Why we need a national strategy to prevent drowning

Globally, drowning is the second leading cause of injury-related deaths among children and also the third leading cause of accidental deaths. According to the WHO, drowning claims around 322,000 lives per year worldwide, with over 90 percent of incidents taking place in low- and middle-income countries. It also causes the deaths of at least 12,000 children per year, which is equivalent to 43 percent of all child deaths. Drowning mortality is the highest among children aged 1-4 years, while more than 50 percent of the deaths occur before the victims' 3rd birthday.

Bangladesh Health and Injury Survey 2016 estimated that its drowning mortality rate of 11.7 per 100,000 persons per year corresponds to a total of 19,247 deaths, two-thirds of them involving children. A study by the Centre for Injury Prevention and Research, Bangladesh (CIPRB) shows that 68 percent of drowning takes place between 9 am and 1 pm and the majority of incidents take place in ponds (66 percent) and ditches (16 percent) located within around forty steps of households. This has been accelerated by the reality that both parents in poorer households often have to work in distant places, leaving their children unattended.

Despite such a reality, drowning has not been mentioned in any of the laws enacted since the country's independence. But the "Multi-Sector Action Plan for Prevention and Control of Non-Communicable Disease, 2018-2025", adopted by the Directorate General of Health Services (DGHS), includes the development of day-care facilities aimed at improving child supervision to reduce exposer to water bodies. The strategy mandated the Ministry of Health and Family Welfare to ensure setting up of day-care centres in partnership with the Ministry of Women and Children Affairs and the Ministry of Local Government, Rural Development and Cooperatives as well as NGOs and private-sector organisations. But there is a lack of leadership and coordination among the ministries concerned, which has further been complicated by the diverse terms of reference, roles, and responsibilities for operationalising multiple interventions of drowning prevention.

Globally, drowning has been considered under the non-communicable disease control segment of the WHO. But if the drowning prevention interventions are thoroughly examined, it would be evident that most of the interventions do not fall under the jurisdiction or scope of the ministry/directorates of health, which creates a problem at the operational level and in designing the delivery portfolio. For example, in Bangladesh, developing the day-care centres, teaching swimming skills, and conducting water safety sessions at schools do not fall under the jurisdiction of the ministry of health. Thus, through the adoption of the National Strategy on Drowning Prevention, the multiple actors working at the national level should be brought under a common accountability and monitoring framework so that they can deliver the interventions necessary to tackle drowning.

And it should be done urgently. A recently published factsheet on drowning, published by the Royal Life Saving Society (RLSS), the Commonwealth's oldest and largest live-saving and drowning prevention organisation, shows that during 2017, about 110,000 people died from drowning in the Commonwealth countries—and India, Bangladesh, and Pakistan account for 78 percent of the estimated fatalities. In this regard, Bangladesh stands 5th among the Commonwealth countries.

Research from home and abroad have identified multiple factors causing drowning deaths, such as lack of physical barriers between people and water, particularly close to home; inadequate supervision of young children; uncovered or unprotected water supplies and lack of safe water crossings; lack of water safety awareness and risky behaviour around water, such as swimming alone; travelling on water, especially in overcrowded and poorly maintained ferries; and flood disasters, whether from extreme rainfall, storm surges, tsunamis or cyclones. In Bangladesh, especially in the health sector, although major advancements have been made so far, drowning continues to be a major factor affecting the mortality rate of children below five years.

To tackle this, the CIPRB has advocated innovative solutions such as the strategic use of barriers to control access to water, creation of a community-based supervision mechanism for pre-school children, and teaching basic swimming skills to school-age children. The supervision mechanism has been especially found to be a cost-effective and useful intervention to protect children aged 1-4 years. The mechanism, designed to function within the context of rural Bangladesh, has been broadly steered by the community-based approaches in which parents of the children play a key role while the community plays a supportive role or acts as a facilitator.

Studies show that teaching children basic swimming skills and water safety with safe rescue skills can help to reduce the rate of drowning. But for a wider impact, it is essential that drowning prevention interventions are integrated with a SDG framework as well as other national priorities relating to the wellbeing of children. It is also necessary to scale up the existing drowning prevention interventions. Most importantly, the government should facilitate a multi-stakeholder coordination mechanism to reduce deaths from drowning, with particular focus on the approval of a comprehensive national strategy on drowning prevention; allocating resources to scale up the day-care model adopted; enhancing awareness among the general public; examining the possibilities of engaging government and semi-government agencies like the directorates of primary and secondary education to introduce water safety lessons; engaging the countrywide network of Ansar-VDP to provide first responder services; and widening the scope of the Swimming Federation to provide life-saving training.

Sadrul Hasan Mazumder is a policy activist.

Email: m.sadrul@hotmail.com.