Despite some improving figures such as 58% population with access to basic sanitation services and 36% of the population having access to safely managed water sources, the wider availability of water, sanitation, and hygiene (WASH) still remains a big challenge for Pakistan. Some of the country’s most pressing challenges including high infant mortality rates, stunting and even low school enrolment can be attributed to its lack of adequate and good quality WASH services. The country has the 5th highest number of people (22 million) practicing open defecation with a stark rural-urban sanitation inequality; less than 1% open defecation is reported in urban areas as compared to 19% in rural areas. Besides issues of poor hygiene and discomfort, open defecation could have devastating impacts on the wellbeing of rural women who sometimes face assault and abuse as they relieve themselves outside and often in the dark.

Every year, more than 53,000 children under the age of 5 years die due to illness caused by poor water and sanitation like diarrhoea, and over 4 out of every 10 children are stunted. Moreover, the total economic cost of poor sanitation in Pakistan is nearly PKR 343.7 billion – 3.94% of the country’s GDP according to World Bank statistics. Increased spending on sanitation needs to be the priority as every dollar invested has a Return on Investment (ROI) of $5.5 because of the resultant decrease in healthcare costs, improved productivity and fewer premature deaths among new-borns.

The country has the 5th highest number of people (22 million) practicing open defecation with a stark rural-urban sanitation inequality; less than 1% open defecation is reported in urban areas as compared to 19% in rural areas.

Furthermore, lack of sanitation facilities is deterring children, particularly girls, from enrolling and staying in school. Menstrual hygiene needs are also rarely accommodated in schools, serving as a further deterrent. Waste management is another area that needs immediate attention. As a maximum of the already inadequate WASH infrastructure budget allocations are used by metro cities, villages continue to bear the brunt of limited sanitation infrastructure: 42% of households in rural Punjab, 60% in rural KP and 82% in rural Sindh and Balochistan still lack access to adequate drainage system.

What’s encouraging is the government’s resolve to tackle WASH-related issues which is evident from initiatives such as the Punjab government’s ‘Open Defecation-Free Punjab’ plan and Prime Minister, Imran Khan’s ‘Clean & Green Pakistan’ campaign, besides other community engagement initiatives.

In 2017, UNICEF Pakistan – in collaboration with the Government of Punjab – conducted a series of analyses on the equity of WASH services. It brought to light that the overall allocation to the WASH sector was insufficient, and that the districts with the worst WASH indicators were those with the lowest budget allocations and expenditures. Based on the analyses, the Government of Punjab developed an equity-based resource allocation criteria whose application led to a budget increase from PKR 48 billion to PKR 72 billion but predominately for water in 2016-17 for WASH. UNICEF Pakistan along with provincial governments and other development actors have been implementing Pakistan’s Approach to Total Sanitation (PATS), which was launched in 2010. Its aim is to create Open Defecation Free (ODF) villages by enabling the communities to take control of their own sanitation and achieving a healthy and protective living environment.

While the Government’s measures to improve water, sanitation, and hygiene conditions in Pakistan are laudable, an improved policy level intervention is required to bridge the rural-urban gaps. This calls for strong, sustainable and focused partnerships between governments, development partners, business leaders, academia, innovators, civil society and communities.

Through this approach, UNICEF’s support, reached more than 12 million people via civil society organizations and provincial departments with sanitation facilities in open defecation free (ODF) communities. In 2018 alone, this resulted in around 2 million people living in open-defecation-free communities, 9.69 million people gaining access to safe drinking water through water quality improvement and monitoring systems. 514,900 people gaining access to basic sanitation, and nearly 2.7 million people reached through social and behavioural change interventions.

While the Government’s measures to improve water, sanitation, and hygiene conditions in Pakistan are laudable, an improved policy level intervention is required to bridge the rural-urban gaps. This calls for strong, sustainable and focused partnerships with governments, development partners, business leaders, academia, innovators, civil society and the communities. It will also require effective and equitable investment in the most disadvantaged and marginalized children. This can only happen if the most deprived children are kept at the heart of the agenda while formulating national plans, budgets, and social and economic policies. One can hope that the WASH indicators continue improving, and collective efforts for a cleaner Pakistan become stronger.

The Writer is an Ethiopian national, working as WASH Specialist in UNICEF Pakistan Country office and leads the rural WASH and WASH in School components of the programme.

Published in Daily Times, January 14th 2019.