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Zusha!

Pamoja tuokoe maisha (together we can save lives) – one sticker at a time.

Epidemics are not always disease-related. One of the largest—and growing—epidemics on the global health scene today, particularly in poor nations, is traffic accidents. While the incidence of poverty-related issues like malaria and tuberculosis is decreasing, the trajectory for road fatalities is going the other direction.

The Zusha! road safety campaign is a cost-effective intervention that has been proven to reduce road accidents and save lives by placing stickers inside of public service vehicles (PSVs) that encourage and empower passengers to speak up directly to their drivers against dangerous driving. The program is being scaled up throughout Kenya and is being tested in other parts of Africa.

The Problem

Road accidents are a major cause of death and injury globally; the World Health Organization (WHO) estimates that more than 1.25 million people die in road accidents each year, and another 20-50 million are injured. Road accidents are predicted to be the #5 cause of death globally by 2030.

The problem is especially pronounced in low- and middle-income countries, with the highest road traffic death rate occurring on the African continent. In sub-Saharan Africa, road deaths are the leading cause of death for people ages 15 to 29 and the second leading cause of death for children ages 5 to 14. The situation is particularly grim in Kenya, where the annual rate of road deaths, at 29.1 per 100,000 individuals, is the 15th highest in the world. Such loss of life and associated injuries have enormous socio-economic impact on families, communities, and the nation at large.

Many of the road deaths in Kenya occur in minibuses—“matatus”—the primary mode of transportation in the region. Accidents can occur because of reckless driving such as speeding and dangerous overtaking, often motivated by the fact that the faster a driver goes, the more passengers they serve and the more money they make. Traditional interventions such as speed governors, complaint hotlines, increased traffic enforcement, road improvements and new laws can be extremely expensive as well as slow to implement. Additionally, there’s no evidence that any of these initiatives have worked. More importantly, such approaches do not provide passengers control over ensuring their own safety in real time when subjected to life-threatening, dangerous driving.

The Solution

As the WHO noted in 2013, “Road traffic injuries have been neglected from the global health agenda for many years, despite being predictable and largely preventable.”

Georgetown University’s Drs. James Habyarimana and Billy Jack wanted to identify a way to to reduce the number of casualties at a low cost. Their brainchild proved to be simple, cheap and highly effective: changing the behavior of passengers as well as drivers by way of motivational stickers.

Georgetown’s gui2de, in partnership with the Kenyan insurance company Directline Assurance (DLA) and Kenyan authorities including the National Transport and Safety Authority (NTSA), tested and proved the effectiveness of placing stickers inside matatus and buses with motivational messages that encourage passengers to “Zusha!” against reckless driving– Kiswahili for “protest” or “speak up”– directly to their driver.

How Zusha! is different from other charities

Zusha! has run two randomized control trials which have proven significant impact; it partners with public and private entities, ensuring wide stakeholder input and support; they have a local office in Nairobi, which allows for direct and responsive oversight; the intervention is simple and inexpensive; and in the few short years of its existence, Zusha! has been recognized by multiple selective evaluators and funders for its innovative, effective results in saving lives. 

Why Zusha! is effective

Cost-Effectiveness

The stickers are an intervention that do not require any technology or expertise, they cost less than $1-$2 each for production and placement, and are viewed by millions of passengers throughout Kenya. The cost-effectiveness ratio of Zusha!'s program is estimated to be between $6.50-$11.70 per DALY.

Scale and Sustainability

Following the positive results of the experiments, in May 2015 the intervention was scaled up to the entire country of Kenya in partnership with the NTSA and Directline Assurance. To date, the Zusha! campaign has distributed over 100,000 sets of stickers to over 55,000 unique PSVs.

The program has also been tested through randomized control trials in neighboring Tanzania and Uganda, which concluded in late 2017. Results are forthcoming.

Monitoring and Transparency

Zusha! has conducted 3 major kinds of monitoring to assess the coverage rate of stickers: lottery compliance, National Transport and Safety Authority (NTSA) inspections and bus park checks. According to GiveWell, “in its scaled up program in Kenya, Zusha! has recently implemented strong monitoring and has found estimated coverage rates of about 20-50% among targeted vehicles.”

Proven Impact and Recognition

Between 2007 and 2013, results from two randomized control trials proved that the PSVs in which Zusha! stickers were placed had between 25-50% fewer insurance accident claims, translating annually into an estimated 140 avoided accidents and 55 avoided deaths.

In 2018, Give Well recognized the impact of Zusha! and named it a standout charity, estimating the program’s cost-effectiveness to be similar to that of unconditional cash transfers. In 2017, Good Ventures made a GiveWell Incubation Grant of $900,000 to support the Georgetown University Initiative on Innovation, Development and Evaluation (gui2de) for work on Zusha!.

Partnerships and Accountability

Zusha! is implemented with the help of local partners by the Georgetown University Initiative on Innovation, Development, and Evaluation (gui2de). gui2de conducts empirical field-based research to assess the impact and effectiveness of interventions and policies aimed at empowering individuals in developing countries to improve their lives.

Having an office in Nairobi, known as gui2de-East Africa, means that the program can be run more effectively in a “boots on the ground” manner rather than long-distance. gui2de-East Africa continues to coordinate the national scale-up of Zusha! in Kenya by designing, printing, and distributing stickers around the country, and facilitating support from both private organizations and government agencies.

The program's initial success helped Zusha!’s creators, Professors William Jack and James Habyarimana of Georgetown University, secure a grant from USAID to scale up their intervention nationwide in Kenya and initiate research trials to Tanzania, Rwanda, and Uganda.

Frequently Asked Questions

What do the Zusha! Stickers say?

The stickers feature pictures of accidents or injured passengers with messages like the following, some in English and some in Swahili:

  • Take action against reckless driving. Speak up to the driver now!
  • Don't let an over speeding driver end the life of a child. Demand a safe ride!
  • Over speeding + Overlapping = Death. Speak up to avoid accidents.
  • If only one of the passengers had spoken up!
  • Your family needs you, tell the driver not to be careless with your life!

What if drivers take the stickers off their vehicle’s windows?

To encourage the drivers to place and retain the stickers in their vehicles, the campaign includes a lottery through which public service vehicle (PSV) drivers can win a cash prize if they correctly display the stickers.

What will donations be used for?

Zusha! will use the funds primarily to ensure they can continue designing, printing, and distributing stickers. To conduct those activities, they will also use funding to support a couple of field staff based in their Nairobi office, who will continue collaboration and outreach with partners such as insurance companies and government agencies. Zusha! plans to use donations from TLYCS donors only for these direct project costs, not for rent, general office overhead, etc.

Does Zusha have more room for funding?

GiveWell estimates that Zusha! “could use at least an additional $800,000 per year to support implementation of its program in Kenya.” The degree of rigor that the program will engage in going forward depends on how much support it receives, with priority going to printing and delivery of stickers.

Why does The Life You Can Save recommend Zusha!?

We recommend Zusha! because they have been named a Standout Charity by GiveWell, a highly respected charity evaluator.

Is my donation to Zusha! Tax-deductible?

Donations to Zusha! are tax-deductible for US donors, to the extent allowed by law.

More Information

Resources

Image credits: All photos courtesy of Georgetown University Initiative on Innovation, Development, and Evaluation (gui2de)

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