Pakistan

Country Paper on Sanitation

SACOSAN VI

2016

  2  

Contents ACRONYMS   3  

COUNTRY PROFILE   4  

INTRODUCTION   4  PLANNING AND DEVELOPMENT FRAMEWORK   5  INSTITUTIONAL FRAMEWORK AND LEGAL INSTRUMENTS   5  

PROGRESS AND ACHIEVEMENTS   6  

COVERAGE DEFINITION   6  COVERAGE – HYGIENE BEHAVIOURAL CHANGE   8  POLICY, STRATEGY AND PLANS   10  SECTOR INVESTMENT   11  MONITORING SYSTEM   12  PARTNERSHIPS   13  

CASE STUDIES   14  

GOOD EXAMPLES   14  SOCIAL AND TECHNOLOGICAL ADVANCEMENTS   15  

GAPS AND CHALLENGES   15  

COVERAGE   15  TECHNOLOGY   16  HEALTH   16  EQUITY AND RIGHTS   17  

FUTURE PLAN   18  

SANITATION BEYOND MDGS   18  SUSTAINABILITY   19  OVERCOME THE BARRIERS   19  UNIVERSAL COVERAGE AND IMPROVING SERVICE DELIVERY LEVEL   20  

CONCLUSIONS   20  

PROGRESS ON SACOSAN V DECLARATIONS   22  

CONTACTS   26  

  3  

Acronyms ADP Annual Development Plan AJK Azad Jammu & Kashmir ASER Annual Status of Education Report BISP Benazir Income Support Programme CSOs Civil Society Organisations DPOs Disabled Persons Organisations FATA Federally Administered Tribal Areas GB Gilgit Baltistan GIS Geographic Information System GPS Global Positioning System GSF Global Sanitation Fund  HHs Households IEC Information, Education & Communication IMR Infant Mortality Rate IRRC Integrated Resource Recovery Center  JMP Joint Monitoring Programme KPK Khyber Pakhtunkhwa LG&CD Local Government and Community Development LG&RDD Local Government and Rural Development Department LHWs Lady Health Workers MDG Millennium Development Goals MHM Menstrual Hygiene Management MICS Multiple Indicator Cluster Survey MIS Management Information System MTBF Medium Term Budgetary Framework  MTDF Medium Term Development Framework ODF Open Defecation Free PACOSAN Pakistan Conference on Sanitation PATS Pakistan Approach to Total Sanitation PDHS Pakistan Demographic and Health Survey PHED Public Health Engineering Department PIFRA Project to Improve Financial Report and Auditing  PKR Pakistani Rupee PRSP Poverty Reduction Strategy Papers PSLM Pakistan Social and Living Standards Measurement RSPN Rural Support Programme Network SACOSAN South Asia Conference on Sanitation SDGs Sustainable Development Goals SSS Saaf Suthro Sindh STU Sewage Treatment Unit SWA Sanitation & Water for All TMA Tehsil Municipal Administration U5MR Under 5 Mortality Rate  UCs Union Councils UNDP United Nations Development Programme  UNESCAP United Nations Economic and Social Commission for Asia and the Pacific  UNICEF United Nations Children’s Emergency Fund USD United States Dollar WASA Water and Sanitation Authority WASH Water, Sanitation and Hygiene WSP Water and Sanitation Programme  WSSCC Water Supply and Sanitation Collaborative Council  

  4  

Country Profile Introduction Pakistan has a land area of over 800,000 sq. km, with an estimated population of 191.71 million1 and population density of 234 persons per sq. km. According to the Economic Survey of Pakistan 2014-2015, nearly 116.52 million (60.8%) people of Pakistan reside in rural areas compared to 75.19 million (39.2%) in urban areas indicating a rapid growth of urbanisation in Pakistan. Furthermore, about 33% population of Pakistan is below the age of 15 years.With an average age of 23.6 years, Pakistan is the second youngest country in south Asia. The rapid urbanization and abundance of youth provide Pakistan a unique opportunity to grow. 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 density of population ranges from scarcely populated arid areas especially in Balochistan to some of the highest urban densities like Karachi and Lahore. The overall poverty has reduced to about 12.4%, with 7.1% in urban and 15.1% in rural areas. The reduction in poverty (Fig 1) is likely to be due to a multitude of causes, which include cash disbursements from the Benazir Income Support Programme (BISP), increasing subsidies, increasing remittances from abroad, etc. The divide between the top 60% and bottom 40% of the population has also reduced in the last 10 years, indicating shared prosperity and improvement in equity. Figure  1  -­‐  Poverty  trends  in  Pakistan

   (Source:  Pakistan  Economic  Survey  2013-­‐14.  Ministry  of  Finance,  Government  of  Pakistan)  

                                                                                                               1Economic Survey of Pakistan 2014-15, Ministry of Finance, Government of Pakistan

0.0%$

5.0%$

10.0%$

15.0%$

20.0%$

25.0%$

30.0%$

35.0%$

40.0%$

45.0%$

Overall$ Urban$ Rural$

2000501$

2004505$

2005506$

2007509$

2010511$

  5  

Planning and Development Framework The National Sanitation Policy 2006 envisions creation of an open defecation free environment with safe disposal of liquid and solid waste, and the promotion of health and hygiene practices in the country. The National Sanitation Policy also provides broad guidelines and support to the Federal Government, Provincial Governments, Federally Administrated Territories, the Local Governments and development authorities to enhance sanitation coverage in the country through formulation of their sanitation strategies, plans, programmes and projects. In 2011, the policy and administrative functions of water and sanitation were shifted to the provinces by virtue of a constitutional amendment. Since then, the provinces have almost finalised their provincial sanitation policies, strategies and plans in line with the National Sanitation Policy 2006. The significance of sanitation has been recognised in the Vision 2025 document of Ministry of Planning, Development and Reforms, Government of Pakistan that was launched in August 2014 by the Prime Minster of Pakistan, which is the roadmap of the Government of Pakistan. The document lays emphasis on provision of safe drinking water and improved sanitation through an integrated development strategy. Further, the document highlights water contamination and water quality issues and the pressing need for eliminating open defecation. Presently, the Ministry of Planning, Development and Reforms is in the process of finalising its implementation and monitoring framework, in which one of the key indicators agreed in the document is “Increase of proportion of population with access to improved sanitation from 48% to 90%” by 2025 which is in-line to the SDGs to which Pakistan is a signatory. Institutional Framework and Legal Instruments The responsibility of planning, funding, regulating, monitoring and service delivery of water and sanitation sector rests with the provincial governments who have further delegated it to the local governments. Since the 2001 Local Government Ordinance (LGO), municipal services including water supply and sanitation services are the responsibility of the Tehsil Municipal Administrations (TMAs) across the districts. However, the TMAs mainly functioned for urban areas with very little focus on rural development including rural sanitation. Realising the gap, the Local Government of Acts of 2013 were passed in all provinces of Pakistan, which re-created the rural-urban divide in three provinces except for KP province. In 2015, all provincial governments have completed their local government elections. At the federal level, the Ministry of Climate Change serves as the focal point for Water, Sanitation and Hygiene (WASH) in Pakistan, being the custodian of the National Environmental Policy 2005, National Sanitation Policy 2006, National Drinking Water Policy 2009 and National Climate Change Policy 2012. Furthermore, the Ministry of Planning, Development and Reforms (previously called Planning Commission) and the Ministry of Finance also have critical roles. The Ministry of Planning, Development and Reforms holds the authority for approving provincial development programmes and coordinates and approves projects prepared by the Provinces that cost more than PKR 100 million (about US$ 1 million). The Ministry of Finance allocates resources, is the secretariat of the National Finance Commission and transfers funds to the provinces. The enactment of the 18th Constitutional Amendment shifted the onus of autonomy in allocation and distribution of resources including WASH. The four provincial governments of Pakistan adopted new Local Government Acts (LGAs) 2013. Except for Khyber Pakhtunkhwa (KPK) province, the union councils and zila (district)

  6  

councils will be responsible for services in rural areas; while metropolitan, Municipal Corporation, municipal and town committees will provide services in urban areas. In Khyber Pakhtunkwa, village, tehsil and district councils have been created. The local bodies elections that were pending in four provinces since 2009 were held in 2014-2015. The new local governments are in place in all provinces. One of the core responsibilities of these local councils will be identification, preparation, implementation and monitoring water supply and sanitation schemes at the local and community levels.

Progress and Achievements Coverage Definition According to the Joint Monitoring Programme (JMP) Report 2015, Pakistan has achieved Millennium Development Goal (MDG) target for sanitation by increasing access to improved sanitation from 24% in 1990 to 64% in 2015 global target of sanitation2. Further, Pakistan has made significant progress of reducing open defecation from 49% in 1990 to 13% in 2015 with an average 3.9% annual rate of decline. However, other national surveys show an accelerated rate of progress after 2010, when large scale rural sanitation programmes were implemented under Pakistan Approach to Total Sanitation (PATS) In numerical terms, about 25 million people practice open defecation. However, there is wide disparity between rural and urban areas in terms of open defecation and improved sanitation as only 1% of the urban population report open defecation compared to 21% rural population, while 83% urban population live with improved sanitation compared to 51% of rural population. Pakistan has also made steady progress in the construction of latrines with 83% households (HHs) having flush (74%) and non flush (9%) latrines while 17% HHs are without latrines as per Pakistan Social and Living Standards Measurement (PSLM) Survey 2013-14. The concept of hygienic latrine is lacking at many places especially around construction of septic tanks in urban and peri-urban areas where majority of latrines are connected with drains either covered or open, whereas nearly 55% of rural areas of Pakistan are without any disposalsystem. The latrines are either connected with septic tanks, or drain into unpaved drains leading to nearby fields. Similarly, latrines are not regularly cleaned especially in rural areas due to many reasons including lack of sufficient water, etc. This has been identified by a number of research and baseline studies conducted by sector partners including Save the Children, UNICEF, Plan International, Oxfam GB, WSP and WaterAid. Table 1 illustrates the trends in rural sanitation coverage in Pakistan. Improved sanitation has increased at least ten fold, while open defecation has reduced by more than two-thirds since 1990.

                                                                                                               2JMP Report 2015, WHO/UNICEF

  7  

Table  1  -­‐  Pakistan  rural  sanitation  coverage  trends  

Year Improved Shared Other Unimproved

Open Defecation

1990 5% 1% 27% 67% 1995 9% 2% 26% 63% 2000 20% 4% 23% 53% 2005 30% 6% 22% 42% 2010 41% 8% 19% 32% 2015 51% 10% 18% 21% Figure 2 illustrates the comparison of urban, rural and total sanitation trends, which indicate that rural sanitation campaigns need to be intensified to reduce and eliminate open defecation. Figure 3 illustrates the rural trend for ‘No Toilets’ in Pakistan. The trend lines are based on PSLM data for the last fifteen years, and also portray the projected year when open defecation will end if interventions are sustained at the current pace. Further, by considering 2014 PSLM data as the baseline year, the trend lines have been developed with an annual decline rate 3.9% and 3% indicating the possible year when open defecations will end. Figure  2  -­‐  Pakistan  Urban,  Rural  and  Total  Sanitation  Trends  

(Source:  JMP  Report  2015)

  8  

Figure  3  -­‐  Pakistan  rural  trends  for  no  toilets  

Coverage – Hygiene Behavioural Change In relation to hygiene, about two-thirds of Pakistanis (63.8%) are reported to use soap with water to wash their hands while 84.6% reported to have a specific place for hand washing in their houses (Table 2). Compared to urban areas where 88% reported to use soap and water, only half of the rural population (51.6%) wash their hands with soap. Within the regions, the households that use soap and water to wash hands are the highest in Islamabad with 92.1% followed by Punjab with 71.9%, whereas the lowest are in Balochistan with 33.4% and Sindh with 52.4%. Table  2  -­‐  Hand  washing  facility  and  practice  of  washing  with  soap  

Region Percentage of HHs with Places for Hand

Washing %

Among households where place for hand washing was observed %

Soap and Water Water Only Pakistan 84.6 63.8 25.7 Urban 83.8 88 9.6 Rural 85.0 51.6 33.8 Punjab 87.4 71.9 23.1 Sindh 87.1 52.4 31.3 KPK 66.5 55.4 27.3 Balochistan 89.5 33.4 27.4 ICT- Islamabad 84.9 92.1 04.0

(Source:  Pakistan  Demographic  and  Health  Survey  2012-­‐13) The Ministry of Climate Change is supporting a national hygiene campaign that underpins mass media to accelerate reduction in open defecation and improve hygiene behaviours in collaboration with sector partners and respective provinces. A national song for hygiene has been developed which was aired on hand washing day and later on telecasted on all major television and radio channels of Pakistan. This campaign is being aligned with an advocacy strategy that has been prepared andhas a focus on behavioural change.

Pakistan continues to face the challenge of appropriate solid waste collection and its safe disposal. Presently, 23 % of HHs in Pakistan reported to have a garbage collection system i.e.

  9  

17% by municipality and 6% privately. Compared to urban areas where 57% (48% by municipalities and 9% privately), only 6% rural HHs (2% municipality and 4% privately) have any garbage collection system. The Government of Punjab started Lahore Waste Management Company has now been replicated in five major cities of Punjab and plans are underway to extend this coverage to all other major cities under “litter free’ Punjab initiative. Similarly, Government of Balochistan is planning to start Quetta Waste Management Company. In Sindh, Sindh Solid Waste Management Board 2014 passed by the provincial assembly with the purpose to develop solid waste management arrangements for Karachi and other areas of Sindh. Presently, solid waste management is being tested and piloted in six municipal committees under Sindh Cities Improvement Programme. In KPK, the Clean Peshawar Campaign started in 2015, while solid waste management is an integral component of municipal service delivery programme being implemented in three divisions of KPK. The Local Government & Community Development Department Punjab started a "Rural solid waste management" programme in seven villages of three districts. The pilot model aims at the management of waste at local level by the people who are producing it. The model will be refined / modified after testing it by monitoring the success and problems encountered. After modification/refining, it will be implemented in all the villages of Punjab. School WASH, especially sanitation has been a key focus in the last two years under the education reforms and development agenda of the provinces. The Education Sector Plans developed in four provinces of Pakistan identified WASH as a critical intervention to enhance the quality of education and retention of students. The provinces have increased hygiene and awareness sessions especially about epidemics like dengue, which has been included in the curriculum. Moreover, the institutional monitoring mechanisms of the provincial government have begun to include reporting about functional water supply and latrines especially in Punjab and KPK provinces. According to the Education Profile of 2014, about 69% schools in Pakistan have functional latrines compared to 62% of schools in 2011. Special grants under “missing facilities” with emphasis on WASH facilities have been provided to priority districts in Punjab and KPK provinces, which has led to this change. The Annual Status of Education Report (ASER) 2014 compiled by civil society organisations of Pakistan, based on visits to sampled schools, showed 57% of government primary schools had useable water facility compared to 55% in 2011, while 51% of government primary schools had a functional toilet compared to 43% in 2011. For hygiene, the ‘School of 5’ approach targets hand washing at five critical times is being implemented by Unilever in collaboration with Plan International and WaterAid.The five critical times are; after using a bathroom (private or public), after handling child faeces, before feeding a child, before eating and before preparing food

An operational research under Learning, Action and Learning (Lal: literally meaning ‘Red’ in the local language, Urdu) for Menstrual Hygiene Management (MHM) has been conducted in Pakistan during 2013-2014 in order to understand the ground realities with active participation and feedback of the schoolgirls, teachers and education department officials from designing to execution3. The research resulted in development of a training manual and monitoring toolkit for MHM in schools for the government’s education department. Similarly, a capacity development programme in WASH for distant pre-service teachers training programme has been initiated with AllamaIqbal Open University of Pakistan. The project has developed videos of WASH manual for trainee teachers, which is broadcasted by Pakistan Television under its virtual training support to the distant students.

                                                                                                               3Naeem K et al: Learning Acting and Learning (LAL) research on school MHM in Pakistan, Waterline, Vol 34, No 1, 2015.

  10  

Policy, Strategy and Plans The sanitation policies of all provinces AJK and GB have been developed. The AJK policy has been approved while Balochistan, Khyber Pakhtunkhwa, Punjab and Sindh are still a draft, however all the provinces have developed a sanitation implementation programme and made considerable progress on ground. These policies provide a framework to guide and support provincial institutions, district governments, local government institutions, water utilities and communities for improving sanitation services. The governments of three provinces i.e. Punjab, Balochistan and Khyber Pakhtunkhwa developed their provincial integrated and growth development strategies that include water and sanitation. Punjab has developed its growth strategy 2014-2018 with urban and rural water and sanitation sectors separately linking this to the medium term development framework of the province. Khyber Pakhtunkhwa has developed an integrated development strategy 2014-2018 with water and sanitation sections and financial estimates; and Balochistan developed a comprehensive development strategy 2014-2020 that has dedicated water and sanitation sector approach with required costs.

Similarly, Punjab, the most populous province of Pakistan, the one that bears the main burden of people practising open defecation and the one which has contributed the most in achievement of MDG sanitation target, is ahead of all provinces in recognisingthe importance of improved sanitation, and has developed Punjab WASH Sector Development Plan 2014-2024. The Planincludedkey strategies for enhancing improved sanitation. Based on learnings of UNICEF funded large scale rural sanitation programmes in the province since 2010, the Government of Punjab started a new programme with government funding in 2014 with the title of “Scaling Up Pakistan Approach to Total Sanitation (PATS) – Open Defecation Free (ODF) in Punjab” that underpins the elimination of open defecation in the province in the next five years.

The Government of Balochistan has also developed a ten-year WASH sector plan that is undergoing an approval process. The plan has a major focus on improved sanitation with promotion for open defecation free environment with a reward mechanism. Presently, PATS is being implemented in four districts through local civil society partners while local government department is providing necessary facilitation, with technical assistance of UNICEF. Currently, the local government department of Balochistan has no specific funding and budget line for rural sanitation. In Khyber Pakhtunkhwa province a WatSan Cell under the umbrella of the Local Government and Rural Development Department (LG&RDD), working on sanitation up scaling program in KP, took an initiative in the province with different social sector partners on PATS approach.Under this programme, initially trainings will be conducted in 6 districts and orientation across the province in 26 districts. Further, LG& RDD started a community driven programme of ending open defecation in three districts from September 2015. The number of districts will be increased gradually in phases. The Public Health Engineering Department (PHED) has also set up a Strategic Reform Unit (SRU), which aims to eradicate open defecation in 3 districts.

The Government of Sindh has concieved a large scale up program after the success of pilot in three districts. TheSaaf Suthro Sindh (SSS) programme focuses the entire province fortargetingthe attainment of ODF in two phases, by 2025. The key objectives of the programme are: eradication of open defecation in 16 districts by 2020 and rest of the 8 districts by 2025. The SSS programmeis enablingthe government with an institutional home, the “Sanitation Directorate” to oversee all sanitation related work of the province. Integrated

  11  

solutions inclusive of health and school interventions with sanitation arebeing sought through collaboration among development partners and different stakeholders at the community, district and provincial levels. The Government of Azad Jammu and Kashmir (AJK) started with a CLTS based sanitation program to convert the whole AJK into open defecation free jurisdiction. The program has been being implemented in all 10 districts of AJK. The district of Mirpur where 186 villages have been made ODF through the Local Government Department and technical assistance of WSP, and district has been claimed to be open defecation free in 2015. Sector Investment The share of expenditures made on water and sanitation are about 0.219% of GDP during 2014-2015 compared to about 0.17% of GDP during the 2012-2013 fiscal year. The current budget allocations and expenditures review conducted by the federal government do not provide information around sanitation only. This is partly because of the coding system of financial reporting and absence of a dedicated budget line for sanitation. A review of the provincial budget of Balochistan conducted in 2012 for Comprehensive Development Strategy of Balochistan indicated the share of sanitation as 30% compared to 70% of spending on water supply. Similarly, the Punjab budget of 2014-2015 indicated that the budgetary allocation for sanitation related interventions are around 33% compared to 67% of planned budget for water supply. Further the spending of sanitation is mainly for hardware like drainage, sewerage lanes, etc. Table 3 illustrates that public spending on water and sanitation has apparently declined in the provinces during the three years with a significant increase in 2014-2015 suggesting a recent and improved prioritisation by the political leadership. Realising a 33% share of sanitation in the PKR 54 billion expenditure, the sanitation related expenditure in Pakistan has been PKR 18 billion in 2014-15. Going forward, the government expects that this expenditure will be in access to PKR 20 billion (almost USD 200 million) with the emergence of provincial level sanitation interventions especially in Sindh and Punjab. Based on these trends, it appears that Government of Pakistan will spend USD 1 billion on sanitation in the next 5 years. Table  3  -­‐  Total  financial  expenditures  for  drinking  water  and  sanitation  (PKR  Million)  

Regions 2011-2012 2012-2013 2013-2014 2014-2015 Federal 723 1,940 1,032 1,070 Punjab 16,304 13,986 14,491 27,138 Sindh 6,361 4,624 5,311 7,545 Khyber Pakhtunkhwa

6,647 6,951 4,837 10,104

Balochistan 6,535 6,556 6,329 8,326 Total 36,570 34,057 32,000 54,093 (Source:   Poverty   Reduction   Strategy   Programme   Financial   Progress   Reports,   2012,   2013   and   2014,  Ministry   of   Finance,  Government  of  Pakistan) Moreover, there is a visible increase in the investment made by the provinces on the social mobilisation programme for ODF either through public private partnerships with civil society partners’ organisations or even specific allocations under Annual Development Programmes. These include the following:

  12  

§ Scaling up Pakistan Approach to Total Sanitation (PATS) – ODF in Punjab from 2014/2015 with an allocation of PKR 400 million that focuses on ending open defecation in 3360 villages

§ Saaf Suthro Sindh programme in collaboration with international partners has made a commitment of PKR 2,000 million for ending open defecation and defining total sanitation solutions in 16 districts of the province in three years.

§ A community driven sanitation programme underpinning a behavioural change campaign for health and hygiene in KPK initially for three districts with an allocation of PKR 60 million

§ AJK has also committed PKR 10 million for ODF initiatives in 2014-2015 and already initiated a program in all 10 districts.

§ An average PKR 3 billion (USD 30 Million) are being spent by UN agencies, international NGOs and development partners under humanitarian assistance as well as development programmes for ending open defecation practices and promoting the use of improved sanitation and hygiene practices in addition to access to clean drinking water. Key organisations include UNICEF, WSP, WaterAid and Plan International

Monitoring System Due to complexity of roles and responsibilities assigned to different organisations and institutions working for WASH, a systematic approach and mechanisms for data collection by service providers from village/tehsil level and onward collation and analysis at the departmental level as performance reporting of sanitation services is lacking in the four provinces. While each project/scheme does in theory have a project cycle - based on a series of documents from PC-1 to PC-5, the end of project evaluation stage (PC-V) is rarely undertaken, and therefore bypassing yet another institutional monitoring mechanism. No MIS system exists at the federal level, however, the Poverty Reduction Strategy Papers (PRSP) unit of Ministry of Finance leads on a yearly expenditure review process with the support of provincial finance and statistical departments. The expenditures are reviewed under a financial reporting system called Project to Improve Financial Report and Auditing (PIFRA) that takes water and sanitation under one code. In addition, other mechanisms include provincial PRSP reports, Medium Term Development Framework (MTDF), Medium Term Budgetary Framework (MTBF) and Annual Development Plans (ADP). Generally, the ADP provides the basis for planning, but current arrangements do not support a comprehensive assessment or access to capital expenditure on sanitation and hygiene.

The coverage is assessed and determined through a households’ survey called Pakistan Social Living Standards Measurement (PSLM) survey conducted by the Federal Bureau of Statistics in collaboration with respective Provincial Bureau of Statistics. There are two other reports/sources that provide information about access to water and improved sanitation. These are Multiple Indicator Cluster Survey (MICS) held at the provincial levels and Joint Monitoring Program (JMP) of WHO and UNICEF. Moreover, Pakistan Demographic Health Survey (PDHS) held every five years also collects information of water and sanitation from sampled households. There are varying definitions used by various surveys especially on the definition of what constitutes safe and improved sanitation. Further, it is not possible to determine and assess the collective outputs of water and sanitation carried by different actors and partners across the country due to lack of consistent monitoring and reporting formats at the community, district, provincial and national levels. Hence, the existing reporting mechanisms do not provide a comprehensive and consolidated picture of sanitation sector i.e. investments, costs, outcomes, outputs, inequities, etc.

  13  

The provinces started work around developing a computerized Management Information System (MIS) for water and sanitation projects, which is mainly input driven. This MIS has not been cascaded to all provinces and districts. The experience of using GPS in baseline data of AJK and Sindh proved very useful in not only identifying gaps in WASH services but also pockets of poverty, and this is being scaled up in future baseline, impact and outcome studies. Moreover, while outcome based monitoring is being practiced in the projects implemented in collaboration with international and national partners, it has yet to be integrated in the public funded projects/schemes. The recent provincial plans/strategies in 2014-2015 elaborated key indicators with means of verification and approaches to collect data in line with national needs. However, the provinces would need additional support and facilitation from the national and international partners to implement the M&E framework through capacity building support. Partnerships Pakistan Approach to Total Sanitation (PATS) introduces a mix of several proven approaches to address the demand and supply side interventions for sanitation with the objective to achieve an open defecation free status for the populace of the country. The programme also promotes the use of safe hygienic latrines and encourages improved hygiene behaviours through Information, Education & Communication (IEC) and mass media campaigns while supporting the establishment of markets for low-cost sanitation goods and services. The successful implementation of PATS at scale has been facilitated in partnership with and collaboration amongst a number of stakeholders, namely all levels of government, international and local civil society organisations, NGOs, UN agencies and most importantly, the community members themselves. The proactive advocacy and pooling and sharing of the resources by the sector partner were key factors in developing a unified approach. If the current momentum of collaboration and partnerships is not sustained, there is likelihood that Pakistan may not be able to end open defecation in the next 10 years In order to build the momentum and accelerate the progress on sanitation and hygiene in the country, second Pakistan Conference on Sanitation (PACOSAN- II) was held in February 2015 by the Ministry of Climate Change in collaboration with UNICEF, Plan International, WaterAid, RSPN, WSSCC, WSP of the World Bank and local development partner organisations. Honourable President of Pakistan, H.E. Mr.MamnoonHussain called upon all stakeholders to launch a campaign for improved sanitation in the country. More than five hundred participants unanimously agreed that the focus of proper sanitation and hygiene in Pakistan should be based on a paradigm that is 'people centred, community led, gender sensitive and demand driven'. The event resulted in the PACOSAN-II Declaration which emphasised the need to 'capitalise on the strong political will, local leadership and community ownership’ to boost sanitation coverage and improve hygiene practices. The conference attended by international delegates from Sanitation & Water for All (SWA), SACOSAN member countries, representative of international and national organisations along with academia. The PACOSAN-II served as an opportunity of cross-regional learning among the provinces/regions, and helped the sector to identify the key issues.

  14  

Case Studies Good Examples    Punjab

After massive floods in Pakistan during the year 2010, large-scale rural sanitation programmes were launched under PATS to reach out 8 million people in Pakistan, with support of UNICEF and other development partners including Plan International and WaterAid. The province of Punjab is most populous area of Pakistan having 100 million inhabitants (53% of total) including large number of people practicing open defecation. However, the concerted efforts of Provincial Government and all other stakeholders has enabled to achieve a considerable and visible decline in Open Defecation ratio from 23% in 2011 to 17% in 2013-14 as per MICS. During last three years, the Government of Punjab has conceived WASH sector policies including WASH Sector Development Plan that underpins open defecation free environment, promotion of hygiene behaviours and liquid and solid waste management. In addition, the Punjab approved PKRs 1400 million for PATS and elimination of sewage ponds to achieve open defecation free environment for 2014-2016, and while another commitment of PKRs 1000 million is being envisaged from 2016 onwards. Three key achievements of PATS in Punjab are: Firstly, allocation of PKRs. 1,200 million for three years to scale up PATS and elimination of sewage ponds by the government as there has never been any separate allocation of sanitation for open defection free environment. Secondly, WASH has been integrated in Multi Sector Nutrition Policy of Government of Punjab.Thirdly, strengthening WASH coordination mechanism vis a vis the WASH Coordination Committees that have been notified at the provincial, district, union council and village levels where ODF projects are being implemented.In addition, water, sanitation and hygiene have been reflected as key issues with strategic actions in Punjab Health Sector Plan 2018 and Economic Growth Strategy of Punjab 2018. Sindh

The "Saaf Suthro Sindh" (clean and sanitised Sindh) has been conceived on the basis of the learning of a three-year project implemented in three districts of Sindh province.In the pilot project, the project transformed over 100 villages in three districts into Open Defecation Free and thereby improving the living standard of over an estimated 50,000 individuals. The Saaf Suthro Sindh (SSS) is being envisaged to scale up in 16 rural districts of the province on ending open defecation and proposes integrated solutions for hand washing and village level drainage through behavioural transformation by 2020. The scale-up programme will further add an estimated 10 million people in the programme beneficiaries, spread across over 12,000 villages in 16 districts.

The SSS hinges upon innovation and international cooperation for Pakistan through a programme strategy and interventions including (i) dedication of a provincial sanitation home - a Directorate of Sanitation that houses all sanitation programmes in the province including the SSS Programme, (ii) use of Global Positioning System (GPS) based mobile tracking of data, (iii) team work between Health and Local Government departments at the policy and service delivery level - enabling use of both health and local government functionaries, (iv) use of government procured NGOs as implementing partners, (v) provision of outcome reward to village activists, (vi) linking innovative and affordable supply side options using the private sector, (vii) tracking integrated outcomes for both, sanitation and nutrition, (viii) addressing WASH for schools and rural hospitals.

  15  

The SSS programme is promoting the Community Led Total Sanitation Plus (CLTS+) approach to mobilize community members for analysing their own sanitation status through a participatory process, and communities construct their household latrines according to their capacities and financial resources. The approach motivates the people to change their perceptions from construction to the use of latrines to reduce the risks and hazards of faecal-oral contamination if open defecation continues. The programme ensures sustainability through the Lady Health Workers being the on-ground health advocacy staff and the municipal governments. The SSS is part of the inter-sectoral nutrition framework of Sindh and is being funded by the World Bank, USAID and Government of Sindh with the technical support of WSP and UNICEF.

Social and Technological Advancements According to a survey conducted by the Local Government and Community Development (LG&CD) department Punjab in 2013, there are over 7,000 ponds in Punjab province. These ponds had been previously used for bathing, washing, drinking for livestock and other purposes. Installation of water supply schemes without planning and absence of disposal system for wastewater has turned these ponds into sewage ponds. A pilot project of elimination of sewage ponds in Punjab started in 2013/2014, and initially 78 sewage ponds located in different villages were identified based on the resources. So far 156 ponds have been eliminated and allocations have been made for 100 ponds during 2015-2016. The reclaimed lands are being utilised to develop playfields, parks, schools, health dispensaries, graveyards or other useful purposes. The lessons of these experiences are being documented and shall be shared with newly elected councils for scaling up. UN-Habitat, in close collaboration with the United Nations Economic and Social Commission for Asia and the Pacific (UNESCAP) and the Ministry of Climate Change, is currently implementing a project on “Pro-poor and sustainable solid waste management in secondary cities and small towns’’. The project contributes to this goal by setting up an Integrated Resource Recovery Centre (IRRC) in Islamabad that will enable the city to turn waste into resources through composting, recycling and bio digestion, thereby diverting solid waste from landfills or open dump sites. UNICEF has introduced similar kind of initiative of IRRC in Hyderabad Sindh in collaboration with UN Habitat. These projectsare being carried out through a multi-stakeholder approach, the participation of the Ministry of Climate Change in Islamabad and Local Government in Sindh is instrumental in the successful implementation of this model, as well as in capitalising from the climate benefit of setting-up decentralised solid waste management systems, through the IRRC.

Gaps and Challenges Coverage Based on PSLM 2013-2014, about 30 million population in Pakistan is without toilets. The provincial distribution of this population is: Punjab 17.23 million, Sindh 5.06 million, Khyber Pakhtunkhwa 4.394 million and Balochistan 2.303 million. As per JMP Report 2015, the current annual decline rate of Open Defecation in Pakistan is 3.9%. Based on national statistical data for the last 15 years, Pakistan is likely to end open defecation by 2021-2022. However, the provincial statistical projections indicate that provinces may end open defecation in their respective areas as follows: Punjab 2020-2021, Sindh 2019-2020, Khyber

  16  

Pakhtunkhwa 2022-2023 and Balochistan 2035. It is evident from the national equity study4 conducted by UNICEF Pakistan and recent national surveys that no toilets/open defecation predominantly exists in the poorest groups. Thus, the Government of Pakistan and stakeholders will have to intensify efforts and develop innovative strategies to ensure that Pakistan is able to end open defecation by 2020-2021. Regarding sanitation systems, as per PSLM 2013-2014, more than one-third of HHs (37%) reported no system for wastewater disposal, whereas 36% are connected with open drains, 3% with covered drains and only 24% with underground drains. Compared 62% HHs in urban areas, only 7% HHs of rural areas are connected with underground and covered drains for wastewater drainage. More than half of the rural HHs (55%) are without any sanitation/drainage system for their wastewater disposal. The success of improved sanitation is highly dependent upon development of sustainable sanitation systems with regular operation and maintenance. In addition, there is dire need of introducing wastewater treatment mechanisms at different levels to reduce the environmental hazards as currently less than 5% population is considered to have coverage of wastewater treatment services. Technology A pilot of using GPS in AJK for baseline study has been successful in providing quick analysis but more importantly identification of poverty pockets with poor sanitation services. This is being further tested under the Saaf Suthro Sindh programme to identify the communities with poor sanitation services. The Chief Minister Policy Reforms Unit Balochistan has prepared an interactive Geographic Information System (GIS) map of all rural settlements in all Union Councils, which can aid in identifying growth circles and locating growth points therein with water sources. However, this is missing sanitation related information. The government of Punjab developed an online school reporting system that includes information about WASH facilities in the school, but the system lacks feedback from the local communities about the functionality of the school WASH. The small-scale low cost wetlands have been piloted in District Khairpur Sindh for sewage treatment to address the wastewater issues – particularly for effective decontamination of sewage waste. These wetlands are very low cost with the approximate unit rate of 150 USD and can be easily replicated to address the wastewater issues. The intended result of wetlands is to reduce faecal coliforms from sewage by 90% compared to baseline (current levels of contamination at end of pipe / exit from septic tanks). Similarly, other international organisations in association with local partner organisations have developed a small-scale low cost Sewage Treatment Unit (STU), which is being tested before scaling up. The purpose of STU development is on-site treatment of domestic sewage where conventional means are not possible or available. Health Pakistan is off-track regarding Under 5 Mortality Rate (U5MR) – 89 deaths per 1000 live births against MDG target of 52 and Infant Mortality Rate (IMR) -74 deaths per 1000 live against the MDG target of 40.Based on the PDHS 2012-13, the U5MR improved from 78 to 74 for urban areas, while it increased from 100 to 106 for rural areas. The rural households spend around 20% of their monthly income PKR (410-420) on medical costs, largely due to sanitation and water borne diseases5. A Research Control Trial (RCT) conducted by the World Bank in 5 districts of KPK and Punjab confirmed the direct relationship of diseases                                                                                                                4Mapping of inequities in basic water supply and sanitation services in Pakistan. UNICEF 2014 5 Economic Survey of Pakistan 2014-2015

  17  

especially diarrhoea with quality of water which in turn depended on the sanitation status including open defecation.

Acute respiratory infections, malaria, and dehydration caused by severe diarrhoea are major causes of childhood mortality in Pakistan. Each year approximately 53,300 children in the country die due to diarrhoea, respectively. Pneumonia, diarrhoea and malaria collectively contribute to around 50% of deaths in children6. The PDHS 2012-13 found that 23% of children under 5 years had diarrhoea in the two weeks before the survey. However, PSLM 2013-2014 reported that 9% children of under 5 years had diarrhoea in the last 30 days, while the baseline of diarrhoea was 26% in 1990.Lady Health Workers (LHWs) are the frontline health force that work for promotive and preventive health care with 84% coverage of the rural population. The sustainability of health promotion and prevention in relation to sanitation is depends highly on institutionalisation of hygiene reporting in the work of LHWs, which is currently missing. A good development in Punjab province is the integration of water and sanitation as key strategic actions for preventive health in Health Sector Plan 2018 indicating a realization among political leadership that investment on water and sanitation is key to overcome the health burden especially water borne diseases.

The National Nutrition Survey 2011 revealed that about 31.5% children under five are underweight in the moderate to severe category and 11.6% in the severe category, while 43.7% are stunted and 15.1% are wasted, both in the moderate to severe category. The Government of Pakistan has adopted an integrated nutrition strategy to address these problems. At provincial level, this is being implemented either as an integrated nutrition programme under health in Punjab7 Sindh and KPK, while Balochistan has developed independent programmes for nutrition. The UN Scaling up Nutrition (SUN), a global nutrition movement continues to provide a single combined platform to the government and relevant stakeholders for enhanced mutual coordination, collaboration, resource e allocation, and a monitoring and evaluation mechanism to overcome malnutrition.The Saaf Suthro Sindhis a nutrition responsive programme, which is working closely with the nutrition cell of Planning and Development department Sindh. Equity and Rights Inequities in relation to access to sanitation exist in geographical as well as income perspectives. As per PSLM 2013-2014, only 1% population in urban areas is without toilets compared to 26% in rural areas portraying the poor conditions of rural sanitation. While comparing rich and poor, only 5% in the 5th quintile is without a toilet compared to 36% in the 1st quintile showing a wide disparity. Similarly, PDHS 2012-2013 showed that only 0.6% urban population is involved in open defecation compared to 31.5% in rural areas.

A national study of mapping the inequities in basic water and sanitation services has been completed in 2015 with the support of UNICEF that provides information about the type of sanitation with different quintiles by using PSLM data serving as a baseline of sanitation services. The WSP - World Bank initiated a WASH poverty diagnostic study that would underpin where the poor are (bottom 40% population) and what kind of access to water and sanitation services these poor have in addition to link with health and education status and services, and proposing and identifying the plausible solutions for these communities. The PHED of Government of Punjab and UNICEF completed a mapping of inequities of WASH

                                                                                                               6 Das, J., and Z.A. Bhutta. 2013. Scale-up plan for essential medicine for child health, diarrhea, pneumonia and malaria. Karachi, Pakistan: Aga Khan University 7Multi-sector Nutrition Strategy for Addressing Under-nutrition in Punjab, 2014. Government of Punjab

  18  

up to tehsil levels by using MICS data in 2015. The study is being used to provide a baseline as well as identification of pockets with poor access to sanitation and high open defecation.

For mainstreaming equity and rights, UNICEF has customized special Participatory Rural Appraisal (PRA) for PATS programmes, which have been adopted in the government programmes. These tools include wellbeing ranking, daily routine charts for men and women and seasonal calendar at the triggering stage. This ensures defining the right target group for sanitation programmes and that the PATS programme serve the lowest income quintiles first without overburdening the disadvantaged groups. In a separate effort sector partners and government stakeholders are involved in introducing ‘Sustainability Check’ for WASH programmes. Sustainability Check will include ensuring responsibilities of duty bearers for sustaining the improved services, diffusion of the new fragile social norms created as a result of programmes and the enabling environment for sustained WASH services as a Theory of Change (TOC) for WASH. WaterAid is undertaking a menstrual hygiene management initiative in collaboration with AGAHE in southern Punjab. Two training manuals have been developed, which are being cascaded to different organisations in phases i.e. Training of Trainers Manual on WASH Rights (Child Rights inclusive and MHM); and Training Module on MHM Entrepreneurs. Similarly, Plan Pakistan is promoting women entrepreneurships, using WASH for triggering, under its HOPE initiative in different regions of the country while focusing on the promotion of rights of the children.

Future Plan Sanitation Beyond MDGs

Though Pakistan has achieved the MDG target of improved sanitation i.e. 65% in 2015, but still an estimated 70 million people in Pakistan live without improved sanitation. This target was around construction of latrines at the households with appropriate connections but little focus on building sanitation systems, hygienic conditions of latrines and needs of vulnerable groups. The Sustainable Development Goals (SDGs), endorsed in September 2015 by the United Nations General Assembly, have a specific Goal 6 related to water and sanitation. This emphasises on achieving access to adequate and equitable sanitation and hygiene for all, and ending open defection, paying special attention to needs of women and girls, and those in vulnerable situations. It also includes untreated wastewater treatment and recycling for safe reuse along with international cooperation and community participation.

Pakistan is in process of developing a monitoring framework for Vision 2025 Pakistan that has the target of “increasing access of improved sanitation to 90% population”. The WASH sector plans and integrated development strategies of the provinces are well aligned with SDGs. However, capacity development of the existing institutions working for WASH would be required to develop their understanding about SDGs, and how these can be transformed and integrated into existing and new programmes. Currently, Pakistan spends 10 times more money on education (2.49% of GDP) compared to water and sanitation (0.22%). Thus, an effective resource mobilisation strategy underpinned by strong evidence based advocacy and communication strategy would need to be developed and implemented with the support of national and international partners.

  19  

Sustainability

There is a realisation among the stakeholders to institutionalise sanitation in the existing capacity development arrangements and training institutions of local governments working in the provinces. Two key training modules (funded by WaterAid and UNICEF respectively) were developed and are in the process of piloting/testing in Punjab and Sindh through existing training institutes of local governments, while a training manual developed by Plan Pakistan for PATS is currently being used for the orientation of local government staff. The smallest administrative units in rural areas of Pakistan are Union Councils and are responsible for identification and monitoring of sanitation related activities.The Service Delivery Assessment Reports have been done by provincial governments in collaboration with WSP in 2013-2015 for Punjab and Sindh. Early results of KPK and FATA are also available. All these reports point towards sustainability as the fundamental issue rather than lack of funds. There is a need to focus towards regulations, O&M and Monitoring and Evaluation for eradicating open defecation and moving the rural communities upward on the ladder of sanitation services.

UNICEF and sector partners in collaboration with provincial governments are planning to undertake a sustainability check to assess improved hygiene behaviours and ODF status in Pakistan to identify the motivators and de-motivators that influence the use of constructed latrines or reasons for reverting back to open defecation practices. The sustainability check will focus on institutional, social, financial, technical and environmental factors (five major dimensions). Overcome the Barriers A Bottleneck Analysis conducted in 2014 and Service Delivery Assessment Report of Water and Sanitation Programme for Punjab and Sindh in 2013/2014 revealed that open defecation was considered as an accepted norm in the rural areas of Pakistan with very limited social pressure on those involved in open defecation. The women and children are generally forced to practice open defecation in the dark or closer to their houses for ensuring their safety and protection, but not realising their implications on human health and hygiene. Building the capacities and motivating the lowest administrative units of local government called Union Councils and Lady Health Workers will need to be maintained to facilitate social mobilisation for enhancing and sustaining ODF status.

As part of anevaluation study8 conducted by UNICEF in 2014-2015, a representative sampled survey was conducted across 5077 households, including 244 villages with a random cluster of 20 households per village. The study was conducted in 163 villages, one to five months after they had declared “open defecation free” status and in the remaining 81 villages where they had not achieved ODF status during the one-year programme duration.On average, more than 20% households reverted to open defecation 1- 5 months after the village was certified as ODF. Further, the evaluation study and stakeholder discussions revealed that poor sustainability of sanitation services are due to a lack of budget and human resources for follow-ups with ODF communities in addition to poor reward or recognition arrangements. More importantly, lack of institutional arrangements for outcome based monitoring and

                                                                                                               8UNICEF internal review 2015. UNICEF Country Office Pakistan

  20  

feedback mechanism with ownerships of the local communities, poor engagement of the private sector and responsibility of public sector departments are some of the major barriers that need to be addressed. Universal Coverage and Improving Service Delivery Level Compared to drinking water, sanitation has been a low priority in the budgetary allocations of the provinces. Although the local governments are custodians of sanitation under the Constitution of Pakistan, especially in rural areas, but this has rarely been recognised. For example, no specific allocation for sanitation exists for Local Government in Balochistan province. Similarly, the financial data from all provinces showed that allocation for sanitation ranges between 25%-30% compared to 70%-75% for water. A proactive advocacy and engagement is being maintained with finance and planning and development departments to introduce sanitation specific reporting. There is lack of availability of an adequate number of trained human resources for improved sanitation especially at the district levels and below. The Local Government Acts 2013 shift the onus of sanitation on the Union Councils (UCs), but the existing staff working in the UCs and even newly elected local representatives at the district, tehsil and village levels are not fully conversant with social mobilisation and behavioural change strategies. In recent years, different training programmes were arranged by national and international partner organisations to build the capacities of local government staff in PATS and rural sanitation.WaterAid, Plan International, UNICEF, Save the Children and WASP has been supporting the Punjab LG&CD department by providing trainings to UC secretaries and other frontline staff on the PATS approach at the Punjab Local Government Academy in Lalamusa. So far 1000 secretaries and frontline municipal workers have been trained through these trainings. However, there is still a long way to go to institutionalise these capacities.

Conclusions Pakistan has made steady progress towards achieving an open defecation free environment and has met the MDG target for sanitation recently, although it still has a long way to go for improved sanitation for all. Pakistan has reached a tipping point and toilet use is fast becoming the new norm. PATS programmes have demonstrated results at large scale in the recent years and this unanimously agreed approach promises to reach all, as envisaged in vision 2025 document of the Pakistan Government and National Sanitation Policy. The provincial government strategies have started to place due emphasis on WASH with necessary financial allocations and setting targets with the advent and implementation of provincial ODF programs in Sindh, AJK and Punjab. Many strong partnerships and cooperation have emerged at the community, district and provincial levels. The sector partners’ advocacy and collaborations with government agencies have begun to scale up social approaches for improved sanitation and hygiene. Furthermore, the sector continues to strive for the approval of provincial sanitation policies, regulatory mechanisms, O&M regimes, specific financial reporting of sanitation allocations/expenditures, and development of a national and provincial monitoring framework to track the progress, achievements and gaps. The formation of new local governments under Local Government Acts 2013 in respective provinces will provide strong leadership and governance to WASH especially hygiene and sanitation. This will be complemented by newly developed WASH sector plans and provincial integrated development strategies. The sector will need to focus on adding the

  21  

capacities of these newly formed local governments for effective execution and implementation of sanitation initiatives and also enhance voices and participation of local communities to ensure ownership and accountability. The sector will also need to focus on mobilising support for solid waste management and menstrual hygiene management. Last but not the least, the implementation, advocacy and monitoring framework will be need to aligned with Sustainable Development Goals.

  22  

Progress on SACOSAN V Declarations    

Declaration Progress 1 Formulate, develop and implement

adequately resourced national/sub national sanitation and hygiene plans with SMART (specific, measurable, achievable, realistic, time-bound) indicators that measure and report on processes and outcomes at every level including households, educational, health, public institutions and workplaces, with disaggregated reporting on gender, age, disability, marginalised and vulnerable groups.

§ The WASH sector plan including sanitation and hygiene has been initiated in three provinces of Pakistan: o Punjab has completed and published

its sector plan o Balochistan has completed its sector

plan and is in the final stages of approval

o Sindh has just initiated the process of developing its sector plan

o Khyber Pakhtunkhwa has developed an integrated development strategy 2014-2018 that has specific indicators and milestones for sanitation

§ At national level, the Vision 2025 document has specific indicators of reaching the target of improved sanitation from 48% to 90% in next 10 years

2 Create a framework and enabling environment including policies, strategies and protocols and the conditions for the fulfilment of the need for universal sanitation and hygiene: women and men, children, adolescent girls, people with disabilities and the elderly.

§ While no specific framework to promote an enabling environment for sanitation has been developed, however, four provinces introduced Local Government Acts 2013 and local bodies/councils have been created through community votes

§ The councils in Balochistan and KPK are functional, while in Punjab and Sindh, these are at the final stages of elections

§ The Local Government Acts 2013 in four provinces seek for devolved sanitation, and new local councils are expected to take charge in 2016

§ Training manuals of WASH including sanitation for local government have been developed in two provinces,and are in the process of being integrated into government systems and structures

  23  

 3 Given that sanitation is about changing

social norms, demand creation, We commit to addressing diversity in service provision for infants, children, youth, adolescent girls, women and men, people with disabilities, chronically ill and elderly in rural areas and people affected by poverty and disasters further exacerbated by climate change.

§ All provinces have launched initiatives for demand creation and influencing the social norms of open defecation through community driven approaches especially in Punjab, Sindh, AJK and KPK. However, there is still need to address gaps in diversity and inclusion of different groups

§ AJK has claimed ‘Mirpur’ as the first district to become 100% open defecation free. Through a region-wide CLTS+ program.

§ Saaf Suthro Sindh programme is developed in close collaboration with inter-sectoral nutritional support programme of P&D Sindh with a focus on achieving open defecation free communities

§ Accelerating Pakistan Approach to Total Sanitation (PATS) in Punjab has also engaged the health department and local communities to reach diverse groups

§ In KPK, in addition to provision of funds to newly elected village level councils, a pilot programme for three districts has been launched to enhance hygiene behaviours

4 Recognise the importance of sustainable environmental sanitation and hygiene in urban areas including solid and liquid waste and faecal sludge management for all urban dwellers, regardless of tenure.

§ Cost sharing urban sanitation projects focusing on external infrastructure with the support of CSOs continue to be piloted and have been initiated at some places especially in Sindh and Punjab provinces

§ The largest wastewater treatment project of PKR 18 billion is under progress to improve effluent management for the city of Karachi

§ The solid waste management initiated in Lahore has been scaled up in five major cities of Punjab. Similarly, another initiative of solid waste management was launched in Islamabad for learning

§ In Khyber Pakhtunkhwa, a water and sanitation company has been established to cater for environmental sanitation needs of Peshawar city

  24  

§ In Quetta, a feasibility study on solid waste management has been completed, and resources have been allocated for 2015-2016

§ The management of faecal sludge in the urban areas continues to be a major issue. For wastewater treatment, two cities in Punjab have been selected to test the model for scalability

5 Prioritise and promote child and disabled friendly services and menstrual hygiene management in all public buildings and especially schools, health clinics and reflect and monitor this in standards, design, delivery and monitoring.

§ The Disabled Persons Organisations (DPOs) have continued to advocate for inclusion of persons with disabilities in WASH initiatives, and technical guidelines have been developed for emergencies including WASH by the Ageing and Disability Task Force

§ Stakeholders in collaboration with UNICEF are developing national Standards for School WASH. The school WASH started to progress well especially in Punjab, however, further work is required to highlight issues of child friendly services in design of public buildings

§ MHM emerged as an important issue and a national working group on MHM has been constituted. The NGOs initiated some good pilots around MHM with women entrepreneurs and low cost healthy sanitary pads. An operational research on MHM was conducted that resulted the development of a training manual and monitoring toolkit

6 Develop and implement guidelines and standards suitable for child, adolescent and gender and disabled friendly WASH facilities, with compliance indicators on hand washing and menstrual hygiene education and practice

§ A national campaign for hygiene underpinning hand washing was launched in 2015

§ All the provinces have drafted their Behavioral Change and Communication strategies and these now need to be transformed into action plans

§ Work on the monitoring framework is still at a conceptual stage and there is need to update WASH national standards so that they are more inclusive for vulnerable groups

     

  25  

   

7 Raise awareness at all levels to foster demand and build capacity for sanitation and hygiene including but not limited to youth led movements, pro-poor public private partnerships and the media.

§ The new provincial programmes on WASH developed after SACOSAN V include a special focus on creating awareness and demand generation e.g. Saaf Suthro Sindh, PATS Punjab, Hygiene Campaign in KPK and PATS Balochistan. These programmes / projects also seek support from CSOs and local stakeholders

§ Corporate partners / organisations like Unilever, Proctor and Gamble, and Reckitt and Benckiser also continue to play a key role in creating awareness on hygiene especially among school children through child to child education and using video clips

§ A media communication strategy is being formulated at the national level with provincial / regional outreach

8 Engage the Health sector at all levels in sanitation and hygiene promotion as critical agents of preventive healthcare.

§ The Lady Health Workers (LHWs) are being engaged effectively in disseminating IEC materials and for demand generation through capacity building especially in Punjab

§ Formal arrangements with health departments are being sought in Sindh for Saaf Suthro Sindh to ensure the sustainability of programme through LHWs

§ Similarly, provincial nutrition strategies and programmes mainly led by the health departments have recognised WASH as a key strategic intervention. WASH is being integrated in Nutrition Project of “Reducing Stunting” especially in Sindh

§ A national consultation of WASH with health and nutrition sector is required to develop a unified strategy of working together

9 Emphasise research and development on low-cost, appropriate sanitation products, linked with sanitation marketing and innovative solutions for environmentally sound sanitation systems.

§ CSOs including UN agencies continue to test and pilot their existing sanitation products and technologies in collaboration with government partners

§ In Punjab, the government initiated

  26  

two pilot wastewater treatment plans to test their viability for scaling-up

§ There is need for specific allocation and engagement with academia for research and development to identify cost effective solutions in WASH

§ A sustainability check initiative has started in Pakistan where the private sector and academia are working together to identify the key issues in reverting to open defecation practices

10 Commit to significant direct participation of children, adolescents, women, the elderly and people with disabilities, as well as decision makers from Health, Education, Environment and Finance to bring their voices clearly into SACOSAN VI and systematically thereafter.

§ Advocacy to decision makers from health, education and finance continues at different levels and forums including PACOSAN II in February 2015 that also provided a good opportunity to different groups to share their voices

§ A youth group from Pakistan attended the sanitation conference in Sri Lanka

§ CSOs organised eight meetings in the country to understand the progress of SACOSAN and also identify potential delegates. Four persons have been selected through this process

       

Contacts MIrfan Tariq Director General (Env& CC) Government of Pakistan Ministry of Climate Change 4th Floor, Local Government and Rural Development Complex Building G-5/2, Islamabad, 44000, Pakistan Ph #+92-51-9245545