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Interventions Part 1: Creches
Humanitarian aid can be dramatic. Disaster relief following tsunamis and earthquakes, evacuations from conflict zones; food drops into areas of starvation and diseases prevented with a single injection, all make compelling viewing. Add a celebrity or two and the world may just pay attention.

But within the aid sphere, child drowning is unassuming – much like drowning itself. It happens quickly, silently and singularly, therefore lacking the mass impact of a natural disaster. 

“The spectacular drowning events happen when a boat sinks, but that’s not where the big numbers are,” said Ross Cox, a public health expert working with The Alliance for Safe Children (TASC) and the director of the SwimSafe program in Da Nang, Vietnam.

“The stuff we’re seeing is in every country in a routine situation. Drowning happens: one, one, one,” he added, indicating the individual nature of drowning. 

But they add up. For all intents and purposes, drowning is an epidemic. When approximately 200,000 children drown every year, it’s hard to consider it anything less. Urgent action and interventions are desperately needed.

Yet far from the dramatic responses which follow the dramatic issues mentioned above, recent studies and pilot programs have pointed to two specific yet simple interventions: a crèche for children aged 1–4 and swimming and water safety lessons for older children. It’s a hard sell in a world of instant gratification and donor fatigue.

But it works – unbelievably well in fact. A report released by UNICEF’s Innocenti Research division1 in 2012 outlines two key elements in the fight to reduce child drowning: firstly, that drowning is a leading cause of death in children after infancy in low- and middle-income countries (LMICs) in Asia; and secondly, that the two interventions can reduce drowning by a staggering 90 per cent.

In the first of this two part series, we will look at the need and effectiveness of crèches.

Crèches, or childcare facilities, simply provide safe and supervised areas for children to go when their parents are busy with day-to-day activities. What is simple and effective in the West can be equally effective in developing countries. They can also be more necessary. 

In LMIC settings, the lifestyle is very much one of subsistence; the work day is usually very long and the workplace is often within or near the home. So too are the drowning hazards.In countries like Bangladesh for example, villages are surrounded by water. Ponds, irrigation channels, wells, rice paddies... water is everywhere. It is little surprise then that most of the younger children who drown do so within 20 metres of the home.

Initial research showed that the busiest time for parents was between the hours of 9am to 1pm. It was also a time when many children aged 1–4 drowned. The simple solution of providing a crèche—called an Anchal in Bangladesh—gave children a safe place to go within the village where they would be supervised and gave parents the peace of mind to know that their children were being looked after.

The pilot program results were startling. They showed that drowning death rates in children who attended Anchals were 82 per cent lower than non-attending children. Knowing how effective the Anchal intervention can be is one thing. Scaling it up to necessary coverage levels is another. 

Yet what may sound potentially cost prohibitive is actually not. To establish a village crèche program in rural Bangladesh costs only $500. To build or refurbish a building costs $80. And for only $45 you can provide the funds for 25 children to attend a crèche for one month.

Crèches are simple, low-cost and highly effective ways to save children’s lives. And with as many as 50 children drowning in Bangladesh every day—as many as Australia loses every year—the time to act is right now.

There are many ways you can help Royal Life Saving prevent child drowning in low- and middle-income countries in Asia. Please visit the Global Drowning Fund to find out more.

1. Child Drowning: Evidence for a newly recognized cause of child mortality in low and middle income countries in Asia and its prevention, was prepared jointly by members from Royal Life Saving Society – Australia, The Alliance for Safe Children (TASC), UNICEF, International Drowning Research Centre – Bangladesh (IDRCB), Centre for Injury Prevention Research, Bangladesh (CIPRB) and the Duke University / University of Singapore Graduate Medical School. The authors represent The Working Group on Child Drowning in LMICs, at the International Drowning Research Centre – Bangladesh.

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