Human development is an increasingly nuanced concept, securing which requires tackling not only economic but a range of socio-political challenges. Availability of sanitation services, including sewage systems and toilet facilities, however, are the most rudimentary of development requirements, yet they remain unavailable to a significant proportion of our populace.Pakistan, along with other South Asian nations, is facing the daunting challenge of providing toilets to millions of people who are still practising open defecation. Pakistan, however, has the dubious distinction of having the worst sanitation conditions within the regional grouping.WashMedia-South Asia — a representative group of journalists from Pakistan, Bangladesh, India, Nepal, and Sri Lanka, focusing on water, sanitation and hygiene issues — has recently highlighted that approximately a fourth of the Pakistani population still defacates in the open.The implications of this disconcerting phenomenon are varied. From an economic perspective, the lack of adequate sanitation is estimated to cause a loss of over Rs340 billion, nearly four per cent of Pakistan’s GDP. This financial implication is calculated on the basis of costs associated with water-borne related death and diseases as well as losses in education, productivity and time due to lack of access to adequate sanitation.While modern toilets are plentiful across affluent urban areas, basic latrine facilities remain scant in rural and unregulated urban slums. Most poor people are thus forced to make use of bushes, river banks, or agricultural fields. With increasingly congested villages and slum areas in towns and peri-urban areas around the country, women and girls walk long distances to find suitable places to relieve themselves.Intestinal and reproductive health complications have been associated with the fact that women often delay doing so until dark. The need for privacy also brings with it a risk of sexual assault. Lack of adequate sanitation also spells bad news for eradicating polio in the country , given that this debilitating disease spreads primarily through the fecal-oral route. It is not surprising to note an evident resurgence of the virus in the slums in Quetta and Karachi.Moreover, open defecation on such a vast scale is polluting water used for drinking and irrigation purposes and agricultural produce consumed by people across the country. Despite multilateral commitments to address the situation, successive governments have not taken this issue seriously. Pakistan is thus listed amongst countries most off-track to achieve sanitation’ related targets under the UN’s Millennium Development Goals for 2015.Our politicians must honour their pledges and take concrete steps by ensuring that more funds are made available for improving the sanitation situation . Sanitation must also become a priority policy issue at all administrative tiers. The current state of apathy is evident from the fact that drinking water supply lines and open sewage drains laying side by side remains commonplace, despite the obvious health hazards posed by such blunders.Many NGOs at the behest of donor agencies like the World Bank are using cost-sharing approaches to sanitation, which essentially shift the burden of state responsibilities onto already marginalised people. It is actually the responsibility of the public sector to ensure that adequate sewage systems are put in at the community level. Citizens themselves should only be focusing on investing in hygienic latrines within their households, which are then linked to a larger sewage system.Unfortunately, this rather basic aspiration of adequate sanitation services seems not much more than wishful thinking given the way things work in countries like ours. Meanwhile, poor people can at least be prompted to desist from open defecation and instead build basic pit latrines, which cost very little money, and need not be linked to a sewage system either.Published in The Express Tribune, August 20, 2012.