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VisionZero’: Is it achievable for rugby-related catastrophic injuries in South Africa?
  1. James Brown1,2,
  2. Wayne Viljoen1,3,
  3. Clint Readhead1,3,
  4. Gail Baerecke4,
  5. Mike Lambert1,2,
  6. Caroline F Finch,
  7. Australian Collaboration for Research into Injury in Sport and its Prevention (ACRISP), Federation University Australia, PO Box 663, Ballarat, Victoria, Australia5
  1. 1 Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
  2. 2 Department of Public and Occupational Health and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
  3. 3 South African Rugby Union, Cape Town, South Africa
  4. 4 Chris Burger Petro Jackson Players’ Fund, Sports Science Institute of South Africa, Cape Town, South Africa
  5. 5 Australian Collaboration for Research into Injury in Sport and its Prevention (ACRISP), Federation University Australia, Ballarat, Australia
  1. Correspondence to Dr James Brown, Division of Exercise Science and Sports Medicine, Department of Human BiologyFaculty of Health Sciences, University of Cape TownCape TownSouth Africa; jamesbrown06{at}

Statistics from

South Africa is home to an estimated 53 million people, 400 000 of whom play rugby union (‘rugby’) ( Although rare, rugby can be associated with permanently disabling injuries, which are tragic for the player and their family and also negative for the sport’s image.1 To reduce these injuries, a nationwide injury prevention programme, called ‘BokSmart’ (, was launched in South Africa in 2009.

Due to its vast socioeconomic disparities, South Africa is a difficult context for the implementation of any health intervention, let alone injury prevention programmes. South Africa ranks as the most inequitable country in the world ( Moreover, this inequity extends to healthcare: a recent report indicated that the poorest quintile of South Africans receive <10% of the country’s health benefits despite requiring close to 40% of these services, according to their self-reported health (figure 1).2 This disparity is partly due to infrastructure deficiencies in under-resourced communities. For example, rugby coaches in low socioeconomic areas mentioned infrastructure-related barriers to implementing BokSmart that were not mentioned by coaches from high socioeconomic areas.3 The fact that the same programme/strategy is implemented into different contexts may affect its success.

Figure 1

Comparison of need (according to self-reported health) and benefits of health services in South Africa. Quintile 1 - richest, Quintile 5 - poorest. Redrawn from.2

The most ambitious injury prevention intervention to date is the Swedish ‘VisionZero’, a road accident prevention initiative.4 While road accident mortalities might never be reduced to zero in Sweden, this intervention was successful because its ambitious name and laudable goal engendered buy-in from both government and the general public.4 Could such an approach be used to also tackle sport injuries?

With the difficult context that South Africa presents for health interventions, a similarly ambitious programme was required to reduce rugby-related catastrophic injuries. This programme, called ‘BokSmart’ (, was only achievable with a marriage between two equally successful organisations, with seemingly opposing goals: the Chris Burger Petro Jackson Players’ Fund and the South African Rugby Union ('SA RUGBY').

The Chris Burger Petro Jackson Players’ Fund: this club wants no more members (injured players)

The Chris Burger Petro Jackson Players’ Fund (CBPJPF) was founded by Morne Du Plessis when his provincial rugby teammate—Chris Burger—was fatally injured during a match ( The CBPJPF aims to assist all seriously injured rugby players through donations made by individuals and organisations, including SA RUGBY. These seriously injured players form the CBPJPF ‘membership’ who often mention their appreciation for this lifeline. However, the founding member of the CBPJPF—Morne Du Plessis—is quick to say ‘we don’t want any new members’.5

However, because of the potential for assistance that the fund offers seriously injured players, there is an incentive to report these injuries, making the fund, via its association with BokSmart, an accurate repository of such injuries. This accurate record is also a constant reminder to the sport’s governing body—SA RUGBY—of what happens when things go wrong.

SA RUGBY: this club wants more members (participants)

The unified SA RUGBY was officially formed in 1992 ( Besides trying to increase participation numbers, part of SA RUGBY’s governance includes player welfare. Player welfare is one of SA RUGBY’s most important strategic objectives. To answer calls for greater safety, SA RUGBY developed their own rugby safety programme using a similar model to New Zealand’s successful RugbySmart programme.6 SA RUGBY’s nationwide injury prevention intervention, BokSmart, was launched in 2009 as a collaboration of SA RUGBY and the CBPJPF.7 The mission of SA RUGBY was to grow the sport of rugby, through the provision of safe playing conditions for all participants.

Uniting these two bodies into a common VisionZero

Despite having seemingly opposing goals, the combination of SA RUGBY and CBPJPF through BokSmart is a necessary union for the reduction of rugby-related catastrophic injuries in South Africa. The relationship between SA RUGBY and CBPJPF ensures that the goal of increasing rugby player numbers does not occur at the expense of concomitantly increasing catastrophic injury numbers. Without their union through BokSmart, these two organisations would both be less effective in achieving their respective goals. Without SA RUGBY, the CBPJPF would be unable to support all of its recipients and without the CBPJPF, SA RUGBY would be less equipped to assist players when things go wrong. Rugby is after all a collision sport, and no matter what you do, there will always be potential for serious injuries to occur. In the inequitable health context of South Africa, the union between SA RUGBY and the CBPJPF is the proverbial lotus flower for rugby players. Empirical evidence from an ecological study suggests that this lofty ideal of VisionZero is starting to be achieved with a reduction in serious injury numbers.8

Whether or not VisionZero is achievable for South African rugby, it is critical that all of rugby’s stakeholders continue to embrace and pursue this goal for the benefit of all players. We challenge all other sporting codes and countries to get on-board the VisionZero bus.


The Australian Colloboration for Research into Injury in Sport and its Prevention (ACRISP )is one of the International Research Centres for the Prevention of Injury and Protection of Athlete Health supported by the IOC. This manuscript was written during a visit to South Africa by Caroline Finch (CFF), which was made possible through a combination of the National Research Foundation of South Africa, the BokSmart programme and the Chris Burger Petro Jackson Players’ Fund.

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  • Contributors JB and CFF conceptualised the idea. JB drafted the first version and CFF edited this. WV, CR, GB and ML then edited the manuscript prior to submission.

  • Funding CFF is funded by a National Health and Medical Research Council Principal Research Fellowship (ID1058737).

  • Competing interests JB’s postdoctoral fellowship is paid for by the BokSmart programme.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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