Institutionalisating drowning prevention interventions

Drowning has been found to be the leading factor causing deaths across the globe, which according to WHO claims the lives of 322,000 individuals every year. There is evidence that ninety percent of these deaths occur in low-and middle-income countries.  

In case of Bangladesh, children up to the age of five are the biggest victims. A Center for Injury Prevention and Research, Bangladesh (CIPRB) study shows that in Bangladesh, more than 18,000 children, aged 1-17,  drown per year, meaning roughly 50 children die every day. 

Therefore, children are the ones most exposed to the adversity of drowning. But communities are not aware of the severity of drowning and building awareness among mass people is essential, although not sufficient. To institutionalise the drowning prevention interventions, globally WHO recommended six proven interventions as the best practice.

Installation of barriers controlling access to water can stop children, even adults who do not know how to swim from getting in contact with open water bodies, reducing the rate of drowning. In high-income countries, incidences of drowning happen mostly in unfenced swimming pools and farm dams. But in low-income countries water bodies remain unfenced everywhere. Across rural communities fencing ponds is not a problem of resources, rather communities, at large, do not recognise drowning as a problem. Massive social and behavioral change, along with communicating with community leaders, might be a solution. 

Ensuring institutional supervision for children who are under 5 years is an effective intervention to protect them from drowning. Childhood drowning tends to occur during guardians' busy hours of doing household works. Several governments, non-government and international agencies are providing institutional supervision to children in Bangladesh having early childhood stimulations, but the purpose of establishing the supervision mechanism is not protecting children from drowning. An intensive review of those institutional supervisions shows that different agencies follow different schedules with diverse operational procedures, based on the purpose of supervision. 

Teaching school-age children swimming and water safety skills can reduce around 90.2 percent drowning of children aged 5-12 years. Implementation guidance by WHO suggests that "schools are the preferred entry point for swim skills and water safety training". CIPRB has developed a frugal structure for teaching swimming techniques available at the rural setting where children aged 4-12 years can learn swimming and water safety skills following a structured curriculum, having adequate safety measures. Such installations are low cost and provide safe areas where children can actively be supervised during sessions. 

Training bystanders in safe rescue and resuscitation is also a useful technique to reduce the rate of drowning.  Management of post-non-fatal drowning cases have been found challenging. Though rescue and resuscitation of drowning victims by bystanders have been found effective, targeting the right group of people to train on resuscitation is a challenge. Studies show that proper training enables individuals to perform safe rescue; even properly trained children aged seven years can provide resuscitation successfully. But the absence of Good Samaritan Law in Bangladesh is a discouraging factor for the bystanders.

To promote multi-sectoral collaboration, CIPRB has played the role of facilitator to develop a multi-stakeholder coordination mechanism through the formation of the National Steering Committee, engaging multiple government and non-government agencies, international development partners, and UN bodies who have proven contributions in child protection in general and drowning prevention in particular. 

Strengthen public awareness of drowning through strategic communications is of utmost importance because the communities who are most vulnerable and have already been affected are not aware of the adversity of drowning. To create effective awareness among communities, it is urgent to undertake massive social and behavioral change communication campaigns; traditional techniques of creating awareness might not be useful here. 

Developing a national water safety plan is essential and DGHS with technical support from CIPRB has developed a national drowning prevention strategy, which has already been vetted by all concerned stakeholders. The strategy is waiting approval of the MoHFW. 

Advance drowning prevention through data collection and well-designed studies where capturing knowledge and translating the knowledge into policy action is critically important. NGOs have been generating exemplary innovations and knowledge of national importance. Despite having functional coordination and greater acceptance of NGOs by the government, Bangladesh Planning Commission considers the data generated only by the Bangladesh Bureau of Statistics (BBS) in setting national plan of actions and providing recommendations for approval of development projects. To institutionalise a process of recognising evidences generated by NGOs, BBS should develop a coordination mechanism of accreditation. Such initiatives will not only widen the scope of BBS but also help the NGOs to institutionalise the evidences generated by implementing multiple programmes. 

Institutionalisations of the tested interventions of drowning prevention are critically important even to achieve several global goals. Otherwise, the majority of the targets of SDGs relating to child mortality cannot be achieved. Most importantly, like other development issues, drowning should be brought or translated into a political agenda where institutionalisation of the interventions is of utmost importance.

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