Back ground (issue/problem) Drowning is the first killer for children aged 14 and under in China. Death rate of drowning among Chinese children’s in rural areas is 1.5 times that of children in urban cities. Open water and other water hazards are the main risks.

Description of the problem Lishui is a community in southern China, Guangzhou provinces. It is an open water-based community. Lishui Hushun Primary School is the one with 2085 students from 8 rural villages. 46% of the students are migrant worker’s children. Community’s injury surveillance told that since 2010, 95% of the children died from drowning were migrant worker’s children and during playing in or near open water in the villages.

Results (effects/changes) In addition to the community injury surveillance system, Lishui community initiated a Risk Assessment System (RAS) and a Safety Enforcement System (SES). The RAS conducted by school teachers and community staffs using photovoice method. Data of the photovoice were evaluated, child-readable signs were assigned at the evaluated risky spots and photovoice exhibition were conducted at school and villages regularly. The SES were conducted by village-based team including school teacher, senior students and community staffs who live in each villages. With the RAS, 137 drowning risky spots were identified, 20% environment related risks were changed, all the risks were marked with safety signs. The SES were conducted by a team of 20 school teachers, 24 senior students and 16 community staffs, educating and enforcing behaviour related risks. Since 2013, there was not a single child died or injured by drowning.

Conclusions Risk assessment using photovoice is a good way for environment change. Photovoice exhibition is a good way for awareness building and behaviour guide. Enforcement through local collaborating teams is effective and sustainable. Drowning to children in rural areas with open water is preventable.