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In search of a political framework

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– The life of Lake Powell

Humans cannot survive without water. We must therefore have a clear understanding of the danger around water and the associated limitations. Given the riverine characteristics of the greater delta, we as residents must maintain a careful balance by focusing on drowning while enhancing the benefits of recreational activities in and around the water. But neither a particular government agency nor an individual organization can act alone to provide comprehensive protection and educate communities to reduce the drowning rate.

Given the outcome of the drowning, it appears under the responsibility of the health service; but if one examines preventive interventions, it is clear that the prioritization of interventions is not singularly within the mandate of the ministry. Given the multisectoral nature of drowning prevention interventions, every attempt to tackle the drowning epidemic – by developing strategies or testing a particular intervention – requires a holistic and coordinated approach.

Globally, drowning is a significant cause of death and is the second leading cause of childhood injury death and also the third leading cause of accidental death. In 2019 alone, the World Health Organization estimated that 236,000 people drown each year, which equates to nearly 650 drowning deaths each day and 27 deaths per hour. It is a problem that transcends borders, affects all countries, but the impact of drowning is felt unevenly. More than 90% of drowning deaths occur in low- and middle-income countries, while the highest rates are recorded in the Western Pacific, Southeast Asia and Africa regions. Drowning is also prevalent in other parts of the world similar to the Delta. Every individual of all ages is directly or indirectly affected where children under 5 and people over 60 have been found to be the most affected section of the population.

The Bangladesh Health and Injury Survey 2016 estimated that the drowning death rate of 11.7 per 100,000 people per year corresponds to a total of 19,247 deaths, two-thirds of which involve children. A recent survey by the Bangladesh Bureau of Statistics shows that in rural areas, under-five mortality from drowning is higher, 9.7%, compared to urban areas, 7%, which is just below the death rate of children of the same age group from pneumonia. The recently released drowning fact sheet, published by the Royal Life Saving Society, shows that in 2017, around 110,000 people died from drowning in Commonwealth countries – and India, Bangladesh and Pakistan account for 78% of estimated deaths where Bangladesh is located. the fifth position among Commonwealth countries.

Despite such a cruel reality, drowning has not been mentioned in any of the laws adopted since independence. But the “Multisectoral action plan for the prevention and control of non-communicable diseases 2018-2025, adopted by the General Directorate of Health Services, includes the development of daycare centers aimed at improving the supervision of children to reduce exposure. to water bodies. The strategy mandated the Ministry of Health and Family Welfare to ensure the establishment of day care centers in partnership with the Ministry of Women and Children and the Ministry of Local Communities, Rural Development and Cooperatives as well. as non-governmental organizations and the private sector.

But there is a lack of leadership and coordination between relevant ministries, which has been further complicated by the diversity of terms of reference, business roles and responsibilities for multiple interventions to prevent drowning. In addition, the strategy focused only on child drowning and, therefore, incorporated improvements in “monitoring of children to reduce exposure to bodies of water”. Thus, it is clear that the strategy did not include drowning that takes place when crossing streams or when crossing bodies of water. The strategy also failed to identify the drowning affected population and possible risk factors and places of occurrence such as beaches and seas, rivers and lakes.

As drowning is considered a non-communicable disease by the World Health Organization, the health service becomes the priority. But if drowning prevention interventions are scrutinized, it would be evident that most of the interventions fall outside the mandate or scope of the ministry or branch of health services, which creates a problem at the health service level. operational and in the design of the service portfolio. . For example, the development of day care centers, the teaching of swimming techniques and the organization of water safety sessions in schools, the regulation of river vehicles, the maintenance of aquatic facilities and the guarantee of basic ferry standards. fall outside the mandate of the Department of Health and Family Welfare.

Media reports have shown that rivers and lakes continue to be the main drowning sites. Constant changes in ground level and hidden dangers such as strong currents, submerged objects, slippery or eroded banks cause hardship for people. In the context of Bangladesh, various aquatic sites and inland waterways are not monitored by rescue or maritime services at all, which is exacerbated by the absence of an emergency, rapid medical assistance affected by geographic isolation and the lack of appropriate means of communication. Preventing drowning in rivers and lakes is a priority, as about 12.3% of the total population of rural communities travel daily by inland waterways, which, according to the Inland Water Transport Authority, are used by about 87.8 million people each year. A wide range of activities and exposure to hazards as well as drowning risk factors such as the use of children for fishing and living in geographically disadvantaged communities make it difficult to prevent drowning in rivers and rivers. lakes.

Multiple factors have been identified as causing drowning deaths where various agencies are expected to remain vigilant, but the responsibility lies with the Department of Health as drowning continues to be a major factor affecting the death rate for children under five. years. It is not simply a problem of coordination, but rather a question of governance, which requires the revision of the legislation and policies which frame the actor concerned and the agency associated with the risk of drowning.

If we take a critical look at the regulations, it appears that inland waterways and transport are governed by the Inland Water Transport Corporation Order 1972 and the Inland Water Transport Authority Ordinance 1958, which require considerable reform and modernization. to protect people, especially those who use the waterways. as the only way to get around, drowning.

Drowning is a well-known complication of natural disasters. The most common in the context of Bangladesh are floods, cyclones, tidal waves, etc. WHO data shows that drowning is responsible for 75% of flood deaths. The risks of drowning increase with flooding, especially in low- and middle-income countries where people live in flood-prone areas and where the capacity to warn, evacuate or protect communities from flooding is low or is only growing. Cyclone Yaas, like the others, which killed several people by drowning, also put people of all ages at risk of drowning. Thus, the integration of drowning risk management into the National Disaster Management Plan 2021-2025, which is now awaiting final approval, is of crucial importance. The UNGA resolution on global drowning prevention also called for developing drowning prevention programs in line with interventions recommended by the World Health Organization, such as barriers, supervision, swimming skills, rescue and resuscitation training, navigation regulation and flood risk management and resilience.

The recently approved Eighth Five-Year Plan 2020-2025, which is the guiding document for the allocation of government resources over the next five years, also lacks special attention to reducing the risk of drowning. Thus, it is imperative to explore the possibilities of adopting a national water safety policy rather than a singular national drowning prevention strategy specifically focused on child drowning, which may undermine the scale of the drowning. problem. There are examples from other countries that have covered drowning prevention by adopting a national water safety policy.

Isn’t it wise to scale up and maintain drowning prevention interventions following a holistic, multisectoral approach? This will alleviate the already overburdened health system which has been further complicated by the Covid-19 epidemic. The adoption of the National Water Security Policy will help bring together multiple actors working at the national level under a common accountability and monitoring framework so that they can provide the necessary response to fight drowning.

It is essential that drowning prevention interventions be integrated into the spirit of the United Nations General Assembly resolution on worldwide drowning prevention, which observed that “drowning prevention would contribute to the achievement of Agenda 2030, more specifically that drowning prevention is an effective measure contributing to the prevention of child deaths and can protect investment in child development “and also” encourage the integration of child death prevention. drownings in existing disaster risk reduction programs, especially in communities at risk of flooding and coastal flooding, including through international, regional and bilateral cooperation. “

To maintain and scale up existing drowning prevention interventions, the government should facilitate a multi-stakeholder coordination mechanism starting with the planning phase to reduce drowning deaths, with particular emphasis on examining the feasibility of drowning. ” adoption of a comprehensive national water security policy, resources to scale up tested drowning prevention interventions, raise public awareness, examine possibilities of involving government and semi-government agencies such as the directorates of the primary and secondary education to introduce water safety courses and expand the scope of the swimming federation to provide lifesaving training.

Sadrul Hasan Mazumder is a political activist.