: How the poor cope with accidents

02 April 2021

Road crashes endanger the lives and livelihoods of millions of road users globally and in India. Owing to the epidemic of road crashes, in 2010, the United Nations General Assembly proclaimed 2011–2020 as the Decade of Action for Road Safety, and two important targets on road safety were included in the Sustainable Development Goals set by the UN as a blueprint for nation to achieve a more sustainable future by 2030.

While Road Traffic Injuries (RTIs) affect the developed and developing world in different ways, they also impact poor households and disadvantaged sections of the population within developing countries differently. World Bank commissioned a survey-based assessment study in association with the Save LIFE Foundation (SLF) to determine such differential impacts more objectively in India. 

This study examined the socio-economic realities and nuances of road crashes at the sub-national level in India, to document inter-linkages between poverty, inequalities, road users, and road crash outcomes. Data from four states – Uttar Pradesh, Bihar, Tamil Nadu and Maharashtra – was analysed. The states were selected on the basis of demographic and geographical representation, magnitude of fatality burden, and socio-economic parameters such as economic growth, poverty rate and social welfare. These states cumulatively represent about one third of total road crash deaths in the country. 

The study quantifies the differential financial impact of RTIs on poor disadvantaged households by comparing a test sample of victims and their family members from Low-Income Households (LIH, i.e., the bottom 40% of the population by per capita income) with a control sample of High Income Households (HIH, i.e., the top 10% of the population in terms of per capita income). It also reveals the gendered and psychological impact of crashes, a subject that has been hitherto unacknowledged. 

It sheds light on the interactions of road crash victims and their families with systems, processes and institutions such as the police, insurance companies and the medical care system at large. Further, this study also captures the level of understanding and awareness of truck drivers on the recently passed Motor Vehicles (Amendment) Act, 2019 and on insurance and compensation in the event of a crash. 

The study reveals that social hierarchies and realities like class, gender and geographical location largely determine road crash outcomes and the severity of their impact in India. It highlights the nature and extent of the disproportionate impact of road crashes in terms of fatalities and serious injuries among poor and rich households. It elaborates on how socioeconomic inequalities affect households and in turn contribute to widening that gap. 

Findings

Some of the key findings of the report are as given below.

• Overall, the post-crash impact was more severe for LIH in Low Capacity States compared to HIH in High Capacity States.

• The incidence of fatality post-crash is higher among victims from LIH than HIH. As high as 44 per cent of the households in rural areas reported at least one death after a road crash compared to 11.6 per cent of households in urban areas. Similarly, LIH reported twice the numbers of deaths post-crash vis-à-vis HIH. Victims from LIH and rural areas are also twice more likely to suffer a disability after a crash than their HIH counterparts.

• The socio-economic burden of road crashes is disproportionately borne by poor households. The decline in total household income was sharper among LIH (75 per cent) than HIH (54 per cent). The severe impact of decline in income was highest among LIH in rural areas (56 per cent) compared to LIH in urban areas (29.5 per cent) and HIH rural (39.5 per cent), and cases where victims died as well as where victims were males.

• The ability to cope with financial distress post crash was better for HIH than LIH. LIH were three times more likely to seek financial help than HIH. Debt rates were also almost three times higher among LIH compared to HIH. In addition to financial distress, poor households experience a deterioration in their quality of life accompanied by psychological suffering and emotional distress.

• Within households, women bear the brunt of care-giving activities post-crash, leading to a double burden of labour and mental load and exacerbated inequality of opportunities in returning to livelihoods and income generating tasks.

• Inequality in insurance coverage and delay in accessing compensation mars the quick recovery process for LIHs. Insurance coverage was significantly higher among HIH and households in urban areas visà- vis LIH and urban areas.

• Information asymmetry and poor awareness of legal compensation among LIH compounds their distress. Only less than a quarter of the LIH victims were aware of the compensation process and insurance clauses; just a handful of the victims availed of government compensation/ex gratia.

• Low rates of insurance coverage and poor awareness related to legal compensation processes among truck drivers. Only a fifth and two-fifths of truck drivers surveyed were covered under medical insurance and life insurance respectively at the time of the crash. Overall, two-thirds of truck drivers were not aware of third-party liability insurance. None of the drivers had applied/benefited from cashless treatment at the hospitals, Solatium Fund for hit and run case or ex gratia schemes.

Key recommendations

The above findings of the report highlight the need for immediate improvements in crash reporting, post crash emergency care and protocols, insurance and compensation systems. It presents an opportunity for development agencies working in the sector to prioritise their targets and budgets, and for policymakers and respective State Governments to mandate a complete policy overhaul of the existing system and implement sustainable, solution oriented, inclusive measures to improve their performance on road safety. The report provides related recommendations for policy reform under six key areas as follows:

1. Need for effective institutional mechanisms and awareness building – There is a need to improve VRU safety especially for LIH in rural areas, who are most at risk in road crashes. There is also a need for the State Governments to ensure greater sensitisation and awareness among stakeholders, especially the police who are often reluctant to file FIRs.

2. Institutionalise post-crash emergency care and make health infrastructure & coverage more accessible & inclusive – The Central Government should urgently implement the cashless treatment scheme under Section 162(2) of Motor Vehicle (Amendment) Act, 2019, reducing Out-of-Pocket- Expenses for LIH, increasing health insurance coverage and extending its scope to address post-crash disability and mental health effects.

3. Provide a social security net for crash victims from LIH through state support – The Central and State Governments should introduce Traffic Crash Injuries and Disabilities: The Burden on Indian Society vocational and educational support for victims and their families through community programmes and special schemes for jobs, skilling and education. Comprehensive rehabilitation support also needs to be extended to crash victims especially those with post-crash disabilities.

4. Create an accessible legal framework for availing insurance and compensation for road crash victims – The Central Government should create schemes to increase insurance coverage and penetration for LIH. Insurance agencies should broaden the scope of insurance policies by including rehabilitation and recovery of crash victims. Since most compensation payments take time to process, under Section 164A of MVAA 2019, the Central Government must make provisions to provide interim compensation to crash victims to provide for immediate relief. The comprehensive coverage of MCTAP needs to be ensured through better mechanisms for effective coordination.

5. Recognize the gendered impact of road crashes and address it through participatory governance and special schemes for women – Central and State Governments should incentivize employment opportunities for women affected by road crashes. Steps could include: encouraging small businesses in work from home set up, providing low-interest loans and emergency cash transfers to post-crash turned female-headed households. Women from households who have lost the breadwinners in road crashes should also be automatically enrolled in the State Government’s employment database.

6. Strengthen post-crash support for children and young adults through state support – State Governments should implement progressive provisions on child road safety under Sections 194B, 129 and 199A of the Motor Vehicles (Amendment) Act, 2019, framing a rigorous policy on child road safety and provide support for children and adolescents affected by road crashes. The State Government should ensure a minimum of three month moratorium on school fees for children impacted by road crashes from LIH.




Within households, women bear the brunt of care-giving activities post-crash, leading to a double burden of labour and mental load and exacerbated inequality of opportunities in returning to livelihoods and income generating tasks.

The report provides detailed recommendations for strengthening institutional agencies to respond to the needs of VRUs and associated households. It lays out suggestions for States to strengthen their institutional capacities, to respond better to the challenges presented by road crashes and improve their performance, and to create efficient mechanisms for LIH to get access to legal and insurance-based compensation after a crash to mitigate their financial burden. These recommendations, if implemented, have the potential to significantly improve the lives of vulnerable road users and to create far-reaching positive road safety outcomes.

MoRTH framework for policy and implementation

The Ministry of Road Transport and Highways (MORTH) has been taking steps to improve road safety in the country. The Ministry’s annual report on Road Accidents in India is a resource for policy makers and researchers alike that provides detailed and comprehensive data on the causes, patterns, types and inter-state and global comparisons of road crashes in the country. Working across the 4Es of road safety – Engineering, Enforcement, Education and Emergency care – the Ministry is undertaking various initiatives to reduce road crash fatalities by at least 50 per cent by 2030.

The Ministry hopes that its framework for operationalising the MVAA will empower states to strengthen their electronic enforcement and monitoring systems, automate and integrate all road safety databases through digitisation, provide speedier assistance to road crash victims, strengthen public transport and improve road user behaviour. We hope that the recommendations listed above will also help evolve the subordinate legislation/rules under the MVAA to make it more inclusive and effective.

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