Pakistan Country Paper
SACOSAN VII
April 2018
Ministry of Climate Change
Government of Pakistan
Islamabad
Table of Contents
Acronyms
1.Introduction
2.Status of Sanitation in Pakistan
i) Access to Improved Sanitation:
ii) In-situ or Off-site Treatment
iii) Hand Washing with Soap
3.Sustainable Development Goals (SDGs) for WASH
4.Policies and Strategies
5.Institutional Arrangements
6.Capacities Development
7.Planning, Monitoring and Review
8.Sector Financing
9.PLANNED ACTIONS FOR 2018-2020
Acronyms
ADP / Annual Development PlanAJK / Azad Jammu &Kashmir
BISP / Benazir Income Support Program
CBN / Cost of Basic Needs
CBOs / Community Based Organizations
CM / Chief Minister
CPEC / China Pakistan Economic Corridor
DRR / Disaster Risk Reduction
FATA / Federally Administered Tribal Areas
GB / Gilgit-Baltistan
GDP / Gross Domestic Product
GIS / Geographical Information Service
GLAAS / Global Analysis and Assessment of Sanitation and Drinking Water
GNI / Gross National Income
HDI / Human Development Index
HHs / House Hold
HR / Human Resource
JMP / Joint Monitoring Program
JSR / Joint Sector Review
KMC / Karachi Municipal Council
KP / Khyber Pakhtunkhaw
LGA / Local Government Act
M&E / Monitoring and Evaluation
MDG / Millennium Development Goals
MEAL / Monitoring, Evaluation and Learning
MICS / Multiple Indicator Cluster Survey
MIS / Management Information System
MoCC / Ministry of Climate Change
MoPDR / Ministry of Planning Development and Reforms
MT / Master Trainers
MTDF / Mid Term Development Framework
NSUSC / North Sindh Urban Services Corporation
OBOR / One Belt One Road Program
P&D / Planning and Development Department
PATS / Pakistan Approach to total Sanitation
PC / Project Cycle
PFC / Provincial Finance Commission
PHED / Public Health and Engineering Department
PRSP / Poverty Reduction Strategy Pakistan
PSLM / Pakistan Social Living Standards Measurement Survey
SACOSAN / South Asian Conference on Sanitation
SDA / Service Delivery Assessments
SDG / Sustainable Development Goals
SSN / Social Safety Net
UN / United Nations
UNICEF / United Nations Children Education Fund
WASA / Water and Sanitation Authority
WASH / Water Sanitation and Hygiene
WinS / WASH in Schools
1.Introduction
Pakistan is the sixth populous[1] country in the world with a population of 207.87 million[2]. Out of this, 132.29 million reside in rural areas and 75.58 million in urban areas. The average population growth rate is 2.4 percent. Based on the current world population estimates of 7.8 billion people[3], Pakistan accounts for about 2.65 percent of the world’s population with one out of every 40 persons globally being a resident of Pakistan. The country is divided into four provinces namely Punjab, Sindh, Balochistan and Khyber Pakhtunkhwa (formerly North West Frontier Province) along with three territories, namely Federally Administered Tribal Areas (FATA); Gilgit Baltistan (GB) and Azad Jammu & Kashmir (AJK).
The Government of Pakistan established new poverty definition in 2015 that is derived from Cost of Basic Needs (CBN) approach. According to this methodology 29.5 percent of the population is estimated to live below poverty line with 18.2 per cent in urban areas and 35.6 per cent in rural areas. Social Safety Nets (SSNs) initiatives have been initiated in Pakistan, as a cushion, to mitigate the devastating effects of poverty. SSNs include non-contributory transfers (unconditional and conditional cash transfers, food and other in-kind transfers, school feeding programs), non-contributory social pensions, and measures to provide access to essential services such as education, health and housing through fee-waivers, public works and social care services. Presently, Benazir Income Support Program (BISP) is the largest SSN that established the eligibility criteria of poverty scorecard for different types of beneficiaries, and serving across the country. The program has assisted a total of 5.4 million people in the country with an annual budget of USD 1.15 billion as of 2018[4].
The United Nations Development Program (UNDP)’s Human Development Report, 2016 ranks Pakistan at 147thout of 188 countries under the Human Development Index (HDI) based on Health (life expectancy at birth), Education (expected years of schooling) and Gross National Income (GNI) per capita. Pakistan’s HDI value is 0.550 out of 1 as against South Asia’s average HDI value of 0.621 and World’s average HDI value of 0.717. The Ministry of Planning, Development and Reforms (MoPDR) launched and disseminated Multidimensional Poverty 2016 report that provided a deep insight on the state of poverty and dynamics in Pakistan. This poverty profile revealed that, in Pakistan poor are predominantly rural, young, poorly educated, mostly deprived of health facilities, and are living in larger households with more children[5]. A recent WB study “WASH Poverty Diagnostic” identifies the state of water and sanitation across poverty levels and districts and also provides evidence that the reason for higher level of stunting in Pakistan is linked to poor sanitation infrastructure, especially in rural areas of Pakistan.The detailed poverty profile helps policy makers in formulating purposeful and targeted poverty alleviation programs.
The current government is striving for generating employment and investment opportunities by facilitating projects like China Pakistan Economic Corridor (CPEC),which a part of China’s One Belt One Road (OBOR) program. The CPEC is believed to enhance the connectivity between the two countries with positive impacts on the trade and industry, while also improving the employment statistics in the region.
Pakistan has made good progress in key health indicators since 2000, where theunder five mortality rate was reduced from 110 per 1000 live births in 2001 to 90 per 1000 live births in 2011, and infant mortality rate from 86 per 1000 live births to 72 per 1000 live births[6]. However, current rates of mortality are still quite high. Despite the progress, the high rates of mortality are the challenge the country has to meet in the years to come. High rates of mortality are attributed to diseases including diarrhea (22.5 percent), acute respiratory illness, and other communicable and vaccine-preventable diseases. Further, malnutrition is very high as is evident from prevalence of Stunting (44 percent) and Underweight (31.5 percent)[7] children. The economic cost of poor water and sanitation services is estimated to be around 3.94 percent of GDP[8] of Pakistan. As per Vision 2025 document of Government of Pakistan, water contamination and poor water quality have direct and very significant impact on the nation’s health with water borne infections that accounts for 70 percent of all common diseases that impact our national health.
2.Status of Sanitation in Pakistan
i) Access to Improved Sanitation:
As per JMP 2017 estimates, Pakistan made significant progress in ending open defecation and moving on the ladder of improved sanitation. Pakistan developed its improved sanitation from 35 percent in year 2000 to 66 percent in 2017, and reduced open defecation from 39.4 percent in year 2000 to 12 percent in 2017. The improved sanitation with latrines not shared with other households is 58 percent while shared latrines with improved sanitation are 8 percent. Pakistan has been one of the 95 countries that achieved the target of MDG in 2015. In figure 01, description of sanitation services as per JMP 2017 is provided with overall national, rural and urban estimates.
According to JMP estimates for 2017, about 88 percent households in Pakistan have latrines that includes both improved as well as unimproved latrines. Overall, 66 percent latrines fit the definition of improved sanitation, of which around 50 percent of latrines are connected with sewerage (27 percent) system and septic tanks (23 percent). There is a significant urban-rural divide in access to sanitation whereimproved sanitation is74 percent in urban areas and 48 percent in rural areas. Hence less than half of the rural population in Pakistan use improved sanitation. There is sharp contrast between income group as only 20 percent of the poorest have access to improved sanitation compared to 82 percent of the richest.In rural areas, a significant number of latrines are either connected to either open or unlined drains leading to nearby fields or pit/dry raised latrines. Similarly, latrine level hygiene is not adequate especially in rural areas due to lack of knowledge and sufficient water among other reasons. There is a dire need for necessary legislative reforms for water and sanitation especially regarding the latrine technology and connection of latrines with appropriate systems that provides either on-site or off-site treatment options.
Figure 1: Sanitation Services in Pakistan- JMP 2017
ii) In-situ or Off-site Treatment
Access to improved sanitation is primarily concerned with the toilet system installed inside the household (HH). However the drainage system, to which the wastewater of the toilet system is connected, is also critical from fecal sludge management point of view. Regarding sanitation systems, as per PSLM 2013-2014, more than one-third of HHs (37 percent) reported no system for wastewater disposal, whereas 36 percent are connected with open drains, three percent with covered drains and only two percent with underground drains. Compared to 62 percent HHs in urban areas, only seven percent HHs of rural areas are connected with underground and covered drains for wastewater drainage.
There is no reliable data available about the on-site treatment as the construction of septic tanks is not generally guided by the recommended international standards, while national standards have not been established yet. Generally, in urban areas sewage is channelled both through piped sewers and open surface drains. The sewage is disposed either to nearby water bodies, or to open depressions and fields. In areas where there is no collection system, ppoorly engineered soakage pits/ wells are used that often contaminates the groundwater. Where human excreta passes through open drains or open places, there is risk of disease outbreak in the neighbourhood. There are few waste water treatment plants in urban localities, and less than one percent of urban sewage is being treated in Pakistan. While such services are not existing in rural areas of Pakistan except for pilot projects which have not been scaled up yet.
iii) Hand Washing with Soap
As per JMP 2017 estimates for Pakistan, around 60 percent of population indicated the practices of hand washing with water and soap, whereas another 31 percent also reported to use water only for washing hands. Compared to 83 percent population of urban areas using water and soap for hand washing, only 46 percent population in rural areas indicated the practices of hand washing with soap, this shows a high level of disparity for hand wash practices between urban and rural areas of Pakistan.
Figure 2: Hygiene- Hand Washing JMP 2017
3.Sustainable Development Goals (SDGs) for WASH
In September 2015, the world adopted the Sustainable Development Goals (SDGs). On 19th February, 2016, Pakistan became one the first countries in the world whose National Assembly passed a unanimous resolution adopting the SDGs Agenda as its own national development agenda. Transforming the new SDG development framework into an action framework required revising existing policies, resourcing the SDG framework and action plan, redesigning the monitoring framework and realigning the governance structures. To initiate the implementation of SDG 6 and its sub-goals/targets related to drinking water and sanitation, a national consultative meeting was held, under the auspices of Ministry of Climate Change in collaboration with provincial governments and sector partners, in Islamabad on 25th July 2016 that was attended by 132 participants. This was subsequently followed by three more national consultative meetings and selected provincial meetings to understand the context and current situation of safely managed drinking water and sanitation services in addition to nurturing the Joint Monitoring Program (JMP) estimates and preparation of GLAAS report 2017. These meetings werehelpful in defining the current level of coverage and access to different aspects of SDG 6 sub goals related to drinking water and sanitation with active involvements of all stakeholders in Pakistan. These also contributed in developing an alignment among different national and provincial assessment surveys for SDG 6.1 and SDG 6.2 i.e., By 2030, achieve universal and equitable access to safe and affordable drinking water for all and by 2030, achieve access to adequate and equitable sanitation and hygiene for all and end open defecation, paying special attention to the needs of women and girls and those in vulnerable situationsrespectively.
Based on the national WASH data diagnostic study conducted by MoCC, literature review, deliberations held at national and provincial levels through SDG localization and technical collaboration with JMP team, the baseline figure of safely managed sanitation in Pakistan is proposed zero in 2017. Though improved sanitation is 66% percent, hand washing with soap is 60 percent, on-site and off-site treatment is not available.
Figure 3: SDG Ladder for Safe Sanitation - JMP 2017
4.Policies and Strategies
There is growing emphasis on the part of the Government of Pakistan for the creation of an enabling environment that underpins provision of sustainable drinking water, sanitation and hygiene (WASH) services. This is evident from the highest-levelpolitical commitment shown in the strategic document of government of Pakistan i.e. Vision 2025 Pakistan. The national policy for sanitation was approved in 2006 and national drinking water policy in 2009.In 2012 the Ministry of Environment was reformed as Ministry of Climate Change while delegating the implementation role to the provincial governments under 18th constitutional amendment approved in 2011. The rule 3(3) of the Rules of Business, 1973 of the Government of Pakistan has allocated the subject of ‘policy, plans and programs regarding Housing, Physical Planning and Human Settlements, including urban water supply, sewerage and drainage’ and this role has been relegated to Ministry of Climate Change (previously Ministry of Environment).
Since the launching of sustainable development goals (SDGs) as Pakistan national development goals in 2016, the Ministry of Climate Change on the auspices of Ministry of Planning, Development and Reforms has initiated a review processfor developing national guidelines, underpinning approved national sanitation policy 2006 and national drinking water policy 2009, that arealigned with SDGs and vision 2025 strategic approaches. Similar kinds of initiatives for reviewing the provincial policies for alignment with SDGs have been initiated in the provinces. Presently, Federal Administrated Tribal Areas (FATA) and Sindh province have approved their sanitation policies while the policies of Punjab, Khyber Pakhtunkhwa (KP), Gilgit Baltistan and Azad Jammu Kashmir are at a draft stage. The Sindh policy 2016 is well aligned with SDGs. Whereas, Punjab and KP provinces have completed stakeholder’sconsultation process for SDG alignment, and draft policies of both provinces have been submitted to the higher authorities for final review and approval. Since 2011, Punjab, Khyber Pakhtunkhwa (KP), Sindh and Federal Administrated Tribal Areas (FATA) have approved provincial drinking water policies, whereas drafts of drinking water policies have beendeveloped in Balochistan, AJK and Gilgit Baltistan as well.
The Service Delivery Assessments (SDAs)were conducted in three provinces of Pakistan with the support of World Bank except for Balochistan. Provincial WASH Steering committees have been constituted in three provinces to take forward the recommendations under SDAs. Further, three provinces except for KP have developed WASH Sector Development Plans with the support of UNICEF. Punjab province has developed its WASH Sector Plan 2014-2024 that has been approved and launched by Planning and Development Department of Government of Punjab in February 2016. This has been now translated into a provincial water roadmap that underpins a periodic strategic review under the senior political leadership of Government of Punjab. The Balochistan province has developed WASH Sector Plan 2015-2025, which is yet in the approval process with the provincial cabinet. The Sindh WASH Sector Plan 2016-2026 has also been developed and Chief Minister of Sindh approved this document in January 2017. The process for development of WASH Sector Plan has been initiated 2018, and other regions shall be completed by 2019.
In addition to WASH specific Bottleneck analyses, sector development plans and service delivery assessments, the provincial governments developed integrated development strategies where WASH has been included as key strategic action like Punjab Growth Strategy 2018 - Accelerating Economic Growth and Social Outcomes, Integrated Development Strategy 2014-2018 KP province, and Comprehensive Development Strategy 2012-2020 Balochistan. Further, for water and sanitation specific legislation, two provinces have drafted municipal water acts that are under discussions with stakeholders and elected local representatives. These Acts have proposed the establishment of Water and Sanitation Commission as regulator for the sector as currently the sector is overseen by multiple sectors without any independent regulatory authority.
Since 2016, Joint Sector Reviews (JSRs) of WASH sector,that refers to a periodic assessment of performance by government, development partners and civil society, has been initiated in Pakistan under the leadership and collaboration of Ministry of Climate Change. The JSRs in Pakistan are primarily guided by WASH Bottleneck Analysis Tool (WASHBAT) that has been developed globally and is now being implemented in number of countries for last few years. The MoCC organized a national training workshop of WASHBAT and JSR process in October 2016, which was attended by provincial and national stakeholders. In December 2016, the MoCC issued guidelines to the provincial departments for rolling out and cascading WASH JSRs in their respective provinces. In 2017, all four provinces conducted JSRs with the intention to integrate JSRs as essential component of country planning while strengthening the government leadership. These JSRs did not only identify key bottlenecks but also provided plans with short-term actions for sector readiness in next two years, along with resources and responsibilities. The JSRs also helped to create awareness and sensitization about the SDGs and created a momentum for understanding and setting the SDG targets in respective provinces based on available resources vis a vis potential capacities, by using SDG-6 costing tools. In KP province, the recommendations of JSR have been integrated into ‘Peshawar Declaration’of November 2017, under KP Provincial Conference on Sanitation endorsed and signed by Mr Innayat Ullah Khan, Senior Minister Local Government and Rural Development Khyber Pakhtunkhwa, showing the highest political commitments for seeking the agenda of transforming the sanitation and sustainability in WASH programs. Similarly, the provincial government of Punjab endorsed WASH JSR Report 2017, along with targets set for SDG 6.1 and 6.2 for the province up to 2030. The Local Government Department of Sindh has also organized a provincial sanitation conference to enhance the learning and sharing among key stakeholders.