3.1. Economic and Agricultural Impact
Economic growth has long been considered a major determinant of peoples’ quality of life with regard to global development. Accordingly, economic indicators such as GDP (or GDP per capita) have been considered a “yardstick” for measuring the progress of development for decades [
10]. It is widely accepted that rural transport infrastructure is a critical driver of economic growth and development, as it contributes to market access, agricultural production, creation of firms, and poverty reduction, and generally facilitates the movement of goods and people [
4,
10,
11,
12,
13,
14,
15,
16,
17,
18,
19,
20]. Further, the literature describes the agriculture sector as the dominant activity [
21] and the “backbone” of many local economies in LMICs [
22], recognizing that a large portion of the world’s rural poor depend upon agriculture for both income and subsistence [
7]. In Sub-Saharan Africa, agricultural work has an employment share of 60% [
11,
21,
23], and in India, about 43% of the country’s land area is used for agriculture that employs over 50% of the country’s workforce [
24]. Additionally, a large majority of households in LMICs live in areas where markets are unevenly distributed across space [
25], and where transportation of people and goods is intrinsically related to the geographic organization of economic activity [
18,
26]. Therefore, the importance of transport infrastructure grows proportionally to remoteness, as rural economics are frequently characterized by under-used resources and marginal economic activities [
27]. Generally, a lack of accessibility in developing contexts has been classified as one of the main drivers of continued poverty, which is displayed by limited agricultural output and economic activity [
4,
28]. Investment in and implementation of transportation infrastructure is often justified and financed by claims that it will contribute to the economic growth of rural and poor communities [
29]. In this way, rural road expenditure has been suggested to be one of the most effective methods of poverty reduction, per dollar spent [
5]. Yet, there are underlying mechanisms that pull these sectors together [
30], and because rural transportation infrastructure is not randomly allocated, the direction of causality between transport infrastructure and economic growth is debated [
11]. There are overarchingly positive trends within the links among rural roads, agriculture, and poverty [
31], yet recent review papers and additional literature concur to suggest that impacts can be both complex and diverse [
7,
32,
33].
A widely discussed burden experienced by rural farmers is limited market access, which can reduce the inputs available to rural farmers, limiting agricultural output [
16]. Poor road conditions and limited rural transportation infrastructure separate farmers from tools, techniques, and strategies, leaving farmers locked in a cycle of poverty with their core income-generating agricultural processes characterized by restricted technologies and limited yields [
23,
30]. Rural farmers are faced recurrently with decisions about upgrading technology and other inputs, which is often expensive, and may not be feasible given a common need to balance market participation with household-level subsistence [
30]. However, improved rural access has aided in supporting rural farmers’ access to technologies, techniques, and useful inputs such as fertilizers, pesticides, irrigation, and mechanized tools, resulting in greater outputs [
9,
24,
31,
34,
35]. For example, after installation of a new trail bridge in rural Nicaragua, farmers spent nearly 60% more on intermediate inputs aimed at boosting their outputs [
25]. Further, improved transportation networks can reduce the costs of holding inventories [
24], make farmers’ income more resilient to changes in transport costs [
30], and may encourage the hiring of additional farm labor [
34]. Increased access may also affect rural farmers’ crop choices [
9], and in some cases, lead to crop diversification [
34]. In sum, evidence suggests that market access and technology adoption amongst rural farmers are intertwined and should be examined jointly as positive outcomes from increased rural connectivity [
30].
Another important focal point of the literature discusses the periphery of urban areas, examining the connections between the urban and rural economic systems instead of addressing them independently [
21,
36,
37]. As modern economic growth in rural areas of LMICs largely involves structural urbanization and movement away from agricultural income and production [
21], transport is a crucial variable in these equations [
10]. In this way, improved transportation infrastructure that creates peri-urban connections has been shown to support increased, or newfound, access to labor markets, and studies confirm that this subsequently drives increased household income [
33,
38]. By allowing movement out of agricultural work and into what is generally described as “non-farm work” or “wage labor” [
33], rural transport infrastructure allows for an increase in income for rural dwellers through self-employment and industrial or manufacturing roles [
9,
14,
24,
29,
33]. Here, previous review papers concur with additional new evidence to show that rural transportation infrastructure brings connections to new labor markets, which contribute directly to increased income by opening new channels of employment [
7,
8,
9]. Described as a primary impact of increased rural accessibility [
36], non-agricultural income is often used as an outcome metric for identifying impacts of increased rural access [
11,
22,
26,
33]. To this end, studies show that participation in non-farm income-generating activities has allowed rural families to increase their incomes and consumption [
39] and quality of life [
40]. A review of the Pradhan Mantri Gram Sadak Yojana (PMGSY) project in India found that a new road in a village contributed to a 9% decrease in the share of workers in agriculture, and a corresponding increase in wage labor [
41]. These results are common within the literature, as demonstrated by a 5% increase in household consumption and a nearly 20% increase in total labor earnings in Indonesia after a one-standard-deviation improvement in road quality [
29], as well as further studies that reported 28% [
38] and 38% [
33] increases in household income, from Nepal and Cameroon, respectively, due to increases in wage labor after newfound road access. Additionally, rural trail bridges in Nicaragua erased an 18% decrease in labor market earnings reported during flood incidents, helping to eliminate market access uncertainty related to extreme weather events [
25].
However, many people live without the means to abandon agriculture as their main source of both income and subsistence, and thus, remain engaged in low-income or subsistence agriculture [
7]. For these rural dwellers, peri-urban accessibility and synergistic connections between markets of different sizes can contribute to poverty reduction and create channels for pro-poor income generation [
14,
37], increase agricultural income, and reduce inequalities between agricultural and manufacturing-based incomes [
29]. Urban and rural market access metrics are difficult to disentangle [
36], as centralized markets rely on the production and transportation of food, which is inherently a spatially diffuse activity occurring in rural areas and influenced by rural markets [
21]. Additionally, smallholder farmers contribute significantly to existing markets, as demonstrated by the 95% of horticultural produce being grown by farmers in Kenya [
44]. Market access is often a large hindrance to growth, as food is difficult and expensive to transport and may spoil along the journey [
17,
44,
45]. Existing transportation barriers fragment food production and distribution operations into “marketsheds”, which increase costs and reduce the welfare of both producers and customers [
11]. This is exemplified by the fact that nearly 50% of African farmers live five hours or more away from markets [
46]. Yet, rural transportation interventions have displayed positive impacts on market access, and the achievement of efficient access to markets is often visualized as an important method to improve the wellbeing of the world’s rural poor [
8,
12,
20,
24,
47,
48]. The economic benefits of rural transportation infrastructure are largely related to market access, which has been shown to increase household consumption and income, human capital and local GDP, and also boost agricultural production [
20,
25,
31,
35,
40,
48]. In alignment with this, the aforementioned Nicaraguan study found that newly implemented trail bridges significantly reduced uncertainty in market access for rural farmers who continued agricultural work after the intervention, and their farm-based income increased by up to 75% [
25].
Transportation is a core component of food security in rural areas in LMICs [
21,
49]. Food is an essential good that requires spatially diffuse production, is bulky and perishable, and is difficult to move [
27,
50,
51]. Beyond access to markets and technologies, farmers in rural areas are heavily dependent on their yields for subsistence and personal consumption. In Uganda, 58% of households across the country are defined as existing in subsistence, and up to 80% of households live in subsistence in particular districts [
21]. In rural areas, costs are high and income levels are low, resulting in a large fraction of total expenditures accredited to food supplies [
21]. Additionally, rural houses tend to consume substantially less, and are generally less food secure than houses which are nearer markets, which is directly influenced by transportation [
20]. The most rural households also have the least diverse and healthy diets [
20]. However, as the benefits related to increased rural transportation infrastructure involve access to markets and non-farm work, these benefits also include improved food security [
49] and per capita food consumption [
39]. Despite little discussion about transportation and food security in previous reviews, the significance of the relationship has been highlighted by ReCAP and the Partnership on Sustainable, Low Carbon Transport (SLoCaT), by directly linking rural transport to SDG 4, which endeavors to achieve food security and zero hunger [
4]. This is illustrated further by a report estimating that the 70% increase required in food production to feed the global population in 2050 could be halved if post-harvest losses were eliminated, which largely occur due to transport inefficiencies [
44].
Another dimension of the literature focuses more directly upon transportation costs, and describes them as both a major impediment to development in Africa and other developing contexts [
21] and a central component of economic theory [
11]. Transport costs generally decrease with the integration of additional transportation infrastructure in rural areas [
8,
16,
30,
31,
44,
46,
52]. However, evidence has pointed to ambiguous pathways by which transport costs are related to market access and economic activity [
20], and further, has shown that transport costs can both newly arise and begin to increase as new services emerge or grow in tandem with new infrastructure [
33]. Other evidence references additional underlying mechanisms of transport costs such as road quality [
44], fuel costs [
12], and overall asset management [
53]. Further, researchers have suggested expanding economic analyses beyond transport costs to examine trade costs, and methods by which a reduction in trade costs may increase income in rural areas [
11,
14,
54].
Alongside the previously described benefits, review papers have acknowledged that within rural transportation, agricultural and economic impacts can vary across contexts [
7,
8,
9]. Firstly, a lack of data, information, and standardized reporting processes related to road conditions, transportation costs, usage, and perceived benefits makes the overarching impacts difficult to measure [
11,
43,
48,
55], especially without incorporating biases [
52]. Similarly, there does not exist a perfect, nor universally utilized, indicator for economic wellbeing, and thus, multiple metrics must be considered in unison to develop a realistic understanding of the impacts of rural transportation and associated interventions [
11,
33]. Accordingly, recent reviews document several economic indicators that serve as measurements of impacts, many of which may be represented per capita or on a community-wide basis [
7,
8,
9]. Another difficulty within rural transportation and agro-economics is endogeneity [
11,
35,
48], which refers to the non-random placement of transportation infrastructure that causes researchers to debate whether rural roads support and stimulate rural economic growth, or whether rural economic growth emerges via other, “natural” means and then attracts allocation of new infrastructure [
11,
20,
43,
54]. This is partially caused by the construction of new infrastructure, or maintenance of existing works occurring in strategic and profitable locations, as determined by implementing and governing organizations [
31,
34]. Accordingly, scholars have reported difficulty in understanding the underlying mechanisms of rural transportation economics [
20], despite observing positive trends in many contexts [
7].
Recent reviews report that the greatest benefits of new rural transport infrastructure could be realized in areas with low road density [
9]; however, impacts are seemingly most significant in close proximity to newly implemented infrastructure, with diminishing returns for the most remote rural dwellers [
8,
9]. The complexity of externalities related to growth in certain areas may lead to only marginal benefits for the poorest households [
7,
8]. Several sources mention that larger impacts from rural transportation interventions are likely to be seen in less-remote rural areas that are in closer proximity to urban centers [
9,
12]. Those who are considered “non-poor” are more likely to reap benefits, as they have the resources to take advantage of new infrastructure, unless implementations are specifically designed to address and consider poor and vulnerable groups [
7,
8]. Accordingly, a Cameroonian study showed that increased road connectivity led to a 33% increase in income for households classified as “above median income” but had no effect on households classified as “below median income”, which exemplifies the suggestion that rural transportation infrastructure may not lead to structural changes [
33], and further, may exacerbate social inequities in certain situations [
15]. In this way, the debate continues about the capacity for rural transportation infrastructure to be a catalyst of systemic economic change and to alleviate poverty in rural areas [
7,
9].
There are vast benefits for rural communities in economic and agricultural sectors accredited to rural transportation infrastructure [
7,
8,
9,
11], including improvement in labor market and agricultural market access, increased access to agricultural inputs, reduction in transportation costs, and improved food security. However, the improvement of rural transportation infrastructure is a necessary but not sufficient condition for poverty alleviation [
7,
8,
9], and the literature still deliberates upon the underlying mechanisms of rural economic networks [
11,
43]. These results do not discourage progress, but encourage closer examination of the systems that create these dynamics at a local level [
43]. Future research in this arena should investigate the overlapping peri-urban space, as migration becomes increasingly common and the lines between rural and urban areas are further blurred. Additionally, approaching rural agro-economics with a food security lens will become increasingly important as populations grow, the climate changes, and food production becomes a greater priority. Lastly, promoting pro-poor interventions and integrations in rural economic systems will become an important branch of future work. Overall, economic benefits will remain a powerful means of attracting further research and investment into the rural transportation sector, and transportation contains great potential to contribute to scalable poverty alleviation in rural areas of LMICs.
Table 1 provides a summary of key points related to the impacts of economics and agriculture while
Table 2 summaries future research recommendations.
3.2. Policy and Governance Impact and Implications
Rural transportation infrastructure and services require planning, funding, maintenance, and regulation, coordinated through transport-specific policy and governance on a local, national, regional, or international level [
2,
7,
56,
57,
58,
59,
60,
61]. Generally, there is agreement within the literature that transport policies often display limited effectiveness and sustainability [
58], due to a host of challenges experienced by governments in LMICs, including varying levels of political commitment, accountability, benevolence, capacity, and fiscal efficiency [
62]. In response, leaders within the sector, such as ReCAP and SLoCaT, have produced literature and key messages directly addressing the governance of rural transportation, calling for increased and improved funding and commitment to rural access, as well as localization of policies, strategies, and action plans specifically in rural and disadvantaged communities [
49]. Additionally, many studies propose new tools, guidelines, and methodologies of collecting data, projecting theoretical outcomes, and advising evidence-based policy and decision making [
1,
57,
60,
63,
64,
65]. Further, many sources concur that governments have overlooked the importance of transport services, unrealistically expecting the private sector to fill this gap [
7,
47,
66]. Lastly, despite trends toward decentralization of governance and support of localized government within recent years [
56], the poorest of the poor continue to miss out on the benefits of infrastructure and transport-based investments [
7,
58]. In recognition of these challenges, authors advocate for a “rights-based” method of governance that ties transport and policy together by addressing transportation as a precondition that is distilled from, and directly impacting peoples’ access to, basic human rights [
67]. However, effective transportation policies are often lacking in developing countries, and often fail to address the specific challenges and opportunities presented by the rural context due to an urban focus [
47,
56,
65].
Previous review papers have generally acknowledged investment in rural transportation infrastructure as a primary output and display of policy and governance [
7,
8]. Investment in rural roads has positive benefits in many respects [
7,
8], yet newer studies have shown that there are nuances and difficulties attached to large-scale rural transportation financing, and emphasize examining the social benefits of investment returns, beyond just economics [
7,
41,
62,
63,
67,
68,
69]. Financing is one of the most prominent and thoroughly studied components of transportation policy and governance in LMICs [
9,
62]. Generally, it is thought to be the responsibility of the central governments of LMICs to subsidize infrastructure interventions [
62], with potential financial help from development organizations or multilaterals [
2]. However, vast gaps exist between projected needs and actual funding. For example, in 2019, global spending on road transport from the world’s top 10 official development finance (ODF) donors amounted to approximately USD 10.4 billion, and yet, the Africa Infrastructure Country Diagnostic claimed that funding needs for road infrastructure in Africa alone can reach up to USD 18 billion annually [
11]. Therefore, it is frequently suggested that governments of LMICs create a consistent revenue stream to fund rural infrastructure investments, such as tolls or fuel taxes [
2], yet this is rarely seen in practice, especially in rural and poor areas [
56,
62,
69]. The impetus placed upon governments is motivated by evidence included in previous review papers suggesting that investment in rural roads has delivered broad benefits, including high levels of economic return and poverty reduction when compared to other forms of public spending, especially in countries with low road network densities [
7,
8,
9]. Additional research has echoed the value and potentially transformative nature of rural transportation investment on sustainable development in LMICs. However, authors are wary about the difficulties of fully understanding and addressing the complex factors that determine the cost-benefits, cost-effectiveness, and ability to reach rural people [
9,
56,
62,
69]. While construction costs and engineering inputs can be calculated with relative ease, evaluating the benefits of infrastructure projects is a considerably more difficult and nebulous endeavor [
11]. Investments into different interventions have different levels of effectiveness in different contexts [
7], in part due to varying levels of institutional weakness, including commitment-, finance-, and benevolence-related issues across contexts [
62]. Previous reviews have focused on investment specifically in rural roads, and only briefly discussed investment in other interventions such as trails and trail bridges [
7,
8,
9]. Recent literature has continued this trend and expanded to include results that support funding of maintenance of bridges and culverts, and general “spot-improvements” in rural road networks [
63,
64,
65,
70,
71,
72]. Overarchingly, the financial component of rural transportation governance is quite complicated, and relies heavily upon the management and mitigation of institutional weaknesses, which tend to compound and result in ineffective financing or project choice [
62].
There is substantial evidence pointing to data and informational gaps that are limiting the extent to which investments can impact rural communities [
56]. Previous review papers initially suggested that data gaps existed with regard to supporting policymakers’ decisions [
7,
8], and newer research concurs but also addresses the vast dependence of prioritization and planning of transportation interventions upon relevant data [
11,
60]. Information supporting the initiation of interventions as well as examining their impacts can be both exceedingly difficult and expensive to acquire [
11,
60]. Recent literature also acknowledges that governments often have different bodies that collect and manage data, and may have additional bodies based upon the classification of particular infrastructure [
73]. In some situations, however, funding and resources may be limited enough that relying on estimation or secondary data is more effective. Overall, it is suggested that regardless of the data collection methods, rural transportation investments should be grounded by comparative and empirical analyses that help to ensure the maximum benefit is reached by use of the available resources [
11,
56]. Increased access to data by policymakers will help to relieve the financial information asymmetry that contributes to institutional weakness [
62].
A consequence of a lack of evidence-based transport policy for rural communities is the tendency for the poorest people in a given community to miss out on the benefits of rural transportation infrastructure and services altogether [
7,
8,
58]. Despite the larger populations of poor community members in rural areas [
67], review papers have acknowledged that those who benefit from new roads, and any services that develop as a consequence, will typically only be those who can afford to do so [
7]. Evidence has noted that local elites are often better situated to experience benefits such as saved costs, increased productivity, added land value, and increased access to social services than the rural poor [
67]. Additionally, government “non-benevolence” often favors these wealthier community members over their comparatively poor and rural counterparts [
7,
62]. A related phenomenon is called “cream-skimming,” which suggests that only the most profitable interventions are financed, systematically leaving out the poor [
62]. Often, this occurs because the data regarding the impacts of rural transportation investments upon the poorest of the poor is lacking [
7], and in this way, transport governance without specific “pro-poor” approaches and methodologies may actually exacerbate inequality in rural areas [
7,
67]. In response, authors have suggested decentralized management of rural transportation infrastructure, which can more accurately and effectively respond to the needs of rural populations [
56,
65]. Aside from this, very few strategies and examples of pro-poor policymaking and rural transportation interventions exist. One of the few is Vietnam’s significant public spending on transportation in the late 1990s and early 2000s. An impact evaluation from 2002 positions the intervention as directly pro-poor, evidenced by explicitly pro-poor strategization found in all stages of the project, which resulted in the poorest 40% of households experiencing some of the strongest impacts of the intervention [
67]. An additional example is found in the Beni-Jomsom-Sadak road constructed by the Nepali Army, as it helped increase the income of the poorest households in the area by 28% and had a neutral impact upon wealthier households [
38].
Conclusively, policy and governance play enormous roles in the direction of rural transportation infrastructure and services, and are intertwined with many basic human rights, such as access to water, sanitation, healthcare, and education. Carefully planned and comparatively analyzed investments should continue to produce cross-sectoral and multidimensional benefits, if based on thoughtfully collected and managed data and evidence. Future research should expand upon the non-monetized benefits realized through interventions, and expand political frameworks to consider services and universal coverage as priorities. Authorities should focus on continuing the general trend of decentralization of governance seen in the past three decades [
56], in an effort to incorporate local and context-specific solutions, especially related to a changing climate [
2,
63,
74]. Pro-poor policies and financing mechanisms should be prioritized [
67], and rural–urban linkages should be examined for their contributions to growth [
37]. Rural transportation’s emergence as a sector in its own right should be acknowledged and supported at a policy level to continue utilizing infrastructure and services as vectors for sustainable and inclusive development in LMICs. Additionally, combatting governmental non-benevolence will be an important step in ensuring that the rural poor are adequately served by transportation infrastructure.
Table 3 provides a summary of key points related to policy and governance while
Table 4 summaries future research recommendations.
3.3. Health Impact
Access to healthcare is a multidimensional metric [
75]; however, physical (or geographic) access is consistently described as one of the most critical components of access to healthcare globally [
76,
77]. The literature shows that lack of physical access remains a dominating factor in decreased utilization of healthcare services which, in turn, propagates negative health outcomes [
77,
78,
79,
80,
81,
82,
83,
84,
85]. Previous transportation sector review papers have noted the substantial evidence that depicts time, distance, travel mode, and infrastructure as combining transport-related factors that result in the decreased usage of healthcare services and negative health outcomes [
7,
8,
9]. Access to healthcare is widely considered to be a basic human right [
85,
86] and a pillar of sustainable development [
84]. However, physical access remains an issue, especially in rural and high poverty areas within LMICs [
77,
81]. These communities are systematically left out of the majority of health services [
87] by the geographic bias of healthcare centers and corresponding transportation networks toward wealthier and more populous urban centers [
83,
88,
89]. Subsequently, in large part due to transportation-based issues, many people in rural and impoverished communities simply go without healthcare services [
90], and therefore, face immense health challenges [
76,
86,
91]. However, previous reviews of existing evidence have found positive correlations when investigating the impacts of rural road improvement upon healthcare access in rural communities [
8,
9].
While previous reviews suggest that the medical literature downplays the impacts of transportation on rural health [
7], there now exists a host of evidence about communities facing geographic barriers to healthcare around the world. Many publications from both medical- and transportation-based sources point to transportation obstacles as significant barriers to care [
92,
93,
94,
95,
96,
97,
98,
99]. Often, publications use distance to describe a lack of access [
78,
80,
81,
82,
83,
84,
85,
90,
100,
101,
102,
103,
104]. The concept of “distance decay” [
76,
105] suggests that utilization of healthcare services decreases as the distance required to reach them increases. However, in LMICs, the Euclidean [geometric straight line] distance between a person’s place of dwelling and place of healthcare is typically an inaccurate indicator of their ability to access healthcare [
84,
91,
102]. In many circumstances, time is a more accurate metric for measuring access, as it considers the details of travel more closely [
77,
78,
84,
89,
91,
103,
106]. The mode of travel and the status of transportation infrastructure are critically important factors that influence the amount of time required for access [
82,
86,
102,
107,
108,
109]. Many poor rural families do not own vehicles, cannot afford to hire vehicles [
110] and are not within reach of public transportation systems that typically only follow patterns of commerce [
90]. Thus, the available modes of transportation are often less advanced, and people are left to rely upon low-technology and high-effort options, compounding the burdensome and time-consuming nature of their journeys [
84,
86,
101,
110,
111,
112]. Additionally, an ill or injured person, or an adult traveling with children, will have decreased ability to travel via these means, and doing so can be slow, dangerous, or life-threatening [
81,
82,
84]. Furthermore, limited road networks, poor quality of roads, and precarious terrain may also restrict travel mode options, and decrease the prevalence of public transportation services [
81,
82,
113]. In accordance, the World Health Organization (WHO) recommends using time over distance as the primary metric for measuring physical access specifically because of varying modes of travel, unpredictable routes, challenging infrastructural situations, and seasonal changes related to accessibility [
78,
84,
107,
108]. Despite the WHO’s recommendation, which dates back to 2001 [
114], there is no universally agreed-upon standard for acceptable travel time to medical care. Within the literature, standards for timely access can range from 30 min to 60 min [
84], and even up to 2 h, as used by a WHO report examining travel time to reach emergency obstetric care in Burkina Faso [
115].
Additional research expands upon previous reviews by showing examples of circumstances where health outcomes were affected by a lack of access, namely limited tuberculosis testing in Ghana [
79], decreased immunization rates in Nepal [
103], and increased mortality coupled with decreased life expectancy in rural Brazil [
100]. The evidence in medical- and transportation-based sources describing geographic barriers to care is plentiful and continues to grow, yet the evidence of infrastructure interventions directly improving healthcare usage and resulting in positive healthcare outcomes is less substantial, and largely anecdotal [
7]. Additional sources have added to the anecdotal pool of evidence, such as a report that notes improvements in access to healthcare via the creation of a community-run bus service in Sri Lanka [
116]. Sectoral reviews have begun to expand upon existing evidence by including various studies, which show that improved transportation infrastructure increases vaccination rates, attendance at hospitals, use of birth attendants, use of latrines, access to preventative care, access to clean water, use of contraceptives, and reductions in morbidity [
8,
9]. Beyond these reviews, a small number of studies exist confirming the positive impacts of road improvement projects, such as a 10% increase in post-intervention hospital access in Ghana [
12], and a 30% increase in post-intervention access to medical facilities in India [
117]. Additionally, a study in Cambodia showed an increase in the availability and usage of public transport to reach healthcare after a road improvement project [
86].
Previous review papers have shown that women and children are disproportionately affected by transportation-based barriers to healthcare, as confirmed by significant evidence from the medical and transportation fields [
7,
8,
9,
118,
119,
120,
121,
122,
123,
124,
125,
126,
127,
128,
129,
130,
131]. A 2017 meta-analysis examining Sub-Saharan Africa found that women traveled, on average, 15 km and 108 minutes walking to reach skilled child birthing services, far beyond a 5 km maximum walking distance for heavily pregnant women, and a reported 60 minute WHO maximum travel recommendation for pregnant women [
132]. Geographic access to care has been described as the single greatest contributor to maternal mortality [
113], and accordingly, access to maternal care has previously been described as the greatest perceived benefit of improved roads for women [
8]. It is known that distance is a disincentive for women in seeking care [
102,
110,
133,
134] and usage of health facilities for skilled care at childbirth was found to be inversely correlated with the distance and time women were required to travel [
132]. Limited use of skilled care for childbirth poses a tremendous issue for both maternal and child survival and is, thus, a critically important aspect of sustainable development [
105]. In addition, previous reviews have noted that access to an all-season road can have significant positive impacts for women with regard to their awareness of contraceptives [
9].
The relationship between rural transportation and access to healthcare has been intensively studied, yet new research has shown increased nuance and illuminated particular areas that require additional analysis. Another future inquiry lies within the suggestion that increased connectivity may result in increased transmission of communicable diseases, contributing to negative health outcomes [
8,
9]. Future research will need to tackle the deeper social and cultural inequities and inequalities [
136]. Additionally, improved ambulances and systems of emergency health present a promising subject for further research in this sector, as they are important for child birthing and other emergency reproductive health needs [
137,
138,
139]. Lastly, disadvantaged groups within communities, such as those living with disabilities, should be prioritized, as evidence shows that people living with disabilities experience geographic barriers to healthcare acutely [
103,
104,
140,
141,
142,
143]. Research from Thailand found that physical disabilities severely limited people’s movement, unless they could afford to hire transportation, which was rarely possible [
109]. However, future research should include expanding upon the examination of mobility, health, and disabilities, to support inclusive transportation infrastructure interventions and address the needs of disabled community members directly.
Table 5 provides a summary of key points related to health while
Table 6 summaries future research recommendations.
3.4. Gender Impact
Rural transportation infrastructure, and corresponding services, may appear to impact entire populations equally, yet there exists wide agreement within the literature that the effects are heavily gendered [
136,
144,
145,
146]. Men and women do not reap the benefits of transportation infrastructure equally, as specific gendered challenges may limit women’s ability to utilize infrastructure and services. Further, ongoing gender inequity and inequality delay development progress in low-income countries [
136,
146,
147]. Infrastructure interventions, especially those that are “gender-blind” [
144,
146,
148], often lean toward men’s needs and result in the continuation of the status quo, propagating inequalities along gender lines [
136]. The opposite perspective, “gender-aware” approaches, which tackle typically unspoken issues of gender upfront, recognize underlying social trends, and acknowledge distinct mobility needs have been transformational in certain cases [
144]. Correspondingly, mobility has been recognized as a key dimension of gender equality [
149], and interventions that support women’s mobility have been shown to influence more egalitarian attitudes about gender in rural communities [
150]. Previous review papers have briefly acknowledged that there are benefits specific to women, which are evidenced by positive correlations between improved transport infrastructure and an increase in educational, health-based, and economic opportunities available to women [
8,
9]. Further, previous review papers have pointed out that rural men and women travel differently, in terms of frequency, distance, and purpose [
7], and recent research has shown that these differences produce different perspectives about needs and benefits from transportation infrastructure [
144,
145,
149]. In accordance, projects such as the Gender Mainstreaming research initiative from ReCAP have emerged to place explicit attention on gendered transportation issues and build upon the limited evidence base of gender-disaggregated transportation information and perspectives [
144,
151].
Employment is directly related to men and women’s daily travel patterns and usage of transportation infrastructure, and is in itself gendered. Limited transport and transportation infrastructure exacerbates gender roles that make entrepreneurship difficult [
152], and limit women’s work to domestic and agricultural duties [
148]. A disproportionate level of household duties fall on women, who embark upon shorter, but more frequent trips, as they are typically burdened with activities such as the collection of water and firewood [
28,
144,
145,
146,
149,
153,
154,
155]. Women frequently travel with dependents [
148], and because they have less access to vehicular travel than men, often walk further and rely upon more basic infrastructure such as footpaths and trail bridges to complete household chores [
144]. Women are more likely to be responsible for unpaid care [or household] work [
136,
148], which results in exclusion from other economic opportunities [
144], and keeps them physically distanced from formalized work opportunities [
151]. This type of travel caused by gendered work and social standing also negatively affects women’s food security as compared to men [
156]. Because of this overburden, women’s economic gains and status in society are restricted [
155]. However, a theory of change derived from a systematic review suggests that improved mobility can enhance women and girls’ economic advancement via access to formalized opportunities [
149]. Further, studies based in India have examined the impacts of rural transportation infrastructure on women’s employment and economic gains, finding positive correlations, and generally showing that women are more likely to find paid work outside of their homes or farms when transportation infrastructure is improved on a local level [
150,
155]. Evidence from Bangladesh shows that improving rural access can improve women’s economic status by providing women with the opportunity to develop micro-, small-, and medium-sized enterprises [
28]. Additionally, research from Nicaragua showed that rural trail bridges allowing new and safe access resulted in a 60% increase in women entering the labor market [
25]. Further, there is substantial evidence pointing to the benefits of the inclusion and employment of women in rural road maintenance, construction, rehabilitation, management, and planning, affirmed by previous review papers [
7,
149,
153,
157]. Via this inclusion, women can realize short-term economic benefits [
7,
146], but also long-term entrepreneurial opportunities, and see progress towards higher social status and development of their agency through expression of specific needs in infrastructural planning and implementation processes [
7,
149,
153,
157,
158].
Women often find themselves reliant upon public transportation in contexts where female vehicle ownership is not socially accepted [
136], or when they are culturally restricted from using particular intermediate modes of transportation (IMTs) such as bicycles [
7,
144,
148,
154]. Yet, public transportation is typically less accessible for women and girls due to the cost and the types of trips that they need to make [
144,
145,
149], and difficulties are compounded by safety and security concerns [
146,
148,
153,
159]. In accordance, a lack of access to safe transportation has been suggested to be a main barrier for women’s access to the labor market [
160]. Further, gender-based violence is common in public transportation services and urban periphery areas [
7,
149], and provides a significant roadblock to women’s mobility overall [
148]. Security concerns have been described as a main factor impacting women’s travel decisions [
149]. Increased transportation infrastructure also adds to the amount of traffic and cash that flows through particular areas, to which violence and harassment have been attributed as unforeseen byproducts [
148]. Clearly, underlying sociocultural norms play a role, and emphasize the importance of rural transportation interventions and systems that take gender-aware approaches to specifically and distinctly address women’s safety and security concerns [
144,
147,
148,
157,
161,
162,
163].
Despite the significant amount of evidence and encouraging progress contributed to the rural transportation sector concerning gender from groups such as ReCAP, future research should expand to directly incorporate gender into policies and practices, and acquire gender-disaggregated data to support and enforce policy decisions [
28,
147,
157,
161,
162,
163,
164]. Gender mainstreaming has been termed an obligation and responsibility of the transport sector, warranting radical change [
136]. In this way, women’s perspectives should be included more closely and genuinely [
137], in order to break down the “invisibility” that women routinely experience in conversations of policy, planning, and management [
146,
147,
151,
163]. Gender-specific monitoring and evaluation of projects and policies will be a crucial step in developing both equity and accountability [
152,
163]. Further, gender impacts should be considered alongside other vulnerabilities that can exacerbate transportation issues, such as disabilities and marginalization of particular ethnic groups [
153,
163]. Additionally, and while incorporating gender-aware approaches, interventions will need to specifically address men’s perspectives and overarching power with regard to women’s mobility, as men play a critical leading role in the success, failure, and change of future interventions in the transportation sector [
149,
164]. Lastly, there is a dearth of information describing gender-based transportation issues outside of the gender-binary classification. Expanding perspectives to incorporate gender fluidity and non-binary experiences of gender will be a valuable step in making rural transportation interventions and services inclusive and sustainable for all in the future.
Table 7 provides a summary of key points related to gender while
Table 8 summaries future research recommendations.
3.5. Education Impact
Education is considered a basic human right, a key to long-term poverty reduction, and its importance for all aspects of developmental progress is reinforced by the inclusion of SDG 4 [
165]. Despite these benefits that are vastly accepted by governments, NGOs, and economists [
166], a variety of barriers to education persist, demonstrated by the 17% of adolescents and youth globally that are not in school [
167]. Transportation infrastructure plays a critical role in ensuring that both students and teachers can access and utilize schools [
168,
169]. However, previous review papers describing rural transportation infrastructure and its impact upon education have only begun to elucidate evidence and useful conclusions. A positive correlation between transportation infrastructure and various educational metrics is mentioned, and nuanced concepts such as employment tradeoffs and teacher absenteeism are briefly discussed [
7,
9]. Beyond this, however, the evidence base for educational impacts with regard to increased transportation infrastructure connectivity is weak and warrants additional research [
8].
Multiple aspects of rural transportation become important when examining its relationship to education. Factors that make school access difficult can combine and interact in a way that is described as the “distance cost” of attending school [
170]. In many cases, the physical distance alone is enough to negatively impact educational enrollment and attainment [
169,
171]. Evidence from rural China describes an average commute of up to 5 km for a primary school [
171] and a study from Brazil mentions commutes of up to 12 km [
172]. Further evidence from Brazil shows that a longer journey to school, even in urban areas, directly correlates with decreases in educational performance [
173]. Beyond distance, travel mode also represents a critical aspect of distance cost, and rural community members are often relegated to low-tech options such as walking [
172,
174,
175]. Walking to school is indicative of both geographic isolation and socioeconomic status, as evidenced in data from South Africa that showed 81% of students in rural areas and 85% of commuters from the lowest socioeconomic quintile walked the entirety of their commutes to school. Walking these distances can negatively impact school attendance, as shown in Nepal, where students who walked their commutes to school demonstrated higher dropout rates in more rural areas [
174]. A third factor in defining the cost of attending school is safety, which directly affects the ability and willingness of students to make the journey. Dynamics of safety that rural people are forced to consider as they commute to schools daily include pavement quality, lighting of roadways [
86], overall length of the journey [
165,
166], weather events, and animal attacks [
172]. Additionally, the infrastructure itself affects the distance cost of attending school [
86]. A study in India found that much higher poverty rates and lower rates of educational attainment existed in the nearly half of the country’s rural villages that [in 2001] were not connected by all-season roads [
176]. Beyond connectivity, or quantity of roads and infrastructure, the inferior quality of aging and decaying roads and infrastructure contributed to an increased distance cost in rural Brazil [
172].
Despite the multidimensional transportation barriers between students and schools, a small number of recent studies show that improved infrastructure can help to decrease distance costs and improve educational outcomes. An Indian study that focused on the construction of new feeder roads displayed a 7% increase in post-construction enrollment [
176]. Similarly, a small but positive correlation between road density and primary school enrollment was shown in Namibia [
177], and improved roads in Cambodia led to increased numbers of teachers in schools [
86]. Additional evidence shows that improvements in road infrastructure can support encouragement of community usage of the infrastructure as well as creation of transport services, such as an increase in familial interest in purchasing two-wheeled vehicles to help children travel to school more easily and consistently in Cambodia [
86]. Generally, these results are in line with recent reviews that also show positive correlations [
8,
9].
Several recent studies have illuminated an important component of the relationship between rural transportation infrastructure and education: the tradeoff between human capital and short-term profit opportunity costs. In previous review papers, the critical nuance presented in this tradeoff has only very briefly been discussed [
7,
8,
9]. When new roads are constructed in villages, community members become connected to educational institutions, but they are also directly connected to labor markets. In many circumstances [
31,
176,
179], newfound exposure to labor markets can decrease both enrollment and attainment as boys and girls as young as 12 years old find low-skill employment to supplement their families’ incomes. Often, children leave school early to pursue work in businesses run by their parents or other household members [
86]. While these circumstances are heavily dependent on localized market structures and opportunities, they are also impacted by both cultural norms and policy in rural areas that may advocate for education over immediate profit [
176].
There are gendered aspects to be considered with regard to education and transportation. Generally, women have lower access to transportation methods and services [
178], and education is traditionally less valued for girls, meaning they will reap less benefits of improved transport infrastructure for schools [
170,
179]. However, gender-specific interventions can be effective, as displayed by the results of an Indian study that showed a 32% increase in age-appropriate enrollment for girls, as well as a 12% increase in girls passing the secondary school certificate exam when the girls were given bicycles to help access schools [
170]. Additionally, a study in Brazil found that school attendance for girls increased after rural roads were improved [
180]. Beyond these studies, however, increased evidence is required to improve substandard educational opportunities for girls globally.
Generally, there exists a positive correlation between improved transport infrastructure and education as described in new evidence as well as in recent review papers [
7,
8,
9]. However, the overall pool of evidence is still relatively shallow, and calls for additional investigation. A component of future study should focus on increasing directness and decreasing the cost of transportation to school, by identifying transportation programs and policies that function in parallel with other interventions [
172]. Additionally, while many authors still support the construction of new schools over the construction of roads as the most effective intervention [
166,
168,
169,
174,
181], future research should further investigate this approach and associated costs and benefits.
Table 9 provides a summary of key points related to education while
Table 10 summaries future research recommendations.
3.6. Environmental and Climate Change Impact and Implications
Climate change presents one of the greatest challenges to achieving the SDGs by 2030 [
182,
183]. As a major catalyst for over half of the SDGs, and a specific target of SDG 11, rural transportation infrastructure will function as a “lifeline” for poor rural communities as the “deep uncertainty” of climate change manifests [
4,
59,
63,
183,
184]. The impacts of climate change upon rural transportation infrastructure are only briefly referenced by previous review papers [
9], yet the immensity and inevitability of changes are widely agreed upon in subsequent literature [
185,
186,
187,
188,
189,
190]. Similarly, the widely acknowledged social and economic benefits of rural transportation infrastructure, as described throughout previous sections of this paper, are a point of agreement within the literature. However, researchers concur that these benefits have the potential to be decreased or eliminated as extreme weather events and changes in sea levels, temperatures, and precipitation become increasingly intense and commonplace in the near future [
4,
59,
74,
182,
183,
188,
189,
190,
191,
192,
193,
194]. In this way, tradeoffs between rural socioeconomic benefits, transportation finances and investment, and environmental effects will complicate the means by which climate impacts are mitigated. Methods that protect benefits for rural dwellers will require adaptations to the changing climate that incorporate context-specific considerations of the various tradeoffs [
59,
74,
183,
190,
195,
196].
Climate change will disproportionately affect poor communities, and especially those in LMICs that already have minimal infrastructure and services [
59,
74]. For example, countries such as Ethiopia, where 84% of districts are classified as vulnerable to climate change due to a combination of frequent exposure to disasters and already limited rural accessibility [
197], will be especially in need of cross-cutting adaptation from pervasive sectors such as transportation. As such, much of the available literature regarding climate change and rural transportation infrastructure discusses proactive and wide-reaching techniques for climate change mitigation. Strategies such as increasing and institutionalizing maintenance of road networks and building redundancy into transportation networks [
63,
186] embrace mitigation as an opportunity to protect and bolster access, rather than just a challenge [
59,
183,
190]. Similarly, the Africa Community Access Partnership (AfCAP), a component of the ReCAP initiative, was developed to build upon the capacity of transportation authorities across Africa with a heavy focus on climate adaptation. The AfCAP initiative has worked to develop both engineering and non-engineering methods for mitigation, to expand the relatively scarce planning data that exist across Africa, and to develop specific links between climate change and rural transport infrastructure [
187]. Further, authors have suggested particular tools that involve satellite imaging, geographic information systems [GIS], and spatial data, to aid in the mapping of climate change impacts, as well as both infrastructure and community vulnerability [
197]. Generally, other suggestions include adjustment of planning criteria, specific construction materials, methods, and standards, and addressing transport services themselves. Overall, strategies should be backed by resilient and specific designs that are allocated in situations with individualized and contextualized economic and feasibility analyses [
59,
63,
74,
182,
183,
184,
186,
194,
197].
Researchers hypothesize that approximately 25 million km of new roads will be constructed by 2050 [
196], with a large amount, potentially as high as 90%, being constructed in LMICs [
15,
191,
198]. In many of these locations, roads will be constructed in some of the world’s last remaining pristine wilderness areas, despite evidence that roads attract new forms of activity which directly impact land usage, forest cover, and particular species, and may contribute to larger-scale environmental degradation [
9,
15,
191,
192,
195,
196,
198,
201]. Accordingly, new evidence suggests moving away from reactive approaches to environmental damage limitation [
201] and supporting conservative and proactive enforcement strategies that minimize irreversible effects without prohibitively expensive post-construction modifications [
191,
195,
196]. Environmental Impact Assessments [EIAs] can be useful tools in certain cases [
201] and the construction of roads in particular areas where substantial socioeconomic benefits are realized with only minimal environmental damages may be an applicable solution for authorities in LMICs with limited funds and organization [
191,
194,
195,
196,
202]. Areas with biodiversity and carbon-sequestering significance can be largely protected from the cascading effects of transportation infrastructure through bolstered legislation and enforcement [
196], though some authors argue that these are imperfect solutions [
195,
201]. Encouraging governments to tackle even small environmental protection actions in a timely fashion, by promoting specific goals and objectives and including positive reinforcement, has been successful in particular circumstances [
203]. The complexity of the associated balancing act will warrant cooperation and collaboration between political frameworks, ecological experts, and rural infrastructure planners [
9] to effectively manage the trade-offs between social and economic benefits in the short term and environmental impacts in the long term [
198].
Transportation is culpable for 23% of global energy-related carbon dioxide emissions annually, and trends predict that the global number of light-duty vehicles will double by 2050, with the largest increases in India and southeast Asia [
199]. Accordingly, non-motorized and pedestrian infrastructure and services are becoming popularized as a potential means of continuing socioeconomic transportation benefits in urban areas and reducing carbon emissions with limited costs [
199,
200,
204]. Non-motorized traffic represents a majority in many cities of Africa and Asia [
200], where upwards of 60% of the population [on both continents] is expected to live in cities by midcentury [
45]. However, future work in the sector should consider exploring the applicability of IMTs and non-motorized or pedestrian transportation in rural settings, as urbanization expands and reduces the boundaries between urban and rural areas. Presently, these strategies have yet to expand beyond the confines of the urban context and remain focused in the megacities of the global south such as Bangalore, India. However, placing an emphasis on pedestrian infrastructure in low-income urban areas has proven beneficial for low-income communities in those areas [
204] and, thus, the translation to low-income rural settings presents a logical topic for future inquiry.
Especially in poor rural areas, which are dependent on minimal transportation infrastructure, finding context-specific means to adapt to climate change and mitigate negative effects will be a priority in coming years [
198]. A balance between short- and long-term costs and benefits will be required [
194], as well as collaboration between multisectoral bodies that can ultimately combine to drive thoughtful policy-making activities [
59,
71,
74]. Adaptive concepts that integrate climate modeling, mitigation techniques, and methods of maintenance into infrastructure design, planning, and policy will need to continue to gain traction in global discussions [
74,
185,
186,
197]. Additionally, consistent and thorough management of transportation resources with regard to climate change will give governments potential leverage points to influence development and poverty at large [
74,
187]. In this way, future planning should utilize the strengths of local people, who can provide a valuable perspective in ongoing discussions, including their capacities and the impacts on their livelihoods, and should be involved in all stages of this process [
9,
183,
205]. Expanded data will be useful in informing policy change [
187,
197], and may be supported by innovations such as satellite imagery [
15,
51]. Closing the gap between mitigation and adaptation research and associated actions and policies should be a priority within engineering, policy, and infrastructural planning [
59,
74,
183,
190,
206] and will require unified strategies across international, national, and sub-national levels [
187].
Table 11 provides a summary of key points related to climate change and environment while
Table 12 summaries future research recommendations.