- Water and sanitation related diseases are responsible
for some 60 percent of the total number of child mortality cases in Pakistan
By Aoun Sahi
In July 2010, the General Assembly of UN adopted a resolution recognising that access to safe and clean drinking water and sanitation is a human right. Pakistan voted in favour of the resolution. This is not the first time that Pakistan has made such pledges on an international forum. In November 2008, during the third South Asia Conference on Sanitation (SACOSAN) Pakistan, along with other SAARC countries, not only admitted that access to sanitation and safe drinking water is a basic human right but also promised to include water and sanitation as a basic right in the constitution.
The other major commitments the government of Pakistan made during Delhi SACOSAN were to accord priority to sanitation, to improve conditions of sanitary workers, and to achieve MDGs on Sanitation in a time-bound manner. The Delhi declaration also promised to ensure basic access to sanitation facilities to all by reducing disparities through appropriate budgetary policies, with active participation, contribution, decision-making and ownership by communities.
SACOSAN is the only political platform in South Asia region that talks about sanitation. The overall goal of the SACOSAN process was to accelerate the progress of sanitation and hygiene in the south Asia region so as to enhance its peoples’ quality of life in realizing the MDGs.
The fourth SACOSAN is scheduled to be held in Sri Lanka from April 4 to 8 this year. So far, it seems all governments in the region, except Sri Lanka and Maldives, have failed to fulfill their commitment on sanitation. According to the WHO, 1.027 billion (64 percent) out of 1.595 billion in South Asia who do not use improved sanitation facilities and are exposed to severe health risks as well as adding to environmental pollution.
The urban-rural disparity in the use of improved sanitation facilities is another important concern. The majority of the people who do not have access to water are located in rural areas. In Pakistan, 72 percent urban population has access to sanitation facilities while the number is only 29 percent for the rural population.
Pakistan is committed to achieving the MDG target by 2015 of halving the proportion of people without sustainable access to safe and improved sanitation. Given the baseline of 33 percent improved sanitation coverage in 1990 according to the WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation (JMP), the MDG target for Pakistan is 67 percent improved coverage.
Both the costs associated with lack of access to safe water and basic sanitation and benefits derived from improved access are very important for poor people. The ratio of economic returns from every US $1 invested in water and sanitation is estimated at $9 in developing countries (WHO 2008). Despite these benefits, almost all countries in South Asia are off-track in achieving the sanitation related MDGs.
With the current rate of work on sanitation Pakistan will be able to achieve sanitation related MDGs by 2028 instead of 2015. Ironically, Pakistan’s national sanitation policy 2006 promises that 100 percent population will be served with sustainable access to improved sanitation. It is interesting to mention that during Delhi SACOSAN (2008) then environment minister of Pakistan, Hameed Ullah Jan Afridi, declared that Pakistan was not only well on its way towards meeting the MDGs target for sanitation, but would also surpass it soon.
Pakistan is amongst the countries with highest number of people with no access to improved sanitation facilities. There is little separation of industrial waste from municipal waste in Pakistan, with both flowing directly into open drains and then open water bodies. The Pakistan Strategic Country Environmental Assessment notes that nullahs and storm-water drains collect and carry untreated sewage which then flows to streams, rivers and irrigation canals, resulting in widespread bacteriological contamination.
About 2,000 million gallons of sewage is being discharged to surface water bodies every day. It notes that while some sewerage collection systems exist, collection levels are estimated at 50 percent overall in country (and only 20 percent coverage in rural areas), with only 10 percent effectively treated. Treatment plants exist only in a few cities, and few are fully functional. In katchi abadis, almost all wastewater is disposed of through open, unlined drains.
There is no formal solid waste management system that exists in rural areas. As villages grow and urban morphology shifts, this has become a growing problem in large villages and urban areas which are rapidly assuming an urban form. It is estimated that only about 50 percent of solid waste is actually collected with the remaining dumped at roadsides, in drains and at dump sites.
Collection efficiency varies and coverage in higher income areas is generally considerably higher than in low-income ones. Some 250,000 tons of medical waste is produced annually in Pakistan, and mixing of medical waste with municipal solid waste poses further problems. While hospital incineration practices are improving, this remains a serious issue. Agricultural and industrial waste also pose a serious issue. It is estimated that between 1000-1500 tons of outdated pesticides are in stock in Pakistan. Disposal of hazardous waste remains the responsibility of local governments that are ill-equipped to adopt consistent procedures or to regulate the private sector. Uncollected and unsafely disposed of waste poses a serious public health risk through clogging of drains, formation of stagnant ponds, and contamination of soil and water.
The Pakistan Strategic Environmental Assessment (World Bank, 2006) estimates, that of the costs to the national exchequer of environmental degradation, the highest is from water and sanitation. Child mortality in Pakistan remains high in relation to other countries. Although there has been a decline from 117 per 1000 live births in 1986-1990, to 94 per 1000 live births in 2002-2006 showing a 20 decline in 16 years, this still means that one in 11 children will die before reaching the age of 5.
Under-5 mortality is 28 percent higher in rural areas. Water and sanitation related diseases are responsible for some 60 percent of the total number of child mortality cases in Pakistan. It is estimated that the total health costs from these two diseases alone is Rs114 billion or 1.75 percent of GDP. NGOs working on water and sanitation in Pakistan are of the view that the cost to the national exchequer from these two diseases alone is far greater than the resource allocation to water and sanitation.
Access to improved sanitation for all seems a distinct dream at the moment as no political will is there to solve these issues. Our policy makers need to understand that they should spend money on improved sanitation facilities. Civil society organisations hope that Pakistan’s country paper in upcoming SACOSAN in Colombo will be based on ground realities and the government will accept that it has failed to fulfill its commitments made in Delhi SACOSAN in 2008.