Road crashes have become a critical issue in low- and middle-income countries (LMICs), where complex social and systemic factors exacerbate road safety challenges. This study combines Systems-Theoretic Accident Model and Processes-Systems Theoretic Process Analysis (STAMP-STPA) and Design with Intent (DwI), aiming to address both systemic and design-based factors, providing a comprehensive framework for enhancing road safety interventions in LMICs. A case study of a head-on collision in Bangladesh is analyzed using STAMP-STPA and DwI independently where the former identifies control and feedback failures, and the latter generates creative design solutions for road safety improvements. The design ideas generated in DwI workshops are analyzed using natural language processing (NLP) techniques, including topic modeling and bigram analysis, to extract key themes and reveal frequent word pairs for deeper insights. The STAMP-STPA analysis revealed critical systemic vulnerabilities related to road safety policies, vehicle standards, intersection design, and enforcement practices, which aided in proposing ten countermeasures across system levels. The DwI workshop yielded additional design ideas emphasizing infrastructure improvements, driver education, and technological solutions. NLP analysis of workshop data identified four key themes and prominent bigrams, highlighting critical areas for targeted interventions. By combining STAMP-STPA’s systematic analysis with DwI’s participatory, design-focused ideation, stakeholders can identify and implement countermeasures addressing both infrastructural and human factors to enhance road safety. Although this framework, tailored to LMIC contexts, demonstrates its applicability to a real-world case in Bangladesh, future research could expand it by incorporating multiple cases from various LMICs to enhance the generalizability of the findings.