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This paper presents aspects of policy and practice observed in low and middle-income countries (LMICs) and the lessons which can be learned from these and similar initiatives. The role of non-government organisations in capacity building programs and advocacy is identified as a strong foundation for road safety reform. Political will is discussed as a critical component of reform together with the need for a holistic approach to ensure sustainability. The requirement for a strong evidence-base to support evaluation is discussed and the need to ensure strong governance over law enforcement is profiled. Good practice programs are described as well as the importance of harnessing the enthusiasm and dedication of youth in developing and championing initiatives for safer community outcomes. While the lack of resources and financial support may appear as an impediment to some, if viewed as a surmountable challenge, safety outcomes can be achieved. The findings demonstrate that there is a rich environment in LMICs from which to source and undertake key and critical research to stimulate continuous road safety improvement especially in those countries where road trauma remains at a comparatively high level.