Background:

Drowning has been the most neglected and unheeded but preventable health crisis in Low- and Middle-Income Countries. Children, adolescents, and individuals with increased access to water are the at-risk groups for drowning. A forgotten and avoidable epidemic when prevented can enable progress on climate resilience, health equity and Sustainable Development Goals.

Therefore, unveiling the root causes at ground level to identify and establish core solutions around drowning prevention is emphasized by experts. This can be achieved by prioritising equity and inclusion of local communities globally. Advocating policies as well as linking communities to existing or new policies are required.

Visualising Statistics:

World

• Drowning has been recognised as the third leading cause of Unintentional Injury worldwide (WHO).

• Globally, it accounts to approximately 7% of all injury-related deaths.

• The burden and deaths due to unintentional drowning are highest i.e., 90% in the low-and-middle income countries.

India

• Third leading cause of mortality due to unintentional injury in India.

• One of the top 10 causes of death for children, adolescents, and young adults <24 years.

• Approximately, 2,36,000 lives are lost due to drowning every year- about 650 deaths every day and 26 deaths hourly.

• As per WHO 2021, Regional Status Report on Drowning in South-East Asia region, there were around 48,774 deaths in India alone, of which 30% occurred amongst children under 15 years of age.

Highlights of UN’s historic Resolution on Global Drowning Prevention

The historic day of 28th April 2021 marked the Resolution for Global Drowning Prevention by United Nations along with countries with a goal to recognise the importance to prevent hundreds and thousands of deaths due to drowning around the world.

• Proposed by Govt. of Bangladesh and Ireland, co-sponsored by India and 78 countries.

• Designation of the First World Drowning Prevention Day on July 25, 2021.

• Recognised that drowning is preventable, and scalable, low-cost interventions exist that every country should implement.

• Encourage countries to develop National Drowning Prevention Programs as per the recommendations of WHO.

• Enact and enforce Water Safety Laws.

• Public Awareness and BCC Campaigns.

• Research and Development on newer drowning prevention tools and technology

• Capacity building and International Collaboration

A dive into Projects relating to Drowning

Between 2016 and 2020, the George Institute for Global Health conducted research on the health impact of drowning in Bangladesh, India, and Vietnam through community engagement thus providing crucial insights and evidence-based resources to tackle this often unheeded crisis.

PROJECT BHASA in Bangladesh

Evidence-based interventions like:

• Supervised day care sessions (Anchal/Creche)

• Swim Safe program- to teach swimming survival skills

• Water safety in schools

• Rescue training/First responder for community volunteers

Impact of the project:

• 60% reduction in drownings in project areas

• 30,000 children taught water safety over three years

• Over 2800 community volunteers provided rescue training

• Supervised care for 10000 children across 400 childcare centres (Anchals) over 3 years

• Drowning prevention awareness raised with extensive media coverage

5 action points to prevent child drowning:

• Install home-based barriers and fencing to reduce access to water

• Supervised child care and safe spaces

• Train adults in safe resuscitation, rescue or first responder training

• Teach children swimming, water safety and rescue training

• Coordinate drowning prevention efforts with existing government programs

A National Drowning Plan has been developed in Bangladesh as a result of increased awareness and through coordination with communities and Centre for injury prevention and research.

The Sundarbans research by the same institute have made an impact about the unattended national crisis through extensive media coverage. Community feedback and policy analysis from the Sundarbans showed that scaling up effective interventions would best involve three existing social programs:

·       Integrated Child Development Scheme for improved childhood supervision.

·       ASHA community health worker program for improved local first responder training.

·       Involving existing Self-Help Groups.

 WHO Response for Prevention of Drowning:

Practical guidance for the provision of day-care, basic swimming and water safety skills, and safe rescue and resuscitation training (2022):

• Investment in day-care programmes for pre-school children and teaching basic swim skills to children will save 7,74000 children till 2050.

• Effective policies, guidelines and legislations for:

  - Enforcing safe boating, shipping and ferry regulations, better disaster preparedness planning to manage flooding and land use planning.

• A National Water Safety Strategy should be developed for multisectoral action for drowning prevention and subsequent monitoring and evaluation.

• Greater coordination and collaboration among UN Agencies, governments, NGOs and academic institutions.

• Preventing Drowning: An Implementation Guide was released by WHO in May 2017

• The first ever Resolution on drowning prevention linked with sustainable development, social equity, urban health, climate change, disaster risk reduction, child health and wellbeing was adopted by UN General Assembly in April 2021. To establish multisectoral coordination for drowning prevention, WHO and UN declared 25th of July as World Drowning Prevention Day.

• UNGA Resolution for global drowning prevention:

  - The 76th World Health Assembly adopted a resolution to hasten further action through 2029.Establishment of Global Alliance for Drowning Prevention with UN, International development partners and NGOs. A global status report will be released by WHO on drowning prevention in 2024.

• World Health Assembly Resolution for accelerating action on global drowning prevention:

  - Country level: WHO is working with Ministries of Health in LMIC countries and guiding the development of National Drowning Prevention Strategies and supporting evidence-based Drowning Prevention Interventions through research and development.

  - Regional level: WHO organises training programs and workshops.

Government of India Initiatives

• An expert committee was established by Indian Government to draft the Drowning Prevention Framework of India.

• “National Emergency Life Support” course manual in introduced in 2022 by MOHFW.

• “Strategic Framework for Drowning Prevention” unveiled in 13th December 2023 by MOHFW.

The statistics remain uncertain and unreliable in most of the countries as the data is not available. Drowning deaths are frequently under-reported in birth and death registration systems, according to a paper published in the Lancet. The paper also mentioned that a national drowning registry should be the goal but some non-health sector data can also provide relevant insights and help in preventing drowning incidents.

Effective Interventions to prevent Drowning in India

• Installing barriers around water bodies (pools, wells, ponds) to prevent access to water hazards

• Provide safe areas for children to play away from water

• Weather Forecasts regarding risks from natural water bodies

• Training of basic swimming and water safety skills to people who live in vicinity of water or engage in water-activities

• Training for safe rescue and resuscitation techniques such as CPR or mouth-mouth breathing

• Safe boating and Shipping regulations-proper maintenance and use of life jackets

• Flood risk management with flood-resistant infrastructure with early warning systems

According to National Crime Records Bureau, there were 36,362 deaths reported in 2021 in India due to drowning, particularly children being vulnerable. Considering the high human, social and economic impact of drowning and as drowning is completely preventable, there is dire need of following changes in India concerning drowning:

• Need for Drowning Registry

• Need for National Drowning Prevention Strategies

• Supporting evidence-based Drowning Prevention Interventions through research and development

• Drowning prevention under a national program with e-portal

• Strengthen Community participation

• Strengthen Multisectoral coordination and approach

• Strong partnerships between International agencies, NGOS, National Govt, Local bodies, Communities for sustainability of program

Challenges in implementing drowning prevention strategies:

• Population-based data are essential for mitigation which are usually incomplete and unreliable.

• Gaps exist between knowledge and action for prevention of drowning which is attributed to:

  • lack of shared knowledge between sectors,

  • inadequate recognition of local values,

  • insufficient investment in capacity development for prevention interventions,

  • definition and reporting of non-fatal drowning incidents,

  • cultural acceptance,

  • local communities stubborn mindsets

  • capacity limitations among community members for first aid delivery

Way Forward: What Indian government can learn from Vietnam? [8,9,10]

• Specific policy targets to reduce drowning: Vietnam has reduced child drownings cases by 100 each year since 2016. The programme on child accident and injury prevention for the 2021 – 2030, the 10-Year Action Plan aims for a 10% reduction of child drowning deaths by 2025 and 20% by 2030.

• New Life-Saving Drowning Prevention Program was launched in 2018 by Vietnam with multisectoral coordination between Ministry of Labor, Invalids and Social Affairs (MOLISA), Bloomberg Philanthrophies, WHO and Global Health Advocacy Incubator(GHAI).

• A strong legal framework 

• The sustainability of drowning prevention through government funding of the program and integration of standard survival swim and water safety guidelines into the education system.

• Investment of the local authorities 

• Involvement of Families and communities: supervise their children’s safety, teach children swimming and water safety skills, provide safe places away from water and install barriers controlling access to water.

References:

1.    The George Institute for Global Health. (n.d.). Urgent call to act on the drowning epidemic. [online] Available at: https://www.georgeinstitute.org.in/news/urgent-call-to-act-on-the-drowning-epidemic.

2.    The George Institute for Global Health. (2016). Childhood drowning - Stopping a silent epidemic | The George Institute for Global Health. [online] Available at: https://www.georgeinstitute.org/our-impact/case-studies/childhood-drowning-stopping-a-silent-epidemic [Accessed 12 Oct. 2023].

3.    Rashtriya Life Saving Society. (n.d.). Drowning Prevention. [online] Available at: https://www.lifesavingindia.org/drowning-prevention/ [Accessed 12 Oct. 2023].

4.    Gupta, Medhavi & Zwi, Anthony & Jagnoor, J. (2020). Opportunities for drowning interventions using existing government policy and programmes in India. European Journal of Public Health. 30. 10.1093/eurpub/ckaa165.544.

5.    Alam, E. (2023). A neglected national crisis. [online] The Daily Star. Available at: https://www.thedailystar.net/opinion/views/news/neglected-national-crisis-3377411 [Accessed 12 Oct. 2023].

6.    www.who.int. (n.d.). New Life-Saving Drowning Prevention Program in Vietnam launched today. [online] Available at: https://www.who.int/vietnam/news/detail/26-06-2018-new-life-saving-drowning-prevention-program-in-vietnam-launched-today [Accessed 12 Oct. 2023].

7.    VietnamPlus (2021). Vietnam looks to reduce child drownings by 20 percent by 2030 | Society | Vietnam+ (VietnamPlus). [online] VietnamPlus. Available at: https://en.vietnamplus.vn/vietnam-looks-to-reduce-child-drownings-by-20-percent-by-2030/205840.vnp.

8.    Global Health Advocacy Incubator. (n.d.). Government of Vietnam Launches New Effort to Reduce Child Drowning…. [online] Available at: https://www.advocacyincubator.org/featured-stories/2021-11-30-government-of-vietnam-launches-new-effort-to-reduce-child-drowning-death [Accessed 12 Oct. 2023].

9.    www.who.int. (n.d.). Viet Nam marks First World Drowning Prevention Day: anyone can drown, no one should. [online] Available at: https://www.who.int/vietnam/news/detail/23-07-2021-viet-nam-marks-first-world-drowning-prevention-day-anyone-can-drown-no-one-should [Accessed 12 Oct. 2023].

10.Drishtiias.com. (2023). Available at: https://www.drishtiias.com/daily-updates/daily-news-analysis/world-drowning-prevention-day/print_manually [Accessed 12 Oct. 2023].

11.Scarr, J.P., Buse, K., Norton, R., Meddings, D.R. and Jagnoor, J., 2022. Tracing the emergence of drowning prevention on the global health and development agenda: a policy analysis. The Lancet Global Health, 10(7), pp.e1058-e1066.