Background The World Health Organization recommend the teaching of basic swimming skills to school aged children, and the training of community members in rescue and resuscitation as key interventions for the prevention of drowning. Recent practical guidance published by the WHO provides a high-level synopsis of the processes, policies and documents required to implement these interventions. However, since a relatively limited numbers of organisations have experience delivering these interventions in LMIC settings, more detailed guidance is required to ensure safe and effective implementation, particularly during scale-up.

Objective To ensure this practical guidance is applicable and useable in LMICs, we convened practitioners from low-resource settings to identify good practice, barriers to implementation, and co-design technical resources to support intervention delivery.

Methods Gap analysis on the WHO Practical Guidance identified topic areas where the guidance referred to practice, policy or documentation, but provided no (or limited) further detail. Seventeen practitioners (representing 13 countries) delivering basic swimming skills, and twenty-two practitioners (representing 14 countries) delivering rescue and resuscitation training in low-resource settings were identified and sent a questionnaire to understand current practice against the topic areas in the WHO guidance.

Two four-day facilitated workshops, one for basic swimming skills and one for rescue and resuscitation, were then held in Tanzania (Sept 2022) and India (Oct 2023). Facilitators worked through a set of pre-defined questions to identify barriers to implementation, gain consensus on good practice, and develop technical resources that would assist organisations implement the practices.

Results This process identified 8 topic areas where further technical guidance was required including safety critical topics (safeguarding and auditing of training sites), and topics likely to impact programme uptake (addressing fears of disease transmission during resuscitation).

Participants highlighted several barriers to implementing the guidance, including a lack of financial and human resources, community scepticism of the interventions, communication challenges in rural areas, and a lack of standardised and peer-reviewed technical resources tailored to the low-resource environment.

Conclusions Resources developed during the workshops include site safety audit checklists, and an informed consent form that includes guidance on medical screening. Future work will test and evaluate their use.