The challenges of drowning prevention in the Philippines

One lifesaver per family: That’s one of the main ambitions of the Philippine Life Saving Society, a volunteer-based training organization that aims to establish a culture of drowning prevention in a country with about 3,000 such deaths per year, according to official government statistics.

“Our goal is to have at least 75,000 lifesavers nationwide by 2025, fully trained,” Arne Navarra, the president and CEO of the Philippine Life Saving Society, told Devex.

But even with 75,000 lifesavers, Navarra said that’s still far off from reaching “herd immunity,” or the number needed to ensure there’s a lifesaver for every Filipino vulnerable to drowning. 

At least 60% of the population should be fully trained “to attain ‘herd immunity’ for vulnerable Filipino people exposed to water,” he said.

But that may be easier said than done, given the limited resources and attention to drowning as a public health issue. Globally, drowning kills more than 236,000 people per year, which many advocates say is likely an undercount. More than 90% of drowning deaths occur in low- and middle-income countries, according to the World Health Organization.

In 2021, the United Nations General Assembly designated July 25 as World Drowning Prevention Day to raise awareness on ways to prevent drowning. WHO also recommends several evidence-based drowning prevention interventions, which include teaching school-aged children swimming and water safety skills, and training bystanders in safe rescue and resuscitation. But those working to address the issue say much more is needed for drowning to receive attention and the needed resources in global health.

Underreported and under-resourced

Navarra describes drowning in the Philippines as an “epidemic.” But it is largely underreported and the ways to prevent it are under-resourced. His estimates are that reported and unreported drowning incidents in the country are at 10,000, significantly higher than what’s captured by government records.

While drowning is often reported when there are floods in the Philippines during typhoon season, some children drown in a tub or close to their homes where there are open waterways, like a river or a canal. Alcohol intoxication is also a risk factor for drowning. According to a WHO regional report in the Western Pacific, 13% of drowning deaths in the Philippines is associated with alcohol.

Multiple drowning is also very common during holidays, when families go out for recreation and family members try to save their kin from drowning. Even during the COVID-19 pandemic, when lockdowns are in place, there’ve been reports of children sneaking out of their homes and drowning in the provinces, he said.

But there are few organizations working to address the issue, and funding is limited.

In the Philippines, Navarra’s organization relies largely on partnering with local government units, such as local tourism as well as disaster risk reduction offices to pursue drowning prevention programs, such as water safety symposiums in schools, training lifesavers on resuscitation and emergency care, and teaching communities on how to do proper cardiopulmonary resuscitation in the event of a drowning incident. They have training programs, such as for interested physical education teachers, but that comes with a fee.

“We don’t have a funder abroad so we’re only doing a self-sustaining program,” he said.

“Hopefully there are kindred organizations or kindred philanthropists that can [invest] in funding projects,” he added.

Bloomberg Philanthropies is one of the few organizations known to be providing support for drowning prevention globally. Its work spans several countries, including in Bangladesh, where the foundation provides support on community-level day care, while in Vietnam, it supports swimming programs for school-aged children. In Uganda and Ghana, the charity is focusing on quality data gathering on drowning causes to understand what interventions it can support, Dr. Kelly Henning, lead of Bloomberg Philanthropies’ public health program, told Devex.

In the Philippines, the charity has also done some work on drowning prevention through WHO. But Henning agrees there is a lot more work to do.

“Island nations are important … They do have lots of drowning deaths, both among adults and children … And certainly, those are some of the settings where we will be looking at as we move forward with the program,” she said.

Start with children

According to WHO, drowning is one of the leading causes of death globally for children and young people aged 1-24 years old. That’s why WHO’s recommended interventions include putting children in community-based, supervised day care programs, and teaching water safety skills to school-age children from 6 years old.

Dr. David Meddings, who leads WHO’s work on drowning prevention at its headquarters in Geneva, said these interventions have been studied and found to be highly cost effective, similar to other public health interventions such as vaccinations.

But it’s not seen as a public health issue, where the focus is on communicable diseases and which is often the focus of programs working to reduce child mortality.

That’s not unexpected, given that a large percentage of under-5 mortality is caused by infectious diseases, such as diarrheal and respiratory diseases, which often happen in a child’s first year of life, he said. But that focus needs to expand to address other issues, like drowning.

“In most countries, the vast majority of kids are going to make their first birthday, they’re going to survive. Well, how tragic is it that we've sort of invested all this resource and effort into vaccinating them, making sure they're healthy and safe. And then a 14-month-old or an 18-month-old child toddles off, unsupervised in their environment, and they fall into a pond? That’s really silly.” Meddings told Devex, adding that there needs to be a larger awareness of the portfolio of causes that might kill children before the age of 5.

“[Infectious diseases] remain a big problem. Diarrheal disease kills children after the first year of life. But it is fair to recognize that once you get that first 12 month birthday pass, drowning does become an important contributor to under five mortality,” he added.

But implementing drowning prevention interventions can face certain challenges in countries.

In the Philippines, one of Navarra’s frustrations is the lack of water safety training for students in schools.

“All schools must train their students on this too, but it never happens. When you ask why… the answer is always there’s not enough swimming pools,” he said.

Bills were filed in the Philippine House of Representatives that sought to mandate swimming classes in schools for drowning prevention, in addition to proposed legislation in the Senate requiring lifeguards at all public swimming pools and bathing facilities in the country. But none of them became law.

Navarra hopes the new Philippine government will take up the issue as a priority.

“Our ultimate goal is to establish a culture of drowning prevention in order to zero out drowning [in the Philippines],” he said.