Access to water, sanitation and hygiene (WASH) services varies across and between Khyber Pakhtunkhwa (KP) and Punjab Provinces. The Government of KP’s 2017 Health Survey found that 89% of households have access to improved water sources, and 85% have accessed to improved sanitation (Government of KP, 2017). In contrast, according to the Government of the Punjab, access to improved water sources is approximately 94% in the Punjab and access to improved sanitation is 72% (Government of Punjab, 2015).
Disparities exist between rural and urban areas, across wealth quintiles and between districts within each province. UNICEF (2015) argue that addressing these disparities is necessary to achieve universal sanitation. Open defecation is higher in rural areas than urban areas in both provinces (10.9% rural & 0.8% urban in KP, and 25% rural &10% urban in Punjab) (Government of KP, 2017; Agha, 2018). The Pakistan Approach to Total Sanitation, developed following devastating floods in 2010/11, is being implemented in both provinces by government agencies and non-governmental organisations (NGOs).
Sanitation is a gender issue: women and girls face a number of hidden difficulties in accessing sanitation (Ahmed, Miankhel, Kanaganathan & Villeminot, 2015). Due to cultural norms, women
in households without access to improved sanitation often defecate in private (in the house or courtyard) and then dispose of the excreta (Ahmed et al., 2015). This has potential health
consequences as well as dignity concerns. Menstruation is a social taboo in Pakistan and both WaterAid and the Government of the Punjab are working to increase menstrual hygiene management education in schools to create girl friendly environments and the opportunity for girls to stay in school (WaterAid, 2018; Aman, 2018).
Key findings from the report include:
- Access to drainage and the safe disposal of faeces are challenges in both provinces and could lead to drinking water and soil contamination. The World Bank (2018) recommends shifting the emphasis from improving access to sanitation to improving the quality and safety of WASH infrastructure and the safe management of human waste.
- Water and sanitation-related diseases are common in both provinces, for example, 18% of Punjab’s population reported diarrhoea (World Bank, 2017).
- The links between WASH, nutrition and stunting/wasting is receiving increasing attention from the Pakistani government, donors and NGOs. For example, the World Bank is developing a project to support the Government of Punjab’s programme to decrease open defecation in order to combat child stunting. Punjab has the lowest rate of stunting of all the provinces (38% compared to KP’s 49%) but the majority of Pakistan’s stunted children live there, due to its large population share (World Bank, 2018).
- Poor water safety, poor hygiene and poorly sited and constructed pit latrines, as well as poor drainage, can lead to drinking water contamination and waterborne diseases even in villages with access to improved water and sanitation, as illustrated by two case studies from KP (Nawab, Esser & Baig, 2017). Drinking water is not often treated, for example, 93.8% of household in the Punjab do not use any water treatment method (Government of Punjab, 2015).
- Poor hygiene is a problem in both provinces, including low rates of handwashing and poor water storage habits (World Bank, 2018; Nawab et al., 2017).
- Community awareness raising and education tools are important to bring about behaviour change, and also to combat beliefs including water being safe to drink if it is clear and does not smell (Shah, Khan, Kanwal & Bernstein, 2016).
There is a wealth of evidence related to the overall WASH status of Pakistan including the Joint Monitoring Programme and NGO strategies. During the course of this review, it was relatively
easy to locate information related to the extent of services in both KP and Punjab, but less easy to locate case studies on the challenges and issues of these services.