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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Table of Contents
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
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List of Tables, Figures and Boxes
List of tables
Table 1: Poverty and socio-economic inequality...................................................................................17
Table 2: Poor infrastructure and service delivery..................................................................................19
Table 3: Gender inequality and dominant masculinity norms................................................................21
Table 4: Alcohol and drug abuse..........................................................................................................24
Table 5.1 Injuries and male interpersonal violence...............................................................................26
Table 5.2 Injuries and intimate partner violence...................................................................................27
Table 5.3 Injuries and child abuse.......................................................................................................27
Table 6: Traffic injury............................................................................................................................30
Table 7: Suicide ..................................................................................................................................33
Table 8.1: Unintentional injuries due to burns.......................................................................................35
Table 8.2: Unintentional injuries due to drowning.................................................................................35
Table 8.3: Unintentional injuries due to falls.........................................................................................36
Table 8.4: Unintentional injuries due to poisoning.................................................................................36
Table 9: Effective leadership by lead agencies......................................................................................38
Table 10: Intersectoral collaboration ....................................................................................................40
Table 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......................................................................................................3
Figure 2: The generation of injury prevention recommendations............................................................4
Figure 3: Leading types of injury mortality in South Africa......................................................................7
Figure 4: South Africa’s DALYs compared to other WHO regions.............................................................9
Figure 5. Public health approach: Four interconnected phases linking data to action............................12
Figure 6: Ecological model with risk factors for intentional injury.........................................................13
Figure 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...........................8
Box 2: Injury consequences ................................................................................................................10
Box 3: The public health approach to injury prevention.........................................................................12
Box 4: Organising intervention activities...............................................................................................14
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Foreword
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Acknowledgments
I 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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Acronyms
AIDS
Acquired Immune Deficiency Syndrome
AARTO
Administrative Adjudication of Road Traffic Offences
CASE
Community Action towards a Safer Environment
CBOCommunity-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
DOTDepartment of Transport
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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
HIVHuman 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
NPONon-Profit Organisation
NPANational 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
SASouth 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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Glossary
Term
Definition
An injury is the physical damage that results when a human body is suddenly subjected to
Injury
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 is defined in the World Report on Violence and Health (WRVH) as
Intentional injury or
violence
‘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 Self-directed violence or suicide is violence in which the perpetrator and the victim are the same
or suicide
individual (1).
Interpersonal violence is violence between individuals. Interpersonal violence is subdivided
Interpersonal
violence
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 constitutes all forms of physical and/or emotional ill-treatment,
Child abuse or
maltreatment
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 injuries are classified according to their causal mechanism (i.e. how they occurred),
Unintentional injury
with most common sub-categories including road traffic injuries, falls, burns and scalds,
drowning and poisonings (2).
A road traffic crash is defined as ‘a collision or incident that may or may not lead to injury,
Road traffic 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).
A burn occurs when some or all of the different layers of skin cells are destroyed by a
Burns
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).
Poisoning refers to an injury that can result from being exposed to an exogenous substance
Poisons
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).
The WHO defines injury prevention as the actions or interventions that prevent an injury
Injury prevention
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.
Injury prevention interventions may be organised according to three levels of action:
Primary, secondary and • Primary prevention: The prevention of injury before its occurrence.
tertiary prevention
• Secondary: The immediate responses once an injury has occurred. These include prehospital 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.
Prevention may also target specific vulnerable and identified groups:
Universal, selected and • Universal interventions: Targeted at the general population or groups without consideration
indicated interventions 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 is an incidence of ill health. It is measured in various ways, often by the probability
Morbidity
that a randomly selected individual in a population at some date and location will become
seriously ill over some period of time (9).
Mortality is the incidence of death in a population. It is measured in various ways, often by
Mortality
the probability that a randomly selected individual in a population at some date and location
will die in some period of time (9).
A downstream or proximal risk factor is a risk factor that represents an immediate
Downstream or
proximal risk factor
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).
An upstream or distal risk factor is a risk factor that represents underlying social and
Upstream or distal risk
factor
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 Reader
The 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 Summary
When 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
(2)
Reduce risks specific to the
different injury priorities
(3)
Facilitate supportive
institutional and
organisational environments
Objective 2
Objective 1
(1) PRIORITY
CROSS -CUTTING
RISK FACTORS
Promote selected
poverty alleviation
measures targeting
groups at risk for
injuries
Promote selected
health, road
and residential
infrastructure and
services to reduce
the risks for injuries
and contain injury
severity
Objective 3
Objective 4
Facilitate equitable
gender relationships
and norms
Reduce alcohol and
drug abuse
Objective 5
Objective 6
Objective 7
Facilitate
comprehensive
measures to prevent
violence-related
injuries and contain
associated severity
Facilitate
comprehensive
measures to reduce
road traffic-related
injuries and
associated severity
Facilitate
comprehensive
measures to
reduce suiciderelated injuries and
associated severity
Objective 8
(2) RISKS SPECIFIC
TO THE DIFFERENT
INJURY PRIORITIES
(3) SUPPORTIVE
INSTITUTIONAL
AND
ORGANISATIONAL
ENVIRONMENTS
Objective 10
Objective 9
Promote effective
leadership across
lead agencies
Promote
inter-sectoral
collaboration within
Government and
with civil society
Objective 11
Facilitate the
collection and
use of empirical
information
for planning,
implementation and
evaluation
Facilitate
comprehensive
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
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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. INTRODUCTION
There 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 onehalf. 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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Over the past 10–20 years, many industrialised countries have reduced their injury death rates, some by as much as onehalf. 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.
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.
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Figure 1. Selected international, continental and South African policy initiatives that prioritise injury prevention
Strategic Framework for the Prevention of Ifor
njury n South of
Strategic
Framework
the iPrevention
Injury inAfrica South Africa
International policy-­‐related International policy-­
related
initiatives
initiatives The UN Millennium
Millennium The UN
Development Development
Goals
Goals • Reduce child • Reduce child mortality
mortality • Improve maternal • Improve maternal health health
The N Make The
UNUMake
Roads
Roads Safe of
–
Safe
–Decade
Decade of Action Action
Campaign
Campaign • Road
safety • Road safety management
management • Safer roads and • Safer roads and mobility mobility
• Safer vehicles • Safer road users • Safer vehicles
• Post-­‐crash response • Safer road users
• Post-crash response
African policy-­‐related African
policy-­relatedinitiatives initiatives
African Charter on New
• Partnership
New Partnership African
Charter
for
ights and
and for Development
Africa’s onthe theRRights
Africa’s
Welfare of tChild
he Child (NEPAD)
Development Welfare
of the
(ACRWC) (NEPAD) (ACRWC)
• Article 14: Health • Develop
and Health •infrastructure
Develop • Article
14: Health
services to all infrastructure andchildren Health services
• Support to
all
children
•
Support
human • Article 16: resources Protection against human resources development • Article
16:abuse and development
child • Promote torture against Protection
Governance •child
Article 8: abuse1and
• Promote • Ensure capacity Protection of torture
Governance
building family Article • •Article
18: 27: Sexual • Ensure capacity exploitation Protection of family
building
• Article 27: Sexual exploitation
South frican policy-­‐related South A
African
policy-related
initiatives initiatives
SA Presidency:
12 12 SA SA Government
SA Presidency: Government key outcomes
of Action
Programme of key outcomes Programme
Action (2009–
(2009–2014)
2014) • Long and healthy • Improve life
• Improve
health • Long and health rofile profile
of all pSouth
of all South healthy life • All people in SA are Africans
Africans • All eople in SA and
feelpsafe
are and feel • Intensify
fight fight • Intensify safe • Better
and safer against
crimecrime and against South
Africa,and Africa corruption
• Better and corruption and safer world South Africa, Africa and world 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.
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, indepth 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
Outcomes and recommendations Scope and focus Process Desktop review and analysis of evidence 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 •
•
•
•
•
National Steering Committee consultations •
Existing South African policies and prevention programmes •
Review of existing prevention responses and identification of gaps Magnitude: 1
15
road i)•Magnitude: 5 9900
00 hhomicides,
omicides, 113
3 8800
00 road fatalities,666
200sexual sexualoffenses, offenses,7 7500 500
suicides
fatalities, 6 200 suicides ii)
Cross-­‐ c
utting f
actors: e
.g. g
ender • Cross- cutting factors: e.g. gender inequality and inequality nd dominant masculinity, alcohol dominantamasculinity,
alcohol
and drugs
drugs •and Injury
specific factors: e.g. to traffic injury: • Injury specific factors: speeding,
seatbelt
usee.g. to traffic injury: speeding, seatbelt se male violence prevention: • Interventions:
e.g. u
for
iii) responsible
Interventions: e.g. for male conflict
violence fatherhood interventions;
prevention: responsible fatherhood resolution skills
interventions; conflict resolution skills • 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 • 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 STRATEGIC FRAMEWORK Situational analysis • Strategic guidance • Identification of Government programmes • Prioritisation of evidence-­‐led interventions • Sourcing of documentation Stakeholder consultations Departmental technical liaison • Expert opinions: • Priority areas for strategic framework • What works • Service delivery gaps and priorities) • Review of factors to enable Framework implementation, including: • Intervention suitability • Resources • Capacity • 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 • Departmental implementation plans that focus on: •
Outcome(s) •
Strategies •
Interventions •
Action steps •
Lead agency and main responsibilities •
Partner agencies and main responsibilities •
Resource implications 4
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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 servicedelivery 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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2. BURDEN OF INJURIES
Murder affects not only direct victims,
2. BURDEN OF INJURIES
but also the parents, community and perpetrator
InMurder
Gugulethuaffects
in October
20-year-old
man was accused of
not2011,
onlya direct
victims,
killing
3-year-old
boy. Localcommunity
authorities reported
that the young boy
but aalso
the parents,
and perpetrator
was brutally murdered and placed in a suitcase. Provincial task team
In Gugulethu in October 2011, a 20-year-old man was accused of
co-ordinator for the ANC Women’s League pleaded, ‘We are asking our communities to remember that you
killing a 3-year-old boy. Local authorities reported that the young boy
must be aware of your neighbour’s child as
if she or he is your own.’ The mother of the boy, distraught with
was brutally murdered and placed in a suitcase. Provincial task team
lifeless body. A community plagued with violence now seeks revenge
grief, co-ordinator
fainted when
foundWomen’s
her son’s
forshe
the ANC
League
pleaded, ‘We are asking our communities to remember that you
and awaits
accused’s
This ischild
an example
of child
homicide.
Thedistraught
SAPS reported
must bethe
aware
of your trial.
neighbour’s
as if she of
or the
he ishigh
yourlevels
own.’ The
mother
of the boy,
with
grief, fainted
she found
her under
son’s lifeless
body. A community
violence now
revenge
906 murder
caseswhen
against
children
18 in 2010/2011
(13). Itplagued
is hardwith
to quantify
the seeks
broader
impact
awaitsofthe
accused’s
an exampleBesides
of the high
of childofhomicide.
The and
SAPSthe
reported
of theand
murder
a child,
as ittrial.
is ofThis
anyisindividual.
thelevels
heartache
the mother
anger of the
906 murder
casesembodies
against children
under 18notin only
2010/2011
It is hard
to quantify
community,
this case
that murder
affects(13).
the victim
whose
life isthe
cutbroader
short, impact
but also the
of the murder of a child, as it is of any individual. Besides the heartache of the mother and the anger of the
parents, public and perpetrator.
community, this case embodies that murder not only affects the victim whose life is cut short, but also the
parents, public and perpetrator.
South Africa has one of the highest levels of death and disability from injuries (14). In 2010, for example, approximately 15 900
homicides
(15), and
66 200
sexual offences
were(14).
reported
(13).
Annually,approximately
there is an estimated
South(13),
Africa13
has800
oneroad
of thefatalities
highest levels
of death
and disability
from injuries
In 2010,
for example,
15 900
7 500homicides
suicides (19),
while
mortality
to fires,
drowning,
falls and
comprise
12% of all injury
(13), 13
800unintentional
road fatalities injury
(15), and
66 200due
sexual
offences
were reported
(13).poisoning
Annually, there
is an estimated
deaths7 in
thesuicides
country.
Injuries
are the second
largest
contributor,
after
HIV/AIDS,
South
Africa’s
burden12%
of disease,
and
500
(19),
while unintentional
injury
mortality
due to fires,
drowning,
fallstoand
poisoning
comprise
of all injury
deaths
the country.injuries
Injuries due
are the
second largestviolence
contributor,
HIV/AIDS,
to South Africa’s
of disease,
and falls and
are driven
byinintentional
to interpersonal
andafter
road
traffic injuries,
followedburden
by fires,
drowning,
are driven
by intentional
poisoning
(see Figure
3). injuries due to interpersonal violence and road traffic injuries, followed by fires, drowning, falls and
poisoning (see Figure 3).
Figure 3. Leading types of injury mortality in South Africa
Figure 3. Leading types of injury mortality in South Africa
War
0%
Other
6.2%
Road Traffic Injuries
26.7%
Interpersonal
violence
46%
Poisoning
1.1%
Falls
1.7%
Fires
6.9%
Drowning
2.3%
Self-inflected
violence
9%
[Source (11): Norman, Matzopoulos, Groenewald, & Bradshaw, 2007]
7
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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 nonfatal 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 interlinked
In 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 posttraumatic 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).
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.
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 injuryrelated costs of alcohol misuse are estimated to be twice the amount received in excise duties for alcohol (25).
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.
10
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Side Panel: South Africa’s high number of transport-­‐related injuries re more than 200 000 traffic crashes in South Africa every year, many of which are fatal and which ofound consequences. In August 2011, a 32-­‐seater bus was used to transport 58 school children to n Knysna. The driver of the bus lost control, sending the bus plunging into a dam. The driver and 14 children were killed; the remaining 44 children were injured. The Minister of Transport Sibusiso e said in a statement ‘We cannot go on like this. This horrific road crash in Knysna … is yet again an ssary 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).
11
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3. APPROACH, KEY CONCEPTS AND PRINCIPLES
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).
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.
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).
Figure 5. Public health approach: Four interconnected phases linking data to action
Implement Intervention/
and Measure Prevention
Effectiveness
• Community Intervention/
Demonstration Programs
• Training
• Public Awaerness
Develop and Test
Interventions
• Evaluation Research
Identify Causes
• Risk Factor
Identification
Define the Problem
• Data Collection/
Surveilance
Problem
Response
[Source (27): Hammond, Haegerich & Saul, 2009]
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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).
Figure 6. Ecological model with risk factors for intentional injury
[Source (1): Butchart, Phinney, Check & Villaveces, 2004]
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.
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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
Integrated Strategic Framework for the Prevention of Injury and
Violence in South Africa, 2012-2016
VISION
A safe and peaceful South Africa, conducive to physical, mental and social well-being
PURPOSE
To promote injury prevention and safety through focused actions that reduce injuries by
targeting:
1. priority cross-cutting risk factors
2. risks specific to the different injury priorities
3. supportive institutional and organisational environments.
KEY ACTION AREAS
(1)
Reduce injuries by targeting
priority cross cutting risk
factors
(2)
Reduce risks specific to the
different injury priorities
(3)
Facilitate supportive
institutional and
organisational environments
Objective 2
Objective 1
(1) PRIORITY
CROSS -CUTTING
RISK FACTORS
Promote selected
poverty alleviation
measures targeting
groups at risk for
injuries
Promote selected
health, road
and residential
infrastructure and
services to reduce
the risks for injuries
and contain injury
severity
Objective 3
Objective 4
Facilitate equitable
gender relationships
and norms
Reduce alcohol and
drug abuse
Objective 5
Objective 6
Objective 7
Facilitate
comprehensive
measures to prevent
violence-related
injuries and contain
associated severity
Facilitate
comprehensive
measures to reduce
road traffic-related
injuries and
associated severity
Facilitate
comprehensive
measures to
reduce suiciderelated injuries and
associated severity
Objective 8
(2) RISKS SPECIFIC
TO THE DIFFERENT
INJURY PRIORITIES
(3) SUPPORTIVE
INSTITUTIONAL
AND
ORGANISATIONAL
ENVIRONMENTS
Objective 10
Objective 9
Promote effective
leadership across
lead agencies
Promote
inter-sectoral
collaboration within
Government and
with civil society
Objective 11
Facilitate the
collection and
use of empirical
information
for planning,
implementation and
evaluation
Facilitate
comprehensive
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
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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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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.
Objective 2
Objective 1
(1) PRIORITY
CROSS -CUTTING
RISK FACTORS
Promote selected
poverty alleviation
measures targeting
groups at risk for
injuries
Promote selected
health, road
and residential
infrastructure and
services to reduce
the risks for injuries
and contain injury
severity
Objective 3
Objective 4
Facilitate equitable
gender relationships
and norms
Reduce alcohol and
drug abuse
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).
Table 1: Poverty and socio-economic inequality
Extent and evidence of
contribution to injury
CCo-occurring Factors
SA strategies
• 25,7% of population
unemployed
• Underdeveloped infrastructure
• Expanded Public Works Programme (EPWP)
• Richest 10% of
households earn 40 times
more than poorest 50%
• Poor housing conditions; overcrowding
• Men at the Side of the Road Initiative (MSR)
• Unemployment
• 22% of population below
the R283/month poverty
line
• High proportion of burns,
traffic and violent injury in
low-income settings
Key recommendations
• Prioritise targeted job creation, i.e. most vulnerable to injury
Recommended service
delivery priorities
• 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
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.
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Objective 1 11 Objective Objective Objective 1 Promote selected poverty alleviation mm
easures targeting groups at aart t isk for injuries Promote elected overty lleviation m
easures argeting roups isk or njuries Promote sselected ppoverty aalleviation easures ttargeting ggroups rrisk ffor iinjuries Promote selected poverty alleviation measures targeting groups at risk for injuries Lead agency: Lead gency: Lead aagency: Intervention Partners Examples Intervention Partners Examples Intervention Partners Examples Lead agency: Intervention Partners Examples skills Objective 1EDD: EDD: a)a)
Prioritised DPW, South Africa South frica EDD: a)
Prioritised 1.1
Prioritised DDPW, South AA
frica • ••Targeted Targeted kills • •• Develop/impleme
Develop/impleme
Targeted sskills Develop/impleme
South
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PW, job SDALGA, at att Side ooff oothe
tf he Road DPLG/ SALGA, ALGA, Men Men t tfrica the he ide f tthe he oad targeted job targeted job DPLG/ SPW, Men SSide RRoad targeted skills development nt argeted kills DPLG/ development nt ttargeted sskills a) targeted Prioritised EDD: South Ahe Menaat
the
Side
Road
Initiative
•development Targeted skills • nt Develop/impleme
Promote s
elected p
overty a
lleviation m
easures t
argeting g
roups a
t r
isk f
or i
njuries opportunities Treasury Initiative Treasury Initiative opportunities opportunities Treasury Initiative and e
mployment development a
nd and e
mployment development a
nd and e
mployment development a
nd targeted job DPLG/ SALGA, Men at the Side of the Road http://www.msr.org.za/
development nt targeted skills http://www.msr.org.za/
http://www.msr.org.za/
http://www.msr.org.za/
strategy for employment strategy or employment and strategy ffor employment opportunities Treasury Initiative and employment development International
Lead agency: International International International priority interventions f
or priority interventions f
or priority interventions f
or http://www.msr.org.za/
Outcome Strategy1 strategy for employment Baltimore Empowerment Zone: Intervention Partners Baltimore Empowerment Zone: Baltimore Empowerment mpowerment one: Baltimore EExamples ZZone: unemployed single parent unemployed single arent for unemployed single pparent International priority interventions 1994-2004
1994-­‐2004 1994-­‐2004 1994-­‐2004 groups households and groups households nd groups households aand Baltimore E
mpowerment Z
one: unemployed single parent http://www.ebmc.org/home/
a) Prioritised EDD: DPW, South Africa http://www.ebmc.org/home/
http://www.ebmc.org/home/
• groups Targeted skills • youth Develop/impleme
http://www.ebmc.org/home/
in in h
youth in igh igh youth hhigh 1994-­‐2004 households and documents/EBMC%20Job%20
documents/EBMC%20Job%2
documents/EBMC%20Job%2
targeted job DPLG/ S
ALGA, Men at the Side of the Road documents/EBMC%20Job%2
development nt t
argeted s
kills injury s
ettings injury s
ettings injury isn ettings http://www.ebmc.org/home/
youth high Creation0905.pdf
0Creation0905.pdf 0Creation0905.pdf opportunities Treasury Initiative 0Creation0905.pdf and employment development documents/EBMC%20Job%2
injury settings and http://www.msr.org.za/
strategy for employment 0Creation0905.pdf DPLG/ Africa EDD: PLG/ South South frica EDD: DDPLG/ South AA
frica • ••Sustainable work up dp edicated Sustainable ork • •• Scale Scale edicated International Sustainable wwork Scale uup ddedicated priority interventions for EDD: South
Africa
SALGA, PW Public W
orks opportunities work opportunities opportunities work pportunities SALGA, PW Expanded Expanded ublic Works orks SALGA, DDPW Expanded ublic W
opportunities work oo
pportunities Baltimore EPPmpowerment Zone: unemployed single pp arent Expanded
Public
Works
Programme
DDPLG/ South Africa • Sustainable work •
Scale u
dedicated EDD: Programme (
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ssistance and a
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o Programme (
EPWP) and a
ssistance and a
ssistance t
o Programme (
EPWP) and a
ssistance and a
ssistance t
o 1994-­‐2004 groups households a
nd Expanded opportunities work opportunities SALGA, DPW (EPWP) Public Works International to and vulnerable vulnerable International to vulnerable International to vvulnerable vulnerable http://www.ebmc.org/home/
youth in high to Programme aulnerable ssistance and assistance International(EPWP) KATA -­‐Konbit ak aaTk k èt Ansanm households and households and KATA Konbit èt nsanm households nd households nd documents/EBMC%20Job%2
KATA -­‐-­‐Konbit TTèt AAnsanm households aand households aand injury settings International to vulnerable vulnerable KATA -Konbit ak Tèt Ansanm
http://www.usaid.gov/ht/docs/p
communities high injury http://www.usaid.gov/ht/docs/p
communities high injury and 0Creation0905.pdf http://www.usaid.gov/ht/docs/p
communities high injury KATA -­‐Konbit ak Tèt Ansanm households and households http://www.usaid.gov/ht/docs/ps/
s/kata_fact_sheet_final.pdf communities s/kata_fact_sheet_final.pdf communities s/kata_fact_sheet_final.pdf communities http://www.usaid.gov/ht/docs/p
communities high injury kata_fact_sheet_final.pdf
South Africa • Sustainable work • communities Scale up dedicated EDD: DPLG/ s/kata_fact_sheet_final.pdf SALGA, D
PW Expanded Public Works opportunities work o
pportunities Programme (EPWP) and assistance and assistance to International to vulnerable vulnerable KATA -­‐Konbit ak Tèt Ansanm and households and Evidence relevanthouseholds to Objective
2
http://www.usaid.gov/ht/docs/p
communities high injury s/kata_fact_sheet_final.pdf communities Outcome Outcome Outcome Outcome Strategy1 Strategy1 Strategy1 Strategy1 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).
1The
Framework would require Government to engage business, broader civil society sectors including NGOs, and CBOs, the tertiary education sector, and
research
for
successful
and
co-ordinated
implementation.
institutions
1 1 P2 1 revention c olour c oded according to tto o he primary, secondary, tertiary prevention (see Glossary on pn . pp. . c olour olour coded oded according ccording he rimary, econdary, tertiary ertiary prevention revention see Glossary lossary c
c
tthe pprimary, ssecondary, pon
((see G
oon Prevention
P P revention revention interventions
i nterventions interventions interventions are
colour
a re a a re re coded according to athe
primary, secondary,
tertiary prevention
(seetGlossary
p. vi), or multiple
emphases
of
the
vi), o
ultiple einterventions mphases of ootf ahe rcecommended revention, s aafs ollows: vi), multiple ultiple mphases f tre the he ecommended revention, s follows: ollows: secondary, tertiary prevention (see Glossary on p. vi), oom
r r m
eemphases rrecommended pprevention, 1 Pr revention olour coded apccording to tahe pfrimary, recommended
prevention,
as follows:
vi), or multiple emphases of the recommended prevention, as follows: Primary Secondary Tertiary A A cA ombination of ootf wo or oor r Primary Secondary Tertiary ombination f ttwo wo Secondary Tertiary ccombination Primary more types of two or more ypes more ttypes Primary Secondary Tertiary A combination 18
more types 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 f ollows: Secondary Tertiary A combination of two or Primary more types bigDoc.indd 18
2013/02/14 10:05 AM
Table 2. Poor infrastructure and service delivery
Extent and evidence of
contribution to injury
• Trauma care, with few
exceptions, poorly
planned, coordinated and
resourced
• Significant indication of
‘preventable’ mortality
CCo-occurring Factors
• Uneven distribution of
resources and skills
• Low rates of public
medical practitioner and
hospital beds
SA strategies
• Strengthen sub-district
health management
teams capacity for service
delivery
• Delays of quality care
because of multiple
health system transfers
contribute to higher,
more severe injuries
Key recommendations
• Increase resources to
infrastructure and
services to promote
safety
Recommended service
delivery priorities
• Prioritise development of
quality health
infrastructure
• Enhance monitoring and
evaluation
• Appropriate clinical and
referral protocols
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.
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Lead Lead agency: agency: Outcome Outcome Intervention Examples Examples Strategy Strategy Intervention Partners Partners Objective 2
2.1 Enhanced 2.1 Enhanced i)
i) Imp Imp
ii) ii) Impleme
Impleme
DOH DOH South South Africa Africa rove Erove MS EMS nt dedicated nt dedicated Medical Medical Emergency Emergency Transport Transport and Raescue nd Rescue (METRO) (METRO) health health Promote selected health, road and residential inational nfrastructure and services thttp://www.westerncape.gov.za/eng/directo
o reduce the risks for access to to national http://www.westerncape.gov.za/eng/directo
infrastructure infrastructure access injuries nd emergency contain injury severity ries/services/11498/6299 ries/services/11498/6299 injury injury prone parone emergency and sand ervices services that that International International areas areas number number and and promote promote safetysafety
Services 9-­‐1-­‐1 9-­‐1-­‐1 Services system system Lead agency: Outcome Intervention Objective 2 Examples Strategy http://transition.fcc.gov/pshs/services/911-­‐
http://transition.fcc.gov/pshs/services/911-­‐
Partners services/ services/ 2.1 Promote Enhanced selected i)
Imp
ii)
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DOH South aAnd frica h
ealth, r
oad a
nd r
esidential i
nfrastructure s
ervices t
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everity ‘The G
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o national http://www.westerncape.gov.za/eng/directo
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ries/services/11498/6299 injury prone emergency provision provision a
nd a
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hat af/s12-­‐29.pdf International af/s12-­‐29.pdf areas number and Lead atgency: training o to Outcome Strategy Intervention training Examples promote safety International system Partners 9-­‐1-­‐1 Services International prioritise prioritise high high Trauma Trauma care qcare uality quality improvement improvement http://transition.fcc.gov/pshs/services/911-­‐
ii)
Impleme
DOH South frica 2.1 Enhanced injury injury c
atchment catchment •i) Improve Imp
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http://www.who.int/violence_injury_prevent
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rove MS nt dedicated Medical Emergency Transport and Rescue (METRO) health areas areas ion/capacitybuilding/courses/trauma_qualit
EMS Eaccess
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y/en/index.html y/en/index.html http://www.westerncape.gov.za/eng/directories/
national
ries/services/11498/6299 injury prone emergency ‘The Golden Hour’ – Trauma And Acute Care Treasury and paramedic services/11498/6299
prone areas
emergency
and services that areas International number and http://www.transport.gov.za/library/docs/r
DOH: DOH: South South Africa Africa International
•
Review •
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nd a
nd promote safety provision a
nd number and 9-­‐1-­‐1 Services system af/s12-­‐29.pdf ‘The olden Golden Hour’ H–our’ Trauma – Trauma And AAcute nd ACcute are Care 9-1-1
Services
Treasury Treasury ‘The G
develop develop trauma trauma training systemto http://transition.fcc.gov/pshs/services/911-­‐
International http://www.transport.gov.za/library/docs/r
http://www.transport.gov.za/library/docs/r
http://transition.fcc.gov/pshs/services/911-services/
referral protocols protocols prioritise high referral services/ Trauma care quality improvement af/s12-­‐29.pdf af/s12-­‐29.pdf uidelines guidelines for for injury catchment and gand http://www.who.int/violence_injury_prevent
International International D
OH: South A
frica Adjust ambulance first pfirst ••areas aramedics paramedics ion/capacitybuilding/courses/trauma_qualit
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And Acute Care
management http://www.transport.gov.za/library/docs/r
provision and http://www.who.int/violence_injury_prevent
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af/s12-­‐29.pdf International
training atnd o DOH: South A
frica ion/capacitybuilding/courses/trauma_care/e
ion/capacitybuilding/courses/trauma_care/e
• Review International Trauma
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Timprovement rauma And Acute Care prioritise trauma high n/index.html n/index.html Treasury develop Trauma ccare
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qour’ uality http://www.who.int/violence_injury_prevention/
http://www.transport.gov.za/library/docs/r
injury catchment http://www.who.int/violence_injury_prevent
referral protocols af/s12-­‐29.pdf 2.2 2.2 DPW: DPW: South South Africa Africa •and Prioritise •gPrioritise • Identification • Identification and acapacitybuilding/courses/trauma_quality/en/index.html
nd ion/capacitybuilding/courses/trauma_qualit
areas uidelines for Neighbourhood, Neighbourhood, electrificatio
DPLG/ DPLG/ Eskom Eskom rural rdural evelopment development electrificatioprovision provision of of International y/en/index.html first paramedics Trauma care system planning and home home and and SALGA, SALGA, http://financialresults.co.za/2011/eskom_ar
http://financialresults.co.za/2011/eskom_ar
n for n injury for injury electrification electrification at scene management transport transport Treasury Treasury 2011/eskom_foundation2011/rural_develop
2011/eskom_foundation2011/rural_develop
prone prone areas areas infrastructure infrastructure and and DOH: South Africa • Review and South Africa
ment.php ment.php infrastructure infrastructure services services in high-­‐
in hhttp://www.who.int/violence_injury_prevent
igh-­‐
‘The Golden Hour’ –Trauma
Trauma And Acute Care Treasury ion/capacitybuilding/courses/trauma_care/e
‘The Golden Hour’ –International And Acute Care
International conducive conducive to to develop trauma injury injury http://www.transport.gov.za/library/docs/r
Rural Rural Electrification Electrification Corporation Corporation Limited Limited http://www.transport.gov.za/library/docs/raf/s12-29.pdf
n/index.html greater greater safety safety referral protocols neighbourhoods neighbourhoods af/s12-­‐29.pdf http://recindia.nic.in/ http://recindia.nic.in/ International
and guidelines for and rand ecreational recreational International planning
and management
2.2 DPW: Africa Trauma
care system
• Prioritise • Identification and settings settings South first paramedics Trauma care system planning and Neighbourhood, DPLG/ Eskom rural development http://www.who.int/violence_injury_prevention/
electrificatio
provision at scene of management home and SALGA, http://financialresults.co.za/2011/eskom_ar
n for injury Dedicated Dedicated • Identification DPW: DPW: South South Africa Africa electrification • Identification and acapacitybuilding/courses/trauma_care/en/index.html
nd http://www.who.int/violence_injury_prevent
transport Treasury pathways pathways and and development DOT DOT Empowerment Empowerment Impact Impact Assessment Assessment (EmpIA) (EmpIA) prone areas infrastructure development of 2011/eskom_foundation2011/rural_develop
o
f ion/capacitybuilding/courses/trauma_care/e
infrastructure lanes lanes for in fh
or http://www.nra.co.za/live/content.php?Item
http://www.nra.co.za/live/content.php?Item
services igh-­‐ road road user user ment.php n/index.html conducive to vulnerable vulnerable transport _ID=43 injury transport International _ID=43 Rural Corporation Limited International International greater safety road road users users corridors neighbourhoods corridors and and Electrification South frica 2.2 • Prioritise •and Identification and DPW: Safety Safety of vulnerable of vulnerable road ruoad sers users SouthAAfrica
recreational services services http://recindia.nic.in/ rural development DPLG/ Neighbourhood, electrificatio
provision of Eskom http://www.oecd.org/dataoecd/24/4/21034
http://www.oecd.org/dataoecd/24/4/21034
Eskom rural development
settings http://financialresults.co.za/2011/eskom_ar
SALGA, home and n for injury electrification 92.pdf. 92.pdf. http://financialresults.co.za/2011/eskom_ar2011/eskom_
2011/eskom_foundation2011/rural_develop
Treasury prone areas • Identification infrastructure aand nd DPW: transport Dedicated South Africa foundation2011/rural_development.php
ment.php infrastructure services in high-­‐
pathways and DOT Empowerment International Impact Assessment (EmpIA) development of International conducive to injury lanes for http://www.nra.co.za/live/content.php?Item
road user Rural Electrification Corporation Limited
Rural Electrification Corporation Limited greater safety neighbourhoods vulnerable _ID=43 transport http://recindia.nic.in/
http://recindia.nic.in/ and r
ecreational International road users corridors and settings Safety of vulnerable road users services http://www.oecd.org/dataoecd/24/4/21034
South Africa • Identification and DPW: • Dedicated 92.pdf. South Africa
DOT Empowerment Impact Assessment (EmpIA) pathways and development o
f Empowerment Impact Assessment (EmpIA)
http://www.nra.co.za/live/content.php?Item
lanes for road user http://www.nra.co.za/live/content.php?Item_ID=43
_ID=43 vulnerable transport International
International road users corridors and Safety of vulnerable road users
Safety of vulnerable road users services http://www.oecd.org/dataoecd/24/4/2103492.pdf.
http://www.oecd.org/dataoecd/24/4/21034
92.pdf. 20
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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
Table 3. Gender inequality and dominant masculinity norms
Extent and evidence of
contribution to injury
CCo-occurring Factors
• Majority of fatal injuries
due to violence, traffic
crashes, burns and
drowning to young men
• Patriarchal norms
• Lifetime prevalence of
25% among adult women
• Absence of fathers in
child rearing
• 40% of men disclose
having been physically
violent to a partner
• Violence to affirm identity
as males
• Poverty and
unemployment
• Normalisation of
aggression
Key recommendations
Recommended service
delivery priorities
• Promoting cultural and
social norms that support
gender equality and
positive masculinity
• Strengthen national
policies and legislation
aimed at improving status
of women
• Strengthen safe and
nurturing relationships
between children and
caregivers
• Establish communication
strategy to promote
human rights and gender
equality
SA strategies
• 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
• 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
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.
The main outcomes of this objective are to:
(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.
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Objective 3
Facilitate equitable gender relationships and norms
Outcome
Strategy
Intervention
Lead agency:
Partners
Examples
DWCPD/ GCIS:
South Africa
and social norms that
policies and legislation
to review, promote and monitor
Commission of
Promotion of Equality
support gender equality
aimed at improving the
the implementation of national
Gender Equality
and Prevention of Unfair
and positive masculinity
status of women.
policies and legislation
(CGE), DOH, NPA
Discrimination Act http://www.
3.1 Strengthened cultural
• Strengthen national
• Inter-Ministerial Committee
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
• Inter-Ministerial Committee to
DSD/
South Africa
DOJ&CD: CGE
Commission for Gender Equality
strategy, including
develop, implement and
leadership messages to
monitor communication
http://www.cge.org.za/
promote human rights and
strategy
International
social norms that support
Regional Framework for Action
gender equality within an
on Injury and Violence Prevention
equal, gendered
2008-2013
perspective
http://www.wpro.who.int/
internet/resources.ashx/MNH/
injuries_prevention/2008/Regio
nal+Framework+for+Action+V
IP2008-13.pdf
• Establish a communication
• Inter-Ministerial Committee to
DSD:
South Africa
CGE
Sonke Gender Justice
strategy, including
develop, implement and
leadership messages to
monitor communication
http://www.genderjustice.org.za/
promote social norms that
strategy
International
support masculinity
Gender and Access to Health
Services Study
http://www.dh.gov.uk/en/
Publicationsandstatistics/
Publications/
PublicationsPolicyAndGuidance/
DH_092042
• Develop and implement
• Implement evidence-led
DSD:
South Africa
CGE, DPLG, SAPS
Stepping Stones (DOH-MRC)
evidence-led programmes
programmes, prioritise
that address gender
communities with highest injury
International
stereotypes and promote
rates in each province
Mentors in Violence Prevention
gender equality
http://www.jacksonkatz.com/
mvp.html
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3.2 Safe and nurturing
relationships between
children and caregivers
• Expand and strengthen
ECD services for children
• Expand ECD registration in
high-injury communities
DBE:
South Africa
DSD, DOH, SAPS
The Aware Parenting Institute
in low-income and
high-risk families and
communities
http://www.awareparenting.com/
• Develop/implement compulsory
southafrica.htm
safety training for ECD
International
practitioners
Positive Parenting Programme
www.triplep.net/
DSD:
South Africa
DOH, SAPS
The Aware Parenting Institute
• Strengthen and implement
• Implement evidence-led
evidence-led programmes
programmes, prioritise
and services for families
communities with highest injury
http://www.awareparenting.com/
at risk
rates in each province;
southafrica.htm
prioritise young, unemployed
International
and single caregiver families
Positive Parenting Programme
www.triplep.net/
• Develop and implement
• Implement evidence-led
DSD:
South Africa
DOH, SAPS
CASE
evidence-led programmes
programmes, prioritise
and services that enhance
communities with highest
http://www.case.za.org/contact.
parenting skills and
injury rates
html
promote positive
International
fatherhood
Programme H
http://www.promundo.org.br/en/
• Strengthen PHC at facility
• Implement PHC in communities
DOH
South Africa
level and through
with highest injury rates;
South African Gender-based
community health worker
prioritise young, unemployed
Violence and Health Initiative
support to screen, refer
and single caregiver families
http://www.mrc.ac.za/gender/
and support families
sagbvhi.htm
at risk of injury; and
International
promote safe and
Safer communities – Action Plan
nurturing relationships
to reduce Community violence
and sexual violence, New Zealand
2004
Evidence relevant to Objective 4
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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Table 4. Alcohol and drug abuse
Extent and evidence of
contribution to injury
CCo-occurring Factors
• 2010/2011: increase
of 10,2% in drug-related
crime
• Poverty
• 2010/2011: increase
of 4,5% in driving under
influence of alcohol or
drugs
• Widespread trauma
• Strong correlation with
injury
SA strategies
• Prevention of and
Treatment for Substance
Abuse Act 2008
• Unemployment
• Strategic framework
on crime and drugs for
Southern Africa, 2003
• 75% of South Africans
experience at least one
traumatic event during
lifetime
Recommended service
delivery priorities
Key recommendations
• Strengthen and enforce
legislation and policy
• Implement the Second
Biennial Substance Abuse
Summit Resolutions, 2011
(DSD)
• Strengthen mental health
and rehabilitation
services
• Implement and strengthen
community-based mental
health and after care
services, especially in
high-risk settings.
• National Drug Master
Plan, 2012-2016
• Road Traffic Safety
Management Plan for
2015
• Programmes: Arrive Alive
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.
Objective 4 Reduce alcohol and drug abuse Outcome 24
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4.1 Harmonised legislation and policy i)•
4.2 Strengthened mental health and after-­‐care services iii)
Strategy Coordinate strategy to reduce the harmful use of alcohol, across all provinces Intervention ii)
• Implement and monitor master plan/strategy across provinces 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 Lead agency: Partners Inter-­‐Ministerial Committee on Alcohol and Substance Abuse: Examples South Africa Second Biennial Substance Abuse Summit Resolutions, 2011 (DSD); International DTI, DSD DOT, SAPS, WHO, Draft global strategy DOH to reduce the harmful use of alcohol (February, 2010)
DOH/DSD: SRSA, South Africa SAPS SANCA Sinethemba Programme http://www.sancawc.co.z
a/uploads/files/File/sine
thembareport2010.pdf International Midwestern Prevention Project 2013/02/14 10:05 AM
4.1 Harmonised i)
Strategy Coordinate strategy to reduce the harmful use of alcohol, across all provinces Intervention ii) Implement and monitor master plan/strategy across provinces 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 Outcome legislation and policy Partners Inter-­‐Ministerial Committee on Alcohol and Substance Abuse: Examples South Africa Second Biennial Substance Abuse Summit Resolutions, 2011 (DSD); International DTI, DSD DOT, SAPS, WHO, Draft global strategy DOH to reduce the harmful use of alcohol (February, 2010)
DOH/DSD: SRSA, South Africa SAPS SANCA Sinethemba Programme http://www.sancawc.co.za/uploads/
http://www.sancawc.co.z
a/uploads/files/File/sine
files/File/sinethembareport2010.pdf
thembareport2010.pdf International Midwestern Prevention Project http://www.promisingpracti
ces.net/program.asp?progra
mid=72 25
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PRIORITY AREA 2: REDUCE RISKS SPECIFIC TO THE
DIFFERENT INJURY PRIORITIES
Objective 8
(2) RISKS SPECIFIC
TO THE DIFFERENT
INJURY PRIORITIES
Objective 5
Objective 6
Objective 7
Facilitate
comprehensive
measures to prevent
violence-related
injuries and contain
associated severity
Facilitate
comprehensive
measures to reduce
road traffic-related
injuries and
associated severity
Facilitate
comprehensive
measures to
reduce suiciderelated injuries and
associated severity
Facilitate
comprehensive
measures to prevent
and reduce the
severity of injuries
arising from falls,
burns, poisonings
and water related
incidents
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.
Evidence relevant to Objective 5
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).
Table 5.1 Injuries and male interpersonal violence
Extent
Key upstream
factors
Downstream
Factors
• 12 880 male
homicides (age:
15–29; 2007)
• Poverty
• Job loss
• Unemployment
• Conflicts
• 156 505 male
prisoners (as of
10/2010) (of
total of 160 026)
• Inadequate
housing
• Dominant
masculinity
• Communities
with reduced
social capital
• Substance
abuse
• Gender roles/
masculinities
• Weapons
• Gang violence
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
Gaps
Recommended Service
delivery priorities
• Limited policies
• Mobilisation of men
networks
• Limited
interventions
specific to young
males
• Targeted employment
opportunities
• Responsible
fatherhood
interventions
• Conflict resolution
skills
• Reintegration
programmes in jails
• Reduce alcohol & drug
availability/use
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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).
Table 5.2 Injuries and intimate partner violence
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
Key upstream
factors
Downstream
Factors
• Poverty
• Job loss
• Communities
with reduced
social capital
• Partner
substance abuse
• Inadequate
housing
• Relationship
conflicts
• Gender inequity
SA stratergies
• Domestic
Violence
Act 1998 (e.g.
protection orders)
• Sexual Offences
and Related
Matters Act
2007
• Lack of
education
• Maternal, Child
and Women’s
Health Policy
• History of child
sexual abuse
and substance
abuse
• Victim
empowerment
centres
Gaps
Recommended Service
delivery priorities
• Multi-sectoral
approach
• Mobilisation of women
networks
• Targeted mental
health services
• Integrated police,
health and legal
system responses
• Training of police,
prosecutors, judges in
legislation
• Strengthen screening,
investigation and
monitoring
• Mental health services
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).
Table 5.3 Injuries and child abuse
Extent
• 906 murder
cases reported
against children
under 18 in
2010/2011
• SAPS
2010/2011:
28 128 sexual
offences against
children under
18
Key upstream
factors
Downstream
Factors
SA stratergies
• Poverty
• Family job loss
• Children’s Act
• Communities
with reduced
social capital
Inadequate
housing and
community
spaces
• Family
substance abuse
• School Safety
regulations
• Large number of
children
• School sexual
violence and
harassment
prevention
guidelines
• Low family
cohesion
• Child: premature birth, handicaps
• Young maternal
age
• Child Protection
and Support
Services
Programme
Gaps
• Coordinated
response
Recommended Service
delivery priorities
• 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
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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
Outcome
Strategy
Intervention
Lead agency:
Partners
Examples
DBE:
South Africa
skills development
schools that report a
based violence
SAPS, SRSA,
CSVR Youth Violence Prevention Programme
in children and
high rate of violence,
prevention programmes
NYDA
http://www.csvr.org.za/
adolescents
to provide evidence-led
in communities with the
school-based violence
highest violent injury
International
prevention programmes
rates
Violence Intervention Program (VIP)
5.1 Strengthened life
• Identify and prioritise
• Implement evidence-
http://www.umm.edu/shocktrauma/special_
programs/violence_prevention_program_vip.htm
• Strengthen Life
Orientation Module
• Review Life Orientation
DBE
South Africa
Module and enhance
NYDA
Planning, quality assessment and monitoring and
safety promotion
evaluation Branch: DBE
components
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
• Implement training
DOH:
South Africa
SAPS, DOJ&CD
The Primary Health Care Package for South Africa
social work, police,
for the identification,
justice officials and
intervention and referral
– a set of norms and standards
health-care
of intimate partner
http://www.doh.gov.za/docs/policy/norms/full-
professionals to support
violence, and child, youth
norms.html
victims of intimate
and adult victims of
partner violence, and
sexual violence
International
child, youth and adult
National Consensus Guidelines on Identifying and
victims of sexual
Responding to Domestic Violence Victimization
violence
In Health Care Settings – US
http://www.futureswithoutviolence.org/userfiles/
file/Consensus.pdf
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5.2 Reduced access to
firearms and weapons
• Scale up the
• Enforce provisions of
SAPS: DOJ&CD,
South Africa
NPA
Firearm Control Act 2000 SAPS
implementation and
Act: licensing, purchase
enforcement of the
policies, and ban on
http://www.westerncape.gov.za/Text/2003/
Firearms Control Act
carrying firearms in
firearms_control_act_60_of_2000.pdf
of 2000
public
International
Firearms Act (S.C. 1995, c. 39), Canada
http://laws.justice.gc.ca/eng/acts/F-11.6/
5.3 Enhanced victim
• Strengthen and scale up
• Scale up access to
DSD
South Africa/International
identification screening,
access to child-
child-protection services
Inter-agency Child Protection Information
care and support
protection services and
and screening
Management System (IMS)
programmes
screening programmes
programmes in
http://childprotectionims.org/service.php?
in high-risk areas
communities with the
C=admin&M=downloadLoginDocument&fil
highest violence rates
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
• Scale up access to
DOH/DSD
South Africa
increase access to
mental health care and
A Facilitation and Training programme to
mental health care and
victim empowerment
implement the Victim Empowerment Programme
victim empowerment
programmes, including
in Six stations of the South African Police Service
programmes, including
comprehensive rape care
http://www.ipt.co.za/veprep.asp
comprehensive rape
services, in communities
International
care services
with the highest violence
Liverpool VCT, Care and Treatment (LVCT) – Post
rates
Rape Care (PRC)
http://www.endvawnow.org/uploads/browser/
files/programme_profile_and_highlights.pdf
Evidence relevant to Objective 6
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.
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Table 6. Traffic injury
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)
Downstream
Factors
Key upstream
factors
• Infrastructure:
Lack of
pedestrian
walkways, child
play areas
• Excessive travel
time: historical
spatial disparities
• Child pedestrians
in low-income
areas
• Alcohol
SA stratergies
• Speeding
• SA Road
Safety Strategy
2011–2020
• Seatbelt
compliance
• National Transport
Master Plan 2050
• Aggressive road
behaviours
• Public Transport
Strategy
• Driver fatigue
• Others: Arrive
Alive, Scholar
patrol, Bus Rapid
Transport System,
Demerit System,
Taxi
recapitalisation
• Low levels of law
enforcement
Gaps
Recommended Service
delivery priorities
• Pedestrian
infrastructure
• Strengthen Road Safety
Management capacity
• Poor enforcement
• Law enforcement
programmes (seatbelt
use, speeding,
substance abuse,
aggressive driving)
• M&E for existing
programmes
• Educational campaigns
targeting unsafe driver
and pedestrian
behaviour
• Infrastructure, of roads
& for pedestrians
• Separation of
pedestrians, twowheeled, and fourwheeled vehicles
• Affordable and safe
public transport
• Post-crash care
• Alcohol control
measures
Objective 6 places the focus on the facilitation of comprehensive measures to reduce road traffic-related injuries and
associated severity.
The main outcomes of this objective are to:
(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.
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Objective 6
Facilitate comprehensive measures to reduce road traffic-related injuries and associated severity
Outcome
6.1 Environmental
Strategy
• Undertake targeted area-wide
Intervention
• Identify and implement traffic
Lead agency:
Partners
DOT/DHS: RTMC
Examples
South Africa
speed reduction
traffic calming in high-risk
calming measures in
Speed reduction of adjacent
strategies
residential environments using
communities with the highest
traffic: safe demarcated
evidence-led measures
traffic injury rates
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
• Implement a graduated driver
legislation and
licensing system that requires
policy
young drivers to demonstrate
responsible driving behaviour
• Develop a graduated driver
licensing system
DOT:
South Africa
SAPS, Government
Graduated Driver Licensing
sector
System
• Pilot and fully implement a
http://www.saferoads.com/
before obtaining a final
graduated driver licensing
drivers/drivers_gdl_qa.html
unrestricted license
system
International
Learner Driver Development
Project
http://www.ectransport.gov.
za/index.php?option=com_co
ntent&view=article&id=197:
learner-driver-developmentproject&catid=1:latest-news
DOT:
South Africa
point demerit system for traffic
SAPS, Government
AARTO
offences through the AARTO Act
sector
http://aarto.co.za/
• Expedite implementation of the
• Implement AARTO
International
Demerit Point System, Ontario
http://www.mto.gov.on.ca/
english/dandv/driver/demerit.
shtml
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6.3 Optimised
• Expand screening of alcohol,
enforcement of high
speed and seatbelt use among
risk driving
motorists
• Maintain 1 million stops a month
campaign
DOT: Government
sector
South Africa
Rolling Enforcement Plan,
RTMC
behaviours
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
• Expand use of automated
DOT: Government
sector
South Africa
enforcement systems, e.g. using
enforcement systems in road
camera technology for speeding
systems with highest traffic
Suggested Criteria for the
use of Fixed Speed Timing
offense/injury rates
Camera Equipment For Law
Enforcement Purposes
International
Automatic speed enforcement,
Road safety: impact of new
technologies, 2003
• Review inter-departmental
DOT: Government
protocols between DOT, SAPS
protocols and implement
sector
and Criminal Justice for the
recommendations
• Strengthen inter-departmental
South Africa
Road Traffic Management
Corporation http://www.rtmc.
efficient and timeous
co.za/RTMC/Default.jsp
prosecution of offenders
International
Traffic Management New
Zealand
http://www.
trafficmanagementnz.co.nz/
• Implement harm-reduction
• Provinces/ municipalities
programmes targeting drink
to implement harm reduction
driving
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/drunkdriving/campaign/
Evidence relevant to Objective 7
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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Table 7. Suicide
Extent
• 7 500 suicides
annually
• 151 600 non-fatal
suicidal behaviour
• Highest in age
group 25–34:
±33%
• Predominantly
males: ±80%
Key upstream
factors
• Poverty
• Unemployment
• Disillusionment
with social
changes
• Glorification by
media
Downstream
Factors
SA stratergies
• Poor problemsolving ability
• Mental Health
Care Act
• Adolescence and
early adulthood
• Guidelines on
child and youth
mental health and
life skills
• Mood disorders
• Alcohol and drug
abuse
• Exposure to
diseases: chronic,
injuries, cancer,
HIV/AIDS
• Programmes:
Depression and
Anxiety Group,
Life Line, Mental
Health
Information
Centre
Gaps
• Action plans for
implementation of
policies
• Public
awareness
• Media control
poor
• M&E insufficient
• Family
environment
Recommended Service
delivery priorities
• National data and
screening
• Social and mental health
services
• Evidence-led
interventions for highrisk groups, including
high school
programmes, suicide
toll-free line
• Employment
opportunities to youth
and the poor
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.
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Objective 7
Facilitate comprehensive measures to reduce suicide-related injuries and associated severity
Outcome
7.1 Enhanced
Strategy
• Incorporate resilience
Intervention
• Adjust and implement
Lead agency:
Partners
DBE
Examples
South Africa
resilience and life
module within Life
Life Orientation FET
Planning, quality assessment and monitoring
skills in children and
Orientation FET (10–12)
(10–12): Development
and evaluation Branch: DBE
of Self in Society Module
http://www.education.gov.za/TheDBE/
within all schools
DBEStructure/BranchP/tabid/365/Default.
nationally
aspx
adolescents
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
7.3 Improved access to
• Implement school-based
• Implement school-based
DOH/DBE
South Africa
interventions to identify
interventions at Grade
Bishops – Suicide Prevention Policy
and refer learners at risk
R, 8 and 11 to identify
http://www.bishops.org.za/policies/Pastoral/
for suicide
learners at risk for
suicide.pdf
suicide and refer them to
International
appropriate mental health
National Suicide Prevention
services
Strategy for England 2002
• Implement and strengthen
• Develop and expand
DOH/DSD: SRSA
South Africa
mental health
community-based mental
community-based mental
Cape Mental Health
services
health services, especially
health primary, secondary
http://www.capementalhealth.co.za/index.
in high-risk settings
and tertiary prevention
International
services in communities
Community Mental Health Services Block
with highest suicide rates
Grant program
http://store.samhsa.gov/shin/content//
SMA10-4610/SMA10-4610.pdf
Evidence relevant to Objective 8
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.
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Table 8.1: Unintentional injuries due to burns
Injury type
Burns
Extent
• 4 000 deaths
• 1 300 children
Key upstream
factors
Downstream
factors
• Low socioeconomic
status
• Use of paraffin
home
equipment
• House layout
and materials
• Alcohol
• Inadequate
child
supervision
SA stratergies
• Paraffin stove
legislation
• Banning of
fireworks
• Electrification
Gaps
• Safe
specifications
for housing
policy
Recommended
Service delivery
priorities
• Paraffin stove
distribution/
enforcement
• Safe Housing Policy
• Hot water
cylinder
specifications
• Child clothing
standards
• Child garment
policy
• M&E of existing
initiatives
• M&E
Table 8.2: Unintentional injuries due to drowning
Injury type
Drowning
Extent
• 2.3% of all
injury deaths
• Males between
15 and 19
years
• 56% of cases
involve children
under 15 years
Key upstream
factors
Downstream
factors
• Previously
disadvantaged
population
• Alcohol
intoxication
• Unfenced water
and swimming
areas
• Not wearing
life jackets,
esp. male
boaters
• Lack of
parental
supervision
SA stratergies
• Learn to
Swim Program
(Swimming
South Africa
Gaps
• Drowning
prevention
& water
safety policies
& legislation
Recommended
Service delivery
priorities
• 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
Injury type
Falls
Extent
• Children,
especially boys
under 15 years
• Elderly
Key upstream
factors
• Substandard
housing
• Unemployment
• Poverty
Downstream
factors
• Socialisation
and role
expectations
for boys
SA stratergies
• Limited
Gaps
• Research
• Legislation
for children’s
recreation
• Inadequate
supervision
• Limited
South African
prevention
interventions
• Alcohol use
• Unsafe home/
institutional
environment
Recommended
Service delivery
priorities
• Planning and urban
design
• Playgrounds of
adequate safety
standards
• Education to
caregivers and
parents
• Exercise programmes
for elderly
Table 8.4: Unintentional injuries due to poisoning
Injury type
Poisoning
Extent
• 1.1% of injury
mortality
• 40 000–60
000 children
suffer paraffin
poisoning
Key upstream
factors
• Ongoing use
of lead and
other risky
products
• Unsafe
packaging,
labelling,
locations &
containers
Downstream
factors
• Unsafe home
environments
• Limited child
supervision
• Parental
unemployment
SA stratergies
Gaps
• Child-resistant
lids on paraffin
bottles
• Absence of a
national blood
lead
surveillance
system &
of blood
lead screening
programmes
• Phase out of
leaded petrol
• Legislation to
control the use
of lead in paint
Recommended
Service delivery
priorities
• Mandatory safety
standards
• Education campaigns
• Surveillance systems
• Source control
legislation
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).
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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
Outcome
8.1 Strengthened
Strategy
• Review and strengthen the
Intervention
• Commission
Lead agency:
Partners
DHS: DTI
Examples
South Africa
policy for safe home
safety specifications in the
enhancements of
National Building Regulations
and recreational
Housing Policy
safety specifications in
https://www.sabs.co.za/content/uploads/
the Housing Policy, e.g.
files/SANS10400%28colour_and_
specifications to enhance
looseleaf%29.pdf
overall security features
International
such as door locks, hot
Good, Green, Safe and Affordable Housing –
water geysers
Housing Praxis for Urban Sustainability, EU
spaces
http://urbact.eu/fileadmin/Projects/HOPUS/
outputs_media/hopus_booklet__02.pdf
• Develop and strengthen
• Develop and strengthen
DHS/ DCOGTA
South Africa
safety specifications that
safety specifications that
Summary Guidelines and Standards for the
govern recreational
govern recreational
Planning of Social Facilities and Recreational
spaces in high-risk
spaces in high-risk
Spaces in Metropolitan Areas
settings
settings
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
• Subsidise SABS approved
• Implement subsidy
DTI
South Africa
home and recreational
essential home equipment
formula for SABS
Compulsory specifications for non-pressure
equipment
for high-risk areas
approved essential home
paraffin stoves and heaters
equipment for high-risk
http://www.nrcs.org.za/siteimgs/vc/VC9089.
areas, including
pdf
appliances such as
International
stoves, hot water
Renewable Energy Bonus Scheme—Solar
cylinders and fire alarms
Hot Water Rebate, Australia
http://www.climatechange.gov.au/
government/programs-and-rebates/solarhot-water.aspx
DTI
South Africa
• Scale up enforcement of
• Scale up monitoring
the safety standards for
and enforcement of
Compulsory specifications for non-pressure
the distribution and
safety standards for the
paraffin stoves and heaters Standards Act
storage of paraffin
distribution and storage
http://www.nrcs.org.za/siteimgs/vc/VC9089.
of paraffin in
pdf
communities with highest
International
paraffin usage
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: FACILITATE SUPPORTIVE INSTITUTIONAL
AND ORGANISATIONAL ENVIRONMENTS
Priority Area 3 has four objectives, all of which are intended to reduce the risk for injuries.
Objective 10
(3) SUPPORTIVE
INSTITUTIONAL
AND
ORGANISATIONAL
ENVIRONMENTS
Objective 9
Promote effective
leadership across
lead agencies
Promote
inter-sectoral
collaboration within
Government and
with civil society
Objective 11
Objective 12
Facilitate the
collection and
use of empirical
information
for planning,
implementation and
evaluation
Promote effective
and equitable
resource allocation
and utilisation for
the implementation
of evidence-led
interventions
Evidence relevant to Objective 9
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.
Table 9. Effective leadership by lead agencies
Current status and
impact
• Strategic Framework
(SF) will allow
coordination of
violence and injury
prevention at high
level
• Leadership spread
across Departments
SA strategies
Gaps/
Recommendations
Recommended service
delivery priorities
• Communication
strategy between
role-players
• Shared vision of the
Strategic Framework
mission
• High-level leadership
to foster political
commitment
• National Steering
Committee to monitor
implementation of
Strategic Framework
• Demarcation of roles
and responsibilities
• Strategic Framework
recognises critical
inter-sectoral
contributions of all
stakeholders
• Institutionalisation of
Strategic Framework
objectives in
departments
Current supportive
factors
• Mandate Departments
or other agencies to
lead specific
objectives of the
Strategic Framework
• Departments to fund
from existing budgets;
Treasury to
supplement
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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.
Objective 9
Promote effective leadership across lead agencies
Outcome
Strategy
Intervention
Lead agency:
Partners
Examples
Directors-General
South Africa
implementation of
foster political
Steering Committee to
of the Human
HIV/AIDS/STD Strategic Plan for South Africa
the injury prevention
commitment for the
monitor and review the
Development
2007-2011
strategy through
implementation of the
implementation of the
Cluster: All
International
effective leadership
Strategic Framework
Strategic Framework
participating
The National Injury Prevention and Safety
departments
Promotion Plan: 2004–2014 – Canberra
9.1 Effective
• Identify leadership to
• Mandate National
Directors-General
South Africa
or other agencies to
of the Human
National Road Safety Strategy
take responsibility for
Development
2011-2020
the specific goals of the
Cluster: All
International
Strategic Framework
participating
New Zealand Injury Prevention Strategy
departments
2008–2011 Implementation
• Mandate Departments
Evidence relevant to Objective 10
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.
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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.
Table 10: Intersectoral collaboration
Current status and
impact
• 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
Current supportive
factors
• Multiple
understandings of
injury prevention
SA strategies
• Some inter-sectoral
collaboration between
lead agencies in
injury
prevention
• Overall Presidency
Outcomes: All
spheres of
Government
work together
to reduce poverty,
underdevelopment,
and marginalisation of
communities
• Recognition of
centrality of common
socio-economic
contributors
• Government mandate
for injury prevention:
All departments to
work together
Gaps/
Recommendations
Recommended service
delivery priorities
• Agreements with
departments on
Strategic Framework
objectives, outcomes,
interventions and
specific actions
• Departments to
elect internal entity
to lead process and
communicate with
other partners
• Lack of effective
communication
strategies among lead
agencies
• Departments to
communicate specific
responsibilities to
members and to other
partners
• Levels of prevention
prioritisation vary
across departments
• 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
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.
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Objective 10
Promote inter-sectoral collaboration within government and with civil society
Outcome
10.1 Inter-sectoral
Strategy
• Formalise agreements
Intervention
• Departments and
Lead agency:
Partners
All lead departments
Examples
South Africa
collaboration between
with departments
agencies to elect an
HIV/AIDS/STD Strategic Plan for South Africa
departments
and agencies on goals,
internal entity to lead the
2007-2011
outcomes, interventions
process and
International
and specific actions
communicate with other
The National Injury Prevention and Safety
recommended by the
partners
Promotion Plan: 2004–2014 – Canberra
Strategic Framework
• Departments and
All lead departments
South Africa
agencies to
National Road Safety Strategy
communicate their
2011-2020
specific responsibilities
International
to members and to other
Ontario Injury Prevention Strategy 2007
partners
• Departments and
All lead departments
South Africa
agencies to effectively
HIV/AIDS/STD Strategic Plan for South Africa
manage their role in
2007-2011
the initiative, set internal
International
timeframes, carry out
New Zealand Injury Prevention Strategy
responsibilities, and
2008–2011 Implementation
monitor and evaluate
• Departments and
All lead departments
South Africa
agencies to maintain
HIV/AIDS/STD Strategic Plan for South Africa
continuous, long-term
2007-2011
participation in and
International
provide feedback to the
Actions for a safer Europe, Strategy
collaborative initiative
document of the Working Party on Accidents
and its leadership
and Injuries for 2005–2008
Evidence relevant to Objective 11
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.
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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.
Table 11. Information collection for injury prevention planning and decision making
Current status and
impact
• Vested interests of
multiple stakeholders
• Inconsistencies with
surveillance data
across sources
• Limited quality
evaluation of
interventions
Current supportive
factors
• Existing systems
although mostly
manually collected
data
• Development of
automated
technologies in
provinces
SA strategies
• Sector-specific
systems
• Mostly manual data
collection
Gaps/
Recommendations
• Establish national
integrated injury
information system
• Expansion of
automated capture
and reporting webbased surveillance
systems
Recommended service
delivery priorities
• Appoint interdepartmental 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
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
Outcome
11.1 National Integrated Injury
Information System
Strategy
Intervention
Lead agency:
Partners
Examples
DOH, SAPS, DOT:
South Africa
national injury information
to identify stakeholders
EDD,DHS,DCS,
National Injury Mortality
system to monitor and
and implement effective
DOT, DSD, DPW,
Surveillance System (DOH and
evaluate existing initiatives
joint information
DOL, DTI, DBE
SAPPRU)
and programmes
management system
• Establish an integrated
• Inter-departmental group
International
National Vital Statistics System
http://www.cdc.gov/nchs/
nvss.htm
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DOH, SAPS, DOT:
South Africa
standardise and implement
EDD,DHS,DCS,DOT,
Monitoring and Evaluation
monitoring and evaluation
DSD, DPW, DOL, DTI,
branches for lead departments
protocols for existing
DBE
International
• Inter-departmental group to
initiatives and programmes
New Zealand Injury Prevention
Strategy 2008 – 2011
Implementation
• Inter-departmental group
DOH, SAPS, DOT:
South Africa
to develop strategy to
EDD,DHS,DCS,DOT,
Research Information
ensure national
DSD, DPW, DOL, DTI,
Management System (RIMS)
dissemination of
DBE
http://www.uj.ac.za/EN/
information
Research/RIMS/Pages/home.
aspx
International
Public Health
Data Standards Consortium
http://www.phdsc.org/default.
asp
Evidence relevant to Objective 12
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
Outcome
Strategy
Intervention
Lead agency:
Partners
Examples
• Formalise resource
Departments and
All lead
South Africa
resource allocation and utilisation
allocation strategy
agencies to elect
departments
Health Systems Trust resource
for the implementation of
and utilise monitoring
an internal entity to
allocation review
evidence-led interventions
and evaluation system
resource allocation
http://www.hst.org.za/sites/default/files/
for implementation of
strategy and monitor
res_allo.pdf
evidence-led
all movements
International
12.1 Effective and equitable
interventions
UNAIDS – Budget and resource
allocation matrix
http://www.unaids.org/en/media/
unaids/contentassets/documents/
document/2011/ubraf/Appendix4_
Budget_ResultsAllocationMatrix1_
12042011.pdf
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Departments and agencies
All lead
South Africa
to effectively manage their
departments
Monitoring and Evaluation
role in the initiative, set
branches for lead departments
internal timeframes, carry out
International
responsibilities, and monitor
New Zealand Injury Prevention
and evaluate implementation
Strategy 2008–2011
of evidence-led interventions
Implementation
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5. CONCLUSION
The 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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