Over 20,000 people are killed due to road traffic crashes in Bangladesh annually. The country has over 100 road traffic deaths per 10,000 motor vehicles, one of the highest rates in the world. 70% of crash fatalities occur in rural areas. In 2014, Safe Crossings (Netherlands) and CIPRB (Bangladesh) received permission from the government of Bangladesh to design and implement an integrated speed management program to prevent road traffic injuries at three locations on a national highway that passes through villages. The study goal was to understand and quantify the improvement in road safety as a result of small-scale infrastructural adaptations combined with active community involvement and road user education. We had a specific interest in the effects on VRUs. Prior to installing the interventions, the three intervention locations combined had, on average, per year: 110 serious accidents, 12 deaths, and 240 injured people. Pedestrians accounted for 63% of all fatalities in the Before Period. In an ideal world one would like to use accident statistics as the ultimate measure of road safety. In reality, this was not possible as the accident statistics were neither sufficiently accurate nor complete. Hence we had to design an alternative monitoring & evaluation approach. The basic research design is a Before and After study using three methods: i) speed measurement (also in control locations), ii) an accident recording system using local record keepers that we set up ourselves, and iii) conflict observation using the DOCTOR method with video recording. Implementation of all infrastructural interventions was completed in April 2015. The integrated speed management for three locations in Bangladesh has resulted a reduction in road traffic injuries and fatalities of around 60%. The net speed effect is a reduction on average of 13,3 km/h (or 20% in relative terms), suggesting a reduction in the number of people killed of 59% using Nilsson’s power law. Our accident recording system shows a 66% reduction in the number of serious accidents (significant at p < 0.01), a 73% reduction in the number of injured people (significant at p < 0.01), and a 67% reduction in the number of road traffic deaths (significant at p < 0.10).Analysis of the conflict data revealed a 54% reduction in relative terms (52% reduction when taking the traffic volumes into account) in the number of serious conflicts. In addition, no conflicts of the highest severity category occurred in the after period. An additional advantage of the integrated speed management program is that it can be implemented relatively quickly (in 6 to 12 months) and the cost-effectiveness is very high. Our calculation suggests a ‘cost per DALY saved’ of below USD 100. We would like to suggest three specific areas of future research based on this study: i) traffic calming in city environments in LMICs, ii) interventions to further reduce the speed of fast-moving traffic in general and buses in particular and iii) investigating the potential of an integrated speed management program in a large number of locations in LMICs with the joint aim of significantly improving road safety and generating valuable road safety data on (cost-) effectiveness and implementation challenges and solutions.