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Final Technical Report

Development and Implementation of

Evidence-based Interventions for Drowning Prevention

in an Expansion Site in Dagupan City, Philippines

August to December 2011

Submitted by:

Jonathan P. Guevarra

December 2011

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1. Abstract

Assessment was carried out in Lucao, Dagupan City from August to September 2011.

Using the Haddon Matrix, findings revealed several factors that may have led to

incidents of drowning in the community. Results were presented to the members of the

community (barangay council, nurses, midwife and community health workers and

volunteers). Priority interventions were carried from September to December 2011.

Barangay Lucao Drowning Prevention Committee, composed of the three

subcommittees on infrastructure, health, and the monitoring, evaluation and

documentation, was formed. Training on First Aid and Basic Life Support was

conducted and the local officials, health workers and community volunteers were

among the participants. House/door barriers and backyard fences were constructed in

two zones in the village. In addition, several families were beneficiaries of playpens

where very young children can be safely placed when their caretakers have to attend to

household chores and some income-generating activities in the community. Open dug

wells were reconstructed and covered which also served as drowning prevention

strategy in the site. There are other zones in the area that need similar interventions. It

is hoped that the next phase of the project will focus more on the construction of more

barriers and fences in the island zone in the site and that the development of day care

facility for children as a drowning prevention strategy will be realized.

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2. Introduction

Drowning is the third leading cause of unintentional deaths among children worldwide

accounting for 28% of unintentional deaths in this age group. It can result in death

(drowned), morbidity (near-drowning), disability as well as economic, psychosocial and

physical burden on the family and the survivor as well.

The unique geographical and climatic condition of the Philippines makes it at risk for

drowning. As such, drowning is the leading cause of child injury deaths. The lack of

implementation of legislations related to water safety especially those related to local

sea travel has contributed to the rising number of those who drown.

In 2003, the Philippine National Injury Survey was conducted which was the first of its

kind for the Philippines. It was a descriptive study done to show the patterns of fatal and

non-fatal injury by type of injury, by gender and among different age groups. The fatal

injury rate in childhood (0-17 years) was 58.9/100,000 children. The leading cause was

drowning. For children after infancy (1-17 years), drowning was the leading cause of

mortality with a rate of 9.8/100,000 followed by RTA with a rate of 9.1/100,000. A far

third was mortality from violence (3.3/100,000), then animal bite, burn, fall

(2.5/100,000).

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The Department of Health (DOH) has done its part by coming up with policies that will

address the problem of child injury in the country. Through Administrative Order No.

2006-0016 also known as the “National Policy and Strategic Framework on Child Injury

Prevention” (June 2006), DOH began to build the national program on violence and

injury prevention. This policy centered on planning interventions and strategies on

violence and injury prevention in children. One of the priority areas is drowning

prevention.

From 2009-2010, drowning prevention interventions were implemented in two pilot sites

in the cities of Dagupan and Lingayen. Interventions in these pilot sites include

capability-building measures on first aid, basic life support and rescue; development of

barriers, fences and construction of manhole covering; health promotion campaigns

using drowning prevention messages and leaflets; safe community interventions; and

supplies, materials and equipment for use in drowning prevention activities. With the

support of the local leadership, these initiatives proved to be worthwhile endeavors in

support of the Child Injury Prevention Program of the Department of Health (DOH),

Philippines.

With the successful implementation of interventions in the pilot sites, the DOH

embarked on an expansion project to another community in the City of Dagupan. It is

hoped that this will contribute to the decrease in the incidents of drowning in the

expansion site.

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The following were the objectives of the project:

1. To conduct a baseline assessment on drowning in a selected community.

2. To develop evidence-based interventions for drowning prevention in the

community, in collaboration with Department of Health and local stakeholders

3. To implement the interventions in the expansion site within a set time frame

4. To document implementation

Qualitative data collection techniques were used in obtaining baseline data. Specifically

these were:

1. Key Informant Interviews (KII). The Key Informant Interviews were conducted

among local leaders, implementers and health managers. The interviews explored

various aspects regarding drowning that included common place of occurrence;

causes; existing health care and referral system; surveillance and reporting system;

prevention and control measures and activities as well as the features of such;

barriers to the implementation of drowning prevention measures; and their perceived

roles in these initiatives.

2. Focus Group Discussion (FGD). Two Focus Group Discussions were conducted

among community members and representatives of community organizations

concerned with drowning. It explored similar areas of concern as those of the KIIs

conducted.

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3. Review of Records. City and barangay morbidity and mortality data on drowning

that occurred from 2008 to 2011 were obtained.

4. Community walk-throughs. This was accomplished by means of conducting

visits/ocular inspections to zones in the community where drowning and near-

drowning incidents occurred.

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3. Results and Discussion

A. Profile of the City of Dagupan and Lucao (The Expansion Site)

Dagupan is one of the urbanized cities in the Philippines. It is bounded by the Lingayen

Gulf in the north, San Fabian in the northeast, Mangaldan in the east, Calasiao in the

south and Binmaley in the west area in Pangasinan. It has 31 barangays with a land

area of 4, 443 hectares (40.079 square kilometers). More than one third (35.98%) of its

total land area is devoted to agricultural purposes. A little over one fifth (22.88%) is

residential; 2.73% is for commercial purposes; 1.17 is industrial and 1.53 is institutional.

Infrastructure which include parks and playground and roads account for 1.68% and

11.72% of the total land area, respectively. About 7.10% of the total land area of

Dagupan City is still open spaces. Bodies of water account for 15.22% of the city’s total

area.

The estimated total population of the city for 2010 is 161, 473. The population density is

approximately 4,029 per square kilometer. This accounts for approximately 5% of the

total population of the province. The population is relatively young – the population of

those 0 – 17 years old is 63, 737 (see Table1).

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Table 1: POPULATION BY SEX AND AGE STRUCTURE, DAGUPAN CITY: 2010

Both Sexes Male Female

Number Percent Number Percent Number Percent

All ages 157,516 100.00 78,537 49.86 78,979 50.14

Under 1 3,796 2.41 2,000 1.27 1,796 1.14

1-4 14,665 9.31 7,514 4.77 7,151 4.54

5-9 18,303 11.62 9,482 6.02 8,821 5.60

10-14 17,012 10.80 8,663 5.50 8,349 5.30

15-19 16,602 10.54 8,285 5.26 8,317 5.28

20-24 14,791 9.39 7,356 4.67 7,435 4.72

25-29 13,452 8.54 6,757 4.29 6,695 4.25

30-34 10,995 6.98 5,608 3.56 5,387 3.42

35-39 10,270 6.52 5,230 3.32 5,040 3.20

40-44 8,758 5.56 4,332 2.75 4,426 2.81

45-49 7,450 4.73 3,670 2.33 3,780 2.40

50-54 6,301 4.00 3,040 1.93 3,261 2.07

55-59 4,836 3.07 2,331 1.48 2,505 1.59

60-64 3,702 2.35 1,686 1.07 2,016 1.28

65-69 2,504 1.59 1,071 0.68 1,433 0.91

70-74 1,874 1.19 819 0.52 1,055 0.67

75-79 1,134 0.72 425 0.27 709 0.45

80 & above 1,071 0.68 268 0.17 803 0.51

0-17 63,737 40.46 32,630 20.72 31,107 19.75

18 & over 93,779 59.54 45,907 29.14 47,872 30.39

0-14 53,776 34.14 27,659 17.56 26,117 16.58

15-64 97,157 61.68 48,295 30.66 48,862 31.02

65 & over 6,583 4.18 2,583 1.64 4,000 2.54

Source: CPDO Computations based on Census 2007 using ratio and proportion

Dagupan has a Type I climate, that is, it basically has two seasons – the dry season

from November to May and the wet season from June to October. The heaviest rainfall

usually occurs during July and August.

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The city has 59 preschools, 57 elementary schools and 21 secondary schools. Of the

13 academic institutions offering tertiary education, 3 are universities while the rest are

colleges. There are 6 vocational schools in the city.

There are 13 hospitals in the city – one of which is a public hospital. The total bed

capacity for all 13 hospitals is 752.

The three leading causes of morbidity in Dagupan City are mostly infectious in nature -

Upper Respiratory Tract Infections; Skin Diseases / Infected Wounds; and Acute

Gastroenteritis. On the other hand, non-communicable diseases are the leading causes

of mortality. These include cardiovascular diseases; chronic debility / senility; and all

forms of cancer.

Records showed that from 2008 to 2011 (See tables 2, 3, 4 and 5), the occurrences of

drowning reported in the City of Dagupan were 12, 11, 4 and 8 respectively. In all four

years, there were more males who drowned compared to their female counterpart. The

youngest drowning victim was 8 months old while the oldest was 72 years old.

Based on the drowning mortality data, the top leading areas were Bonuan Gueset,

Pantal and Lucao. Bonuan Gueset was the pilot site in 2009-2010 and the project was

already endorsed to local officials for sustainability. On the other hand, residents of

Pantal are being relocated by the local government because most of the houses are

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located along waterways. In consultation with the City Health Office, Lucao was chosen

to be the site for this year’s drowning prevention project.

Table 2. Mortality Report 2008

Name Age Address Sex

C. S. C 30 Calmay M

M P 2 Bonuan Gueset M

R P 3 Pantal M

P P 4 Pantal M

P de V 50 Carael M

C B B 67 Bacayao Norte M

Y Y C 59 Bacayao Norte M

J R L 8 mos Salapingao M

R K M 1 yr.

11mo

Bonuan Gueset M

G Q 18 Pugaro F

A L S 31 Puelay, Caranglaan M

J C 35 Pantal M

Source: Dagupan City Health Office

Table 3. Mortality Report 2009

Name Age Address Sex Death

K R. d C 15 Bonuan Boquig M 1-25-09

L S V 23 Lasip Grande F 1-30-09

B M L M 49 Pogo Grande M 4-4-09

J M S. F 8 Bayanihan, Caranglaan M 4-28-09

R C P 18 Tebeng M 6-27-09

J D C 56 Tambac M 7-21-09

J D 4 Lucao M 10-5-09

P C 72 Bonuan Boquig M 10-9-09

F P 59 Pantal M 10-10-09

D M 48 Pugaro M 11-21-09

D S 56 Lucao M 12-18-09

Source: Dagupan City Health Office

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Table 4. Mortality Report 2010

Name Age Address Sex Death

M R 7 Bacayao Sur M 4-1-10

F P 5 Bonuan Binloc M 9-15-10

J B 2 Pantal M 11-26-10

J K F 9 Salisay F 10-10-10

Source: Dagupan City Health Office

Table 5. Mortality Report 2011 (as of July 2011)

Name Age Address Sex Death

A S R 3 Pantal F 2-7-11

S A 44 Herrero-Perez M 4-17-11

R T. V 11 Caranglaan M 5-28-11

L N 23 Pugaro M 6-1-11

T G 34 Bonuan Binloc M 6-22-11

A B 3 Salapingao M 7-5-11

G D 1.9 Lucao F 7-17-11

N C 44 Pantal M 7-22-11

Source: Dagupan City Health Office

Lucao, one of the barangays in the City of Dagupan was chosen as the expansion site.

This is a barangay located in the southwestern part of Dagupan City. It is bounded on

the south by the Municipality of Calasiao; southeast by Barangay Malued; Northwest by

Barangay Tapuac and Barangay Calmay; and west by the Municipality of Binmaley. Its

total land area is 195.30 square kilometers. In 2010, its total population was 8442 (See

Table 6) and its population density is 47.3 per square kilometer.

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Table 6. POPULATION BY SEX AND AGE STRUCTURE 2010

LUCAO DISTICT, DAGUPAN CITY

Age Bracket

Male Female Total

Number Percent Number Percent Number Percent

0-4 526 6.23 528 6.25 1054 12.48

5-9 500 5.92 502 5.95 1002 11.87

10-14 463 5.48 465 5.51 928 10.89

15-19 450 5.33 452 5.35 902 10.68

20-24 413 4.89 415 4.92 828 9.81

25-29 342 4.05 344 4.07 686 8.12

20-34 302 3.58 303 3.59 605 7.17

35-39 261 3.09 263 3.12 524 6.21

40-44 225 2.67 226 2.68 451 5.35

45-49 189 2.24 191 2.26 380 4.50

50-54 166 1.97 170 2.01 336 3.98

55-59 105 1.24 106 1.26 211 2.50

60-64 93 1.10 93 1.10 186 2.20

65-69 70 0.83 70 0.83 140 1.66

70-74 46 0.54 47 0.56 93 1.10

75 & Over 58 0.69 58 0.69 116 1.38

TOTAL 4209 49.86 4233 50.14 8442 100 Source: CPDO Computations based on Census 2007 using ratio and proportion

Lucao derived its name from Lucan, the vernacular word for clam. It is said that this

bivalve mollusk used to abound in the barangay during the times when it was swampy

and teaming with “Nipa” palms and mangroves. At present, a similar bivalve mollusk

related to the lucan, the oyster, is a major industry in the barangay.

What was once an area dominated by fishponds and rice lands is now converted into

residential and commercial areas. Some of Dagupan City’s prime businesses and

establishments are located in Lucao. These are the Dagupan Cockpit and Sports

Complex, Dagupan Village Hotel, Dagupan Garden Hotel, Inn Asia, Westgate Drive Inn,

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Ayala Life, Bank of the Philippine Islands, Le Chateau Subdivision, Crita Ville and

Tandoc I and II, Petron, Caltex and Jollibee. The CSI Warehouse and CSI City Mall, the

biggest shopping mall north of Manila, is in Lucao.

Lucao has a Barangay Health Station, one private dental clinic and one private

pediatrics clinic. It has a total of 4 physicians and dentists - two each in the private and

public sector. Of the 7 nurses, 3 are in the public sector; while 3 of the 5 midwives are

engaged in private practice. The municipality also has one private PT and pharmacist.

In addition to the medical and paramedical resources, Lucao has 32 BHS/BSPO/BNS.

Like Dagupan City, the 5 leading causes of morbidity in Lucao are infectious in nature –

Acute Respiratory Infection, Dermatitis, Urinary Tract Infection, Bronchitis and Acute

Gastroenteritis. Lifestyle-related diseases account for the leading causes of mortality

specifically hypertension, all forms of cancer, chronic debility / senility and diabetes

mellitus. Pneumonia, together with diabetes mellitus, was equally ranked as a leading

cause of death in this municipality.

There were three drowning cases from Lucao that were reported from 2008 to 2011.

Two of these happened in 2009 while another in 2011.

Aside from drowning cases, through field visits and informal interviews with the

residents of the site, the project team discovered 18 near-drowning cases (below 5

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years of age) in 2 zones (zones 5 and 6) from 2009 to 2011, but these were not

reported and recorded in the community health center.

B. Results of the Key Informant Interviews, Focus Group Discussions and

identification of community structures which may predispose children to drowning.

B.1. Key Informant Interview (KII). Participants to the KII were composed of the

Barangay Captain, a Council member (Kagawad) and two barangay nurses.

Place of Occurrence. When asked about in what places drowning occurred in their

barangay, all the informants mentioned the fishpond. The Kagawad also cited the Lucao

River.

Causes of Drowning. All the informants mentioned the neglect of parents as the cause

of drowning. The Kagawad and one barangay nurse also made mention of the proximity

of the victim’s house to the fishpond.

Health Care and Referral System. An inquiry was made as to the health services / care

given to drowning or near drowning victims. With the exception of the barangay captain

who said that CPR was given, all the other three respondents gave the response that

the victims were brought to the hospital. CPR was also mentioned by the kagawad and

one of the barangay health nurses. However, all three respondents who cited CPR

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expressed some doubts as to the correctness of the technique of doing this life saving

measure.

Surveillance and Reporting System. All of the informants except for one barangay nurse

stated that incidents of drowning / near drowning are reported to the barangay but these

were not recorded. The kagawad and one barangay health nurse said that the victims

were brought to the hospital. The kagawad further added that when incidents are

reported to the barangay, officials go to the victim’s house to extend whatever assistant

they can give to the victim’s family.

Measures in Place on Drowning Prevention. All the informants unanimously said that

there are no policies / measures for drowning prevention.

Activities to Prevent / Minimize Drowning. The two barangay health nurses said that

there are safety nets in the fishponds. Except for one barangay health nurse, all other

three informants cited awareness / health education campaigns. The kagawad was

more specific by saying that reminders should be put in place.

Features / Activities on the Program for Drowning. When an inquiry was done as to

what they think the features / activities of the program on drowning prevention should

be, all respondents mentioned various forms of information dissemination. These

include reminders / signages; information dissemination and training. Two of the four

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respondents cited flotation devices while one barangay nurse mentioned an ordinance

prohibiting those who have drank alcoholic beverages to go to the river.

Barriers Related to Drowning Prevention Program. The two barangay officials said that

the budget is one of the barriers related to drowning prevention programs. On the other

hand, the two barangay health nurses mentioned the availability of the residents as a

barrier to the program. The kagawad also cited the lack of training on Basic Life Support

as a barrier.

Roles in Drowning Prevention Program. The barangay captain stated that providing

leadership is his responsibility in the implementation of policies when asked about their

roles in drowning prevention programs. All other three respondents answered health

education / dissemination as their role in the drowning prevention program. The

barangay kagawad also said that it is his role to monitor the implementation of the

program.

B.2. Focus Group Discussion (FGD). There were two Focus Group Discussions

conducted – one was participated in by Barangay Health Workers from Puroks 1, 2, 6

and 7; BSPO from Purok 6 and 7; the other was participated by the Barangay Health

Worker from Purok 5, Barangay Nutrition Scholar from Purok 4 and a Day Care Worker.

Place of Occurrence. The respondents stated that drowning commonly occurred in the

fishpond and in Lucao River.

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Causes of Drowning. When asked regarding the causes of drowning, some of the

responses given were neglect of parents; hardheadedness and bathing in the creek.

Health Care and Referral System. Some of the respondents mentioned that there was

no first aid given, so the victim was brought straight to the hospital. On the other hand,

one of the respondents said that there was a near-drowning incident so they just

“massaged” the victim.

Surveillance and Reporting System. One of the groups mentioned that since the

kagawad was with them who brought the victim to the hospital, he was also the one who

reported the drowning incident to the barangay. The other group cited that drowning or

near-drowning incidents are not reported to the barangay.

Measures in Place on Drowning Prevention. When an inquiry was made as to the

measures in place on drowning prevention, one group cited that there was no ordinance

while the other mentioned that there are no safety measures in place.

Activities to Prevent / Minimize Drowning. One of the groups mentioned information

dissemination campaigns as part of the activities done to prevent / minimize drowning.

The other group cited the need for training on swimming and first aid.

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Features / Activities on the Program for Drowning. Some of the suggested features /

activities of drowning prevention given were the creation of a committee; passage of an

ordinance on drowning prevention; presence of lifeguards / patrols; and the provision of

boats.

Barriers Related to Drowning Prevention Program. The lack of a budget was the

common barrier for drowning prevention mentioned by both groups. One group also

mentioned cooperation and lack of skills as barriers related to drowning prevention

program.

Roles in Drowning Prevention Program. Both groups unanimously mentioned their

cooperation to the drowning prevention program as to their perceived role. The librarian

was more specific in saying that her role in such a program was for records keeping.

B.3. Community Walk-Throughs

Open Dug Wells. The barangay has five open dug wells which pose danger to young

children living nearby and playing near these wells.

Houses near bodies of water without barriers or backyard fences. The houses without

barriers or backyard fences near bodies of water were identified by the members of the

community drowning prevention committee. Several houses in different parts of the

community were found to be either without house barriers or backyard fences. When

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probed further, it was revealed that there were many children in these identified houses.

For some families, their children encountered near-drowning incidents and two families

had children who were drowned in the past.

B.4. Lucao’s Haddon Matrix

Based on the results of data gathering methods, this is the picture of Lucao’s Haddon

Matrix (Table 7):

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Personal Factors Agent Factors Physical

Environmental

Factors

Social Environmental

Factors

Pre Event Lack of

supervision of

young children

Lack of

knowledge about

water risks

Alcohol intake of

older population

Presence of

fishponds

Proximity of

Lucao River

Presence of

open dug wells

Lack of barriers

Lack of fences

Lack of signages

Lack of ordinance

on drowning

prevention

No health budget

allotted to

drowning

prevention

Lack of a program

on drowning

prevention

Event Children left

unsupervised

Variable water

depth in ponds

and river

Lack of flotation

devices and other

escape

mechanisms

Poor access of

information and

resources for

minimizing risk

Lack of trained

community

personnel /

rescuers

Post Event Lack of

knowledge of

caregivers on

appropriate

measures to

implement

Distance of health

facilities equipped

to deal with

drowning or near-

drowning cases

Inadequate

information on

referral system

Lack of

surveillance and

reporting system

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C. Interventions implemented in the Lucao, Dagupan City

C.1. Formation of the Barangay Drowning Prevention Committee

Right after the presentation of the results of the assessment, Barangay Chairman

formed the Drowning Prevention Committee. It is composed of the Barangay Chairman

as the Over-All chair, Committee Head and Members. Barangay identified three sub-

committees; the infrastructure, health, and monitoring, evaluation and documentation

committees. Each sub-committee is composed of several members. Figure 1 shows the

committee membership.

Figure 1. Lucao Drowning Prevention Committee

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Committee Head

1. The Committee Head reports directly to the Over-All Chairman.

2. Lead the committee in the implementation of activities on drowning prevention.

Infrastructure Sub-committee

1. Identify the areas where drowning prevention interventions will be implemented

2. Canvass and purchase the needed materials, supplies and equipment for the

project

3. Coordinate with community residents regarding the implementation of activities

Health Sub-committee

1. Conduct health education on drowning prevention

2. Accomplish drowning reporting form

3. Implement drowning prevention activities

Monitoring, Evaluation and Documentation Sub-committee

1. Monitor drowning prevention activities in the area

2. Document implementation of drowning prevention activities

3. Prepare quarterly accomplishment report

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C.2. Training on First Aid and Basic Life Support

The barangay council identified the members of the committee to be trained on First Aid

and Basic Life Support. These trainees came from different areas in the barangay. It is

hoped that those who passed the training will be able to assist the community health

workers in responding the injuries that may occur in the community. In addition, first aid

kit, supplies and materials were also made available which they can use when

somebody is injured in the community.

Figure 2. Participants in the First Aid and Basic Life Support Training

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Figure 3. A participant performing the cardiopulmonary resuscitation on a child

(Top picture) and the instructor teaching participants how to perform CPR on an

infant (bottom picture).

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C.3. Seminars on Drowning Prevention and Use of Drowning Report Form

Orientation on drowning prevention was done in Lucao, Dagupan City. This orientation

was attended by the midwife, nurses, barangay health workers (BHWs) and barangay

point service officers (BPSO). They were oriented on what to inspect in the houses and

on what they can teach especially to the mothers on drowning prevention measures

during their house to house visits.

Figure 4. The midwife summarizing the drowning prevention measures to the

barangay health workers and BSPOs

Also during the orientation on drowning prevention, attendees were also taught on how

to accomplish the drowning reporting form. This form was developed in 2009 and used

in the pilot sites. It is hoped that with the use of this form, authorities will be better

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informed on what transpired during the drowning incident. It can also be used in

determining interventions in the future.

Figure 5. Mr. Guevarra discussing the proper way of accomplishing the drowning

reporting form

C.5. Reconstruction and Development of Covering of Open Dug Wells.

Open dug wells were identified in the community. Those open dug wells that are ground

level were reconstructed to make them safer since many children live and play near

these wells. These open dug wells were also covered to make these safe for children.

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Figure 6. Open Dug Wells in Lucao, Dagupan City

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Figure 7. Reconstruction of Open Dug Wells, Lucao, Dagupan City

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Figure 8. Covering of Wells (Upper Photo) and Well with Cover (Lower Photo)

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C.6. House Barriers

Families with many children whose houses are located near or on bodies of water in the

community were identified. House barriers were constructed so that children, especially

those left at home, will not fall in the bodies of water.

Figure 9. Barriers constructed in Houses in Sitio 5, Lucao, Dagupan City

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Figure 10. Barriers constructed in Houses in Sitio 6, Lucao, Dagupan City

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C.7. Backyard Fences

Together with the members of the drowning prevention committee, the families with

victims of drowning and families with children who experienced near-drowning events

were identified. They were supported in constructing backyard fences so that the

children will not anymore be exposed to bodies of water.

Figure 11. Backyard Fences constructed in Lucao, Dagupan City

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C.8. Playpens

Families living near bodies of water with children less than 1 year of age were identified

and became the beneficiaries of the playpens developed in the community. According to

the mothers, there were times when they leave their young children in their homes so

that they can do their household chores and engage in some occupation. They were

worried that their children may fall in the bodies of water surrounding their houses. They

believe that the use of playpen, where they can leave their children temporarily, will be

safer for their children.

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Figure 11. Playpens in Lucao, Dagupan City

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4. Recommendations

WHO is encouraged to support the expansion site in strengthening interventions

in other zones in the community. There are remaining areas (zones 4 and 7) in

the expansion site where barriers, fences, playpens and possibly child day care

facility are needed. It is hoped that the next phase of the project will focus on

these remaining areas.

Community leaders and trained community members must join hands in looking

for ways and means to sustain the efforts that they have started.

Local authorities must continue to support the site in implementing drowning

prevention activities.

5. References

Administrative Order No. 2006-0016, the “National Policy and Strategic

Framework on Child Injury Prevention”, June 2006

Philippine National Injury Survey, 2003

Dagupan City Profile, 2010

Dagupan City Health Office Drowning Report, 2008-2011