Demystifying the TN Model – Understanding the Design Thinking based Systems Approach to Road Safety

Dr. Venkatesh Balasubramanian

The SARS-CoV-2 or COVID-19 as it is popularly referred to has had a major impact on life and livelihood globally in 2020. Based on its impact , WHO had labelled COVID-19 a pandemic on March 11, 2020 [1, 2]. In India, the pandemic has brought about unimaginable cataclysm in terms of loss in life and livelihood. More than 149,255 lives were lost across the nation in 2020 [3]. Businesses were closed for months and livelihood across the spectrum took a sharp negative turn. The GDP registered a negative growth of 23.9% in Q1 of 2020, when the impact of the first wave of the pandemic was at its peak [4].

That the year was “2020” should also give a clarity of vision. To have clarity, let us contrast the loss from pandemic with the loss of life and livelihood from road accidents. Year-on-year the numbers have been marginally increasing and coasting in the neighbourhood of about 150,000 fatalities from road accidents [5]. Top this up with the number of grievous injuries of about 178,000 [5]. These are injuries that lead to an admission in hospital and/ or sustained reduction in quality of life. Additional medical expenses, loss of income due to injuries and disability, not to mention the pain and suffering, degrade the entire family’s quality of life and cumulatively add to the socio-economic burden.

It is reported from studies in Tamil Nadu that the loss of life has an additional dimension. About 84.3% of the fatalities from road are in the age group of 18-57. This age group that is productive and contributes to the economy and society is lost prematurely due to road accidents. Among these, about 87% are men [5]. Considering the common practice in India, which has a predominant male member in the age group of 18-59 as the earning member in the family, the real loss in a fatality from road accident isn’t limited to the one person, but to the entire family including parents, spouse, children and sometimes extended family members. This trend is similar across India as the fatality distribution across age and gender is similar [6].

If the pandemic has taught us anything, it is that we have great intrinsic resources and capability in our country to rapidly build systems and drive a mindset change to steer our nation to safety. This innate ingenuity of Indians to innovate and improvise have ensured that India has one of the lowest observed case-fatality ratio of 1.4% during the pandemic. This has been lower than many of the high-income countries [7]. It is important to note that many of these innovations are the essence of the flagship thought process Atmanirbhar Bharat announced by the Government of India.

It is imperative that we learn and understand our strengths to stop road accident fatalities, which is higher than the Covid-19 toll year-on-year. It is also a mirror to get a visual feedback on the impact of extensive expenditure incurred year-on-year for road safety by the Government, industry and public in the traditional approach. Clearly based on the fatalities and the year-on-year growth, the return on investments from the various initiatives is wanting. We need a radical and innovative approach to bring structural, process and mindset change in the road safety initiative across India.

Road safety requires a disruptive approach to innovate in the problem space. Our transformational lessons from design thinking in manufacturing has introduced a paradigm shift in understanding the complexity of road safety and unique roles each governing stakeholders have. The first premise is to introduce an element of Empathy in the otherwise traditional 4E model of road safety that concerns Engineering, Emergency Care, Enforcement and Education. Empathy provides a perspective of road safety as an animate evolving entity based on the needs of road users. It would allow to integrate the principles of Human Factors to formulate efficient and flexible road safety initiatives.

The second premise is to differentiate preventable mortality and amenable mortality across an accident timeline. In the pre-crash stages, several preventive measures could be implemented by police, transport, health, highways, public or private NGOs/ citizen groups and vehicle manufacturers to reduce the occurrence of an accident. During an accident, the priorities of stakeholders realign and the collective goal should be to provide effective and timely emergency care to the victim.

Strengthening organised trauma care in the state is the key towards increasing the survival rate of the road accident victim. Tamil Nadu Accident and Emergency Care Initiative (TAEI) brought an organisational change and implemented process driven emergency care to a network of selected public hospitals in the high accident corridors of Tamil Nadu. Proper rehabilitation post-accident will lower injury disability and accelerate productivity of the victims. Tamil Nadu was a pioneer state in identifying the importance of stakeholder's integration and formulated evidence-based road safety programs and interventions.

The collective responsibility of road safety is shared among all stakeholders. However, without an overt and specific responsibility, the sustainability of the initiatives can get lost between the gaps. It is essential for each state to adopt a structured framework for a data-driven systems approach to road safety to set realistic targets, strategize programs and action plans. RBG Labs Suzhal Management System (SMS) and RBG Innovation Paradigm (RIP) provides scientific design thinking tools that can lay the platform to design agile road safety systems, framework for implementation, monitor performance and enable continuous improvements.

Transportation Safety Framework offers the first leap that every state will require to frame its Road Safety Goals and Agenda for public policy and decision making. However, the quality of programs can be improved only with high quality data from each of the stakeholders in police, health, highways, transport, vehicle manufacturers etc. The police department in Tamil Nadu took the initiative in collecting road accident data since 2009, which enabled the state to identify vulnerable locations and safety issues.

A decade of road accident data collected by the Tamil Nadu Police Department through the Road Accident Database Management System (RADMS) software provided the evidence that was very crucial in identifying vulnerable regions. Transportation Safety Framework provided a methodology for evaluating these vulnerabilities from the dimensions of human factors engineering, infrastructure engineering, trauma care capabilities and data quality. Death audits involving multiple stakeholders in road safety allowed to gather data on the causes and the impact of an accident.

The Tamil Nadu mantra was to periodically collect, collate, analyse, strategize, implement, evaluate and repeat for continuous improvement. Evidence-based programs implemented towards proactive accident preventive measures, forgiving roads that minimise injury and damage, ubiquitous driver behaviour monitoring, improved safe systems in vehicles and saving lives through organised trauma care were some of the outcomes of the TN success story in achieving 100% of SDG road safety goal.

The TN model of road safety is the culmination of best practices from Design Thinking, Lean Manufacturing and data-driven systems approach to problem solving. This data-driven model of road safety should be adopted by every state in India to identify its road safety demands, and create a clear action plan to start its journey towards preventing road accidents and deaths.

Acknowledgment 

Thanks a bunch to RBG team members Priya Natarajan and Debayan Tiwari!

References

1. Virtual press conference on COVID-19. 11 March 2020, World Health Organisation. https://www.who.int/docs/default-source/coronaviruse/transcripts/who-audio-emergencies-coronavirus-press-conference-full-and-final-11mar2020.pdf?sfvrsn=cb432bb3_2
2. Naming the coronavirus disease (COVID-19) and the virus that causes it. World Health Organisation. 11 February 2020. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/naming-the-coronavirus-disease-(covid-2019)-and-the-virus-that-causes-it
3. COVID-19 Dashboard of India, A crowd sourced Initiative. https://www.covid19india.org/
4. Monetary Policy Report – October 2020, Reserve Bank of India, https://rbidocs.rbi.org.in/rdocs/Publications/PDFs/MPR0910200CB2848C2D8A40758A1FB7AE110E3F16.PDF
5. Road Accidents in India 2019. Ministry of Road Transport and Highways, Government of India. https://morth.nic.in/sites/default/files/RA_Uploading.pdf
6. World report on road traffic injury prevention: summary. Edited by Margie Peden et al., ISBN 92 4 159131 5. https://www.who.int/violence_injury_prevention/publications/road_traffic/world_report/summary_en_rev.pdf
7. Mortality Analyses. The Johns Hopkins Coronavirus Resource Center (CRC). https://coronavirus.jhu.edu/data/mortality

Understanding the Chronology of CoVID-19 2nd Wave in India

Dr. Venkatesh Balasubramanian

The second peaking or wave of COVID pandemic in India at large could be considered as Feb 10, 2021 [1]. While the country is riding this wave, a key observation is the cost and the scale of destruction in its wake. This cost is not just in terms of health and material well-being but also the explosive growth of the fear factor across the population. 

A plethora of reasons have been cited by many starting from vaccination drive to health infrastructure development to complacency in the policy formulation to implementation to the lackadaisical attitude among the public. The merits of each of the causal factors must be analysed with better data when details of the functioning of various offices are available in public domain. 

This article looks at four major events that were commonly reported as super spreading events. While all of them may have contributed in their own way, it isn’t apparent that any of them would’ve been singularly responsible for the 2nd wave that has ravaged the country. 

First of the four major events mentioned in the exhibits is the farmers’ protest in Delhi starting with the protesters breaching security cordons and crossing the bridge on Ghaggar river along the Punjab-Haryana border on November 26, 2020 [2]. The crescendo of this protest was when the protesters breached various barricades and reached the Red Fort on the 72nd Republic Day (January 26, 2021). The farmer protest continues at various locations on Delhi’s border with Haryana and Uttar Pradesh till date.

The second event that is plotted is the opening of cinema halls to 100% capacity from February 01, 2021. The opening of cinema halls is a subject matter under the State list (health and home) and must be decided by the States independently. On March 4, 2021, the Ministry of Health and Family Welfare, Government of India, announced that gaming arcades, children’s play areas, saunas and steam baths in malls can open [3]. Although it is a subject matter of States, February 1, 2021, is taken as a cut-off date when 100% capacity in cinema halls (closed spaces) was permitted by an announcement from the Union Minister for Information and Broadcasting. [4] This is three days after the Honourable Prime Minister had declared, at the World Economic Forum, that India had beaten COVID pandemic. [5]

The Kumbh Mela, held between March 11 to April 27, 2021, in Haridwar, is the third event. An estimated 3.5 million people from across the country had attended this holy festival involving various congregations and taking a dip in the sacred Ganges. Based on various news reports, COVID – appropriate behaviours of masking, social distancing and hand cleanliness were flouted as a norm [6].

Elections across four States and one Union Territory was announced by the Election Commission of India on February 26, 2021 [7]. These elections were held in phases between March 27 to April 29, 2021. The State of West Bengal voted in all the eight phases, Assam voted in three phases while Kerala, Tamil Nadu and Puducherry voted on a single day. The process of reaching out to people for canvasing and the very process of polling had brought about COVID – inappropriate behaviour across the States [8][9]. This is the fourth major event.

On February 10, 2021, two weeks after the January 26, 2021, protests, COVID-19 cases across the country started increasing. India recorded 11,421 positive cases [1]. Since that day, India has recorded a 131.75% increase in confirmed SARS CoV2 cases (Exhibit 1).

Exhibits 2 – 13 shows that after the four major events, caseloads across the States began to increase. These events enabled higher level of public contact and in three of them – farmers’ protests, Kumbh Mela and elections – COVID-appropriate behaviour was not followed.

Among the States that went to the polls, Kerala recorded a spike in cases after the elections were announced (Exhibit 2). In West Bengal (Exhibit 3), the caseload began to increase after March 1, 2021 [1] and followed by a sharp uptick from the time when Kumbh Mela began. This period also witnessed heightened political activity in the poll-bound States. The cases continued the upward spiral as election rallies became a regular feature in the States. Since February 10, 2021, confirmed cases in West Bengal is up by 101.53%.

Uttarakhand, which hosted the Kumbh Mela, recorded a 188.68% (Exhibit 4) increase in confirmed cases from February 27, 2021, its inflection point. On March 11, 2021, when the Kumbh Mela started, it had reported 57 SARS CoV2 cases [1]. On May 11, 2021, two weeks after the festival ended, it reported 7,554 positive cases [1]. 

Neighbouring State of Uttar Pradesh (Exhibit 13) recorded a 170.15% increase in confirmed cases from that inflection point. Its caseload went up from March 16, 2021, onwards, when it recorded 161 cases [1], and touched 34,813 on April 27, 2021 [1]. Confirmed cases post the beginning of Kumbh Mela surged in Gujarat (184.31%), Karnataka (135.95%) and Delhi (119.74%). (Exhibits 5, 6 & 7 respectively).

Punjab recorded 198 cases on February 10, 2021, and since then its caseload climbed to 8,575 on May 12, 2021 [1]. They recorded 183.99% increase in SARS CoV2 cases from their inflection point (Exhibit 8). Haryana recorded a 160.34% rise in confirmed cases since February 10, 2021 (Exhibit 9). From 198 on February 10, 2021, its daily caseload touched 387 on February 24 [1]. This State reported 15,786 positive cases on May 4, 2021.

Kerala (Exhibit 2) had confirmed positive cases hovering around 5,000 through out 2020. Their caseload started to decrease from February 9, 2021, and touched a low 1,804 on March 18, 2021. The State’s caseload began to gradually increase from March 19, 2021 and exponentially from the 2nd week of April 2021. On May 12, it reported 38,143 cases [1].

Maharashtra (Exhibit 10) starts seeing a reduction in cases in November and when life gets back to normal the cases shoot up due to COVID-inappropriate behaviour, showing early signs of the 2nd wave.

In Tamil Nadu (Exhibit 11), there was a steady decline in cases from November 2020 till February 26, 2021, when it recorded 456 cases [1]. The daily caseload breached the 1,000-mark on March 21, 2021 [1]. As the election campaigns by all political parties went on a feverish pace drawing huge crowds, the caseloads exponentially grew to touch 10,015 on April 21, 2021 [1].

Even as we assess the short-term and long-term damage of SARS CoV2 in India, learnings from these four events and their impact are essential from a disaster management point of view to plan unlocking and moderating social behaviour. This will most likely soften the impact of the 3rd wave that is imminent. 

Based on the demographics of population that have been inoculated and infected the 3rd wave is likely to pound the productive age group of 18-45 years and possibly children who are below the age of 18 years. 

With the healthcare infrastructure for all practical purposes broken across the country in the current wave and the fatigue of healthcare providers clearly visible, it is important that appropriate data-driven approach to healthcare policy is essential across the country to avoid another disaster.

Acknowledgement

Thanks a bunch to RBG team members Rangam Harikrishna, Debayan Tiwari and Vishal Kannan!

Reference

1. Sutra, Covid India Prediction (https://www.sutra-india.in/)
2. Farmers Protest: Bricks Thrown, Barricades Flung into River in Farmers Vs Cops on Bridge - YouTube (https://youtu.be/y0udrbkylo8)
3. New unlock rules: Gaming arcades, children’s play areas in malls, saunas and steam baths may open - The Economic Times (http://www.ecoti.in/ZM_iIb via @economictimes)
4. 100% occupancy in cinema halls, theatres from 1 Feb, new SOPs issued (https://www.livemint.com/news/india/100-occupancy-in-cinema-halls-theatres-from-1-feb-new-sops-issued-11612072123623.html)
5. PM Modi's Address at World Economic Forum: "India Beat All Odds in Coronavirus Fight" (https://youtu.be/z7p5kDtH-mc) 
6. Kumbh Mela attended by 3.5 million pilgrims as India becomes the second most COVID-19 affected country in the world | Business Insider India (https://www.businessinsider.in/india/news/kumbh-mela-attended-by-3-5-million-pilgrims-as-india-becomes-the-second-most-covid-19-affected-country-in-the-world/slidelist/82044773.cms?utm_source=copy-link&utm_medium=referral&utm_campaign=Click_through_social_share)
7. https://eci.gov.in/files/file/12919-general-election-to-the-legislative-assemblies-of-assam-kerala-tamil-nadu-west-bengal-and-puducherry-2021/ 
8. Lives matter or polls? Covid-19 norms flouted during election season | India Today (https://www.indiatoday.in/india/video/humans-or-polls-covid-19-norms-flouted-during-election-season-1792376-2021-04-18)
9. Supreme Court Order - Civil Appeal No. 1767 of 2021. (https://main.sci.gov.in/supremecourt/2021/11474/11474_2021_35_1502_27915_Judgement_06-May-2021.pdf )

Exhibit 1 – India 

Exhibit 1: The exhibit shows COVID-19 cases in India along with the dates of major events considered to be super spreaders across the Nation The country recorded a 131.75% increase in confirmed positive cases since Feb 10, 2021 (Inflection point) 

Exhibit 2 – Kerala  

Exhibit 2: The exhibit shows COVID-19 cases in Kerala along with the dates of major events considered to be super spreaders across the Nation The country recorded a 75.03% increase in confirmed positive cases since Feb 18, 2021 (Inflection point) 

Exhibit 3 – West Bengal

Exhibit 3: The exhibit shows COVID-19 cases in West Bengal along with the dates of major events considered to be super spreaders across the Nation The country recorded a 100.98% increase in confirmed positive cases since Feb 19, 2021 (Inflection point) 

 

Exhibit 4 – Uttarakhand 

Exhibit 4: The exhibit shows COVID-19 cases in Uttarakhand along with the dates of major events considered to be super spreaders across the Nation The country recorded a 188.68% increase in confirmed positive cases since Feb 27, 2021 (Inflection point) 

 

Exhibit 5 – Gujarat 

Exhibit 5: The exhibit shows COVID-19 cases in Gujarat along with the dates of major events considered to be super spreaders across the Nation The country recorded a 184.31% increase in confirmed positive cases since Feb 12, 2021 (Inflection point) 

 

Exhibit 6 – Karnataka 

 

Exhibit 6: The exhibit shows COVID-19 cases in Karnataka along with the dates of major events considered to be super spreaders across the Nation The country recorded a 135.95% increase in confirmed positive cases since Feb 26, 2021 (Inflection point) 

 

Exhibit 7 – Delhi 

 

Exhibit 7: The exhibit shows COVID-19 cases in Delhi along with the dates of major events considered to be super spreaders across the Nation The country recorded a 119.74% increase in confirmed positive cases since Feb 22, 2021 (Inflection point)

 

Exhibit 8 – Punjab 

Exhibit 8: The exhibit shows COVID-19 cases in Punjab along with the dates of major events considered to be super spreaders across the Nation The country recorded a 183.99% increase in confirmed positive cases since Feb 10, 2021 (Inflection point) 

 

Exhibit 9 – Haryana 

Exhibit 9: The exhibit shows COVID-19 cases in Haryana along with the dates of major events considered to be super spreaders across the Nation The country recorded a 160.34% increase in confirmed positive cases since Feb 20, 2021 (Inflection point) 

Exhibit 10 – Maharashtra 

Exhibit 10: The exhibit shows COVID-19 cases in Maharashtra along with the dates of major events considered to be super spreaders across the Nation The country recorded a 180.83% increase in confirmed positive cases since Feb 11, 2021 (Inflection point) 

 

Exhibit 11 – Tamil Nadu 

Exhibit 11: The exhibit shows COVID-19 cases in Tamil Nadu along with the dates of major events considered to be super spreaders across the Nation The country recorded a 91.89% increase in confirmed positive cases since Feb 25, 2021 (Inflection point) 

Exhibit 12 – Rajasthan  

Exhibit 12: The exhibit shows COVID-19 cases in Rajasthan along with the dates of major events considered to be super spreaders across the Nation The country recorded a 172.19% increase in confirmed positive cases since Feb 27, 2021 (Inflection point) 

 

Exhibit 13 – Uttar Pradesh 

Exhibit 13: The exhibit shows COVID-19 cases in Uttar Pradesh along with the dates of major events considered to be super spreaders across the Nation The country recorded a 170.15% increase in confirmed positive cases since Feb 23, 2021 (Inflection point)