Empowering communities to save children from drowning

Bangladesh has been on the track towards achieving the targets of the global goals but with a few exceptions. Despite the major advancements made so far especially in the health sector, drowning has been found to be the dominating factor affecting the mortality rate of children below five years. The World Health Organisation (WHO) reported that Bangladesh has one of the highest under-five drowning rates in the world.

Drowning is the second leading cause of injury-related deaths among children worldwide and WHO data show approximately 322,000 people die from drowning annually. Ninety-seven percent of these deaths occur in low-and middle-income countries (LMICs), and about 20 percent among under-five children.

Every year in Bangladesh, more than 18,000 children aged 1-17 drown. This means roughly 50 children die from drowning every day. Among the children of this group, those who cross their second birth year remain at the highest risk, and a study found such incidences take place between 9:00am and 1:00pm when parents, particularly mothers, remain busy with household work.

File Photo: Reuters.

A lack of supervision, high exposure to water hazards, a lack of education, and poverty are some of the major risk factors for childhood drowning in Bangladesh. It has been evidenced from earlier studies in Bangladesh that if the under-five children are brought under close supervision through enrolment in crèches, arranging door-to-door safety education, educating communities about injury prevention, conducting a social autopsy of injury deaths, and engaging communities, 82 percent of drowning deaths can be reduced.

Evidence shows that a combination of community-led interventions is effective in reducing the rate of drowning in the Bangladeshi context, where ensuring a massive community movement government patronisation is a must.

The Drowning Prevention Partnership (DPP) of the Centre for Injury Prevention and Research, Bangladesh  (CIPRB) and icddr,b – coordinated by Synergos with technical support from the Johns Hopkins International Injury Research Unit (JH-IIRU) and financial support from Bloomberg Philanthropies – has intervened through research to test the large-scale effectiveness of evidence-based interventions to prevent childhood drowning in rural Bangladesh.

Under the trial both CIPRB and icddr,b introduced two interventions – a crèche facility (also known as a community day-care) for rural children and the provision of playpens.

In the community daycare, a caregiver along with her assistant supervise between 15-30 children six days a week between 9:00am and 1:00pm, the period when the children are most at risk for drowning in rural Bangladesh.

During this period, they get lessons on safety, development, hygiene, nutrition and other health issues of children.

The SoLiD project playpens are four-sided rigid structures with slats that serve as a barrier to protect the child from the surrounding water hazards.

It is a useful aid to parental supervision, especially during critical times when mothers or fathers are busy with household chores.

Two types of playpens (wooden and plastic) are used in the project, both of which are locally manufactured and based on international safety standards.

Throughout the process, community leaders were engaged in overseeing the management of the interventions and more importantly, shouldering the responsibility to sustain similar efforts.

Otherwise, wide-scale implementations of community crèche seem to end when external singular donor funding runs out.

Socially and culturally accepted, crèches have now been found as a cost-effective useful intervention to protect children aged 1-4 from drowning. Such crèches, designed and adapted to function in the realities of rural Bangladesh, have been broadly steered by the community-based approaches in which parents played the key role while the community acted as a facilitator.

Over the last four years, CIPRB and icddr,b have been providing services to more than 70,000 children while they require to reach an additional 15 million children. It has been evident from the study that a crèche is effective for childhood drowning prevention, which costs only $26 per child a year on average. This has been found to be a cost-effective model for childhood drowning prevention.

Most importantly, such interventions not only reduce drowning deaths but also provide a safe environment for children to learn and facilitate their early childhood development. It has been evident from other studies of CIPRB that children who receive care in crèches are better performers in school compared to others who did not have access to such supervision and services.

Initiatives supported by Bloomberg Philanthropies by engaging its local partners have been advocating for scaling up and sustaining the interventions across the country, which now require government interventions and policy guidance for sustainability. Given their nature, effective sustainability of the tested interventions requires engagement of multiple stakeholders, both government and non-government ones.

Meanwhile, the Ministry of Women and Children Affairs has developed a project to scale up the daycare model with swimming learning facilities to ensure all children under the age of 5 have access to affordable supervision that will also be useful to help with their cognitive development. Following the complex nature of approving development projects and allocation of government resources, the initiative of the ministry should be among the priorities of the government as the evidence generated in Bangladesh has been adopted by the WHO and is being replicated in other parts of the globe.

It is worth mentioning that Royal National Lifeboat Institution (RNLI) has been advocating with the United Nations (UN) to adopt the first-ever UN resolution on drowning prevention. Ambassador Rabab Fatima, permanent representative of Bangladesh to the UN, has been leading the negotiation along with seven other countries.

In the global context, scaling up the tested interventions of drowning prevention, though frugal, is a great concern. Integration of drowning prevention interventions with the Sustainable Development Goals (SDGs) and other global commitments related to the wellbeing of children and recognising country-specific activities, such as inclusion of water safety in education curricula or child welfare activities, is the key to ensuring the process of scalability and sustainability.

Now, it is evident that to achieve several global goals, it is imperative to scale up the drowning prevention interventions. Following the principle of the whole-of-government approach, development and political leaders need to engage in discussions and formulate an affordable solution to reduce the drowning epidemic, without which the majority of the targets of the SDGs related to child mortality cannot be achieved.

Given the current scope of the WHO, drowning has been considered an issue under the non-communicable disease control segment. But from multiple studies like SoLiD, it is evident that most of the effective interventions do not fall under the jurisdiction or scope of the department of health, which creates a problem at the global level.

In the Bangladeshi context, developing day-care centres, teaching swimming skills, and conducting water safety sessions in schools do not fall under the jurisdiction of the Ministry of Health and Family Welfare. Thus, through the adoption of a holistic approach having stakeholder-specific interventions for drowning prevention, the multiple actors at the national level should be made accountable to deal with the adversity of drowning.

Mobilising resources to support the interventions for drowning prevention should be discussed in the national policy fora, leading to the development of a multi-stakeholder coordination mechanism for accumulating resources and its monitoring framework. The frugal innovation like crèches – designed to save children from drowning and having unique features and opportunities for promoting stimulations for early childhood development across the global context – should be dealt with through multifaceted efforts.

Such opportunities should be linked with all multilateral agencies concerned having a special mandate to ensure welfare, including safety and education for children. More importantly, these interventions have created the scope for women's social and economic empowerment through their engagement in running the day-care facilities, including transferring the lifesaving skill of swimming.

In Bangladesh's policy discourses, drowning has so far been mentioned in the Multi-sectoral Action Plan for Prevention and Control of Non-communicable Diseases 2018-2025 and the strategy for Integrated Management of Child Illness (IMCI). But in the implementation phases, drowning has not yet been prioritised.

For instance, considering the multi-sectoral approach of drowning prevention and surfacing of policy attention, it was a requirement to bring in a separate strategy for drowning prevention. CIPRB's decades of experience gained through implementing SoLiD, PRECISE, and BHASA suggests that if a multi-stakeholder coordination mechanism cannot be established, it is not possible to address drowning for which a separate national drowning prevention strategy is a must.

Thus, CIPRB shouldered the responsibility and has been providing technical assistance to the Directorate General of Health Services to develop the national strategy on drowning prevention, where evidence generated through these studies was instrumental.

So, to scale up the frugal innovations of drowning, resource mobilisation is difficult, but it is urgent to bring those interventions by rethinking policy issues, such as approving the national drowning prevention strategy, setting up a multi-stakeholder coordination mechanism at the ministry level, setting up a national monitoring framework for follow-up of progress and developing a stakeholder-specific module for reporting, and reforming the resource allocation process and bringing the drowning prevention interventions under revenue scheme with proper legislative and policy guidance.

Sadrul Hasan Mazumder is a policy activist and can be reached at m.sadrul@hotmail.com