AS reported in this paper (March 23), Pakistan pays heavily for poor sanitation, according to UN estimates. Poor sanitation costs Pakistan over $4.2 billion or 6.3 per cent of its GDP. The UN Deputy Secretary-General, Jan Eliasson, has called for urgent action to end the crisis of 2.5 billion people without basic sanitation.

The Joint Monitoring Programme, 2012, reports 2.6 billion people lacking improved sanitation in 2010. However, researchers at the University of North Carolina correct the JMP estimates, saying that the figure of 2.6 billion should be 4.3 billion (Baum, R. et al., 2013).

In rural Sindh, only 10 per cent of the population has access to sanitation. In villages, excreta accumulations can be found outside of homes. This becomes a major source of infectious diseases, and the main sufferers are women, children, old people and people already suffering from diseases.

Poor sanitation breeds flies and insects, which further spreads the diseases. Coupled with poor hygiene, the resulting pollution creeps in the drinking water because in villages the poor Sindhi women store their water in earthen utensils, vulnerable to contamination, and this completes a vicious cycle of diseases.

Human excreta have been implicated in the transmission of many infectious diseases, including cholera, typhoid, malaria, infectious hepatitis, schistosomiasis, polio, trachoma and ascariasis. The recent outbreak of hepatitis A in Swat has been attributed to poor sanitation and hygiene in the area. Poor health associated with inadequate hygiene and sanitation is more life-threatening to poor people in Sindh. Diarrhoea is four times more likely to be fatal in undernourished children, and worms stunt the physical and intellectual growth of poor children.

According to the World Bank, the total economic impacts of inadequate sanitation in Pakistan amount to a loss of $5.7 billion. These economic impacts are equivalent to about 3.9 per cent of Pakistan’s gross domestic product. A USAID report estimates that 250,000 child deaths occur each year in Pakistan due to waterborne disease.

About 40 per cent of hospital beds in Sindh are occupied by patients suffering from water-and sanitation-related diseases, such as typhoid, cholera, dysentery and hepatitis, which are responsible for one-third of all deaths.

The Pakistan Strategic Environmental Assessment (World Bank, 2006) estimates that the water and sanitation sector has the highest financial cost to Pakistan from environmental degradation at Rs112 billion a year. This is based on health cost of only diarrhoea and typhoid and accounts for 1.81 per cent of GDP. In 2004, the WHO undertook an analysis of the economic benefits of sanitation. It showed that $1 invested would give an economic return of between $3 and $14.

The impact of improved hygiene (principally hand washing) can be gauged from the work of Dr Stephen Luby and his team, who conducted research in a squatter settlements in Karachi in 2004 and concluded: “In a setting in which diarrhoea is a leading cause of child death, improvement in hand washing in the household reduced the incidence of diarrhoea among children at high risk of death from diarrhoea.”

In rural Sindh, sanitation and hygiene are fundamental to the broader rural development. They reduce diseases, allow children (especially girls) to gain access to schools and reduce the time women spend on collecting water. The interconnections of sanitation and hygiene with health, education, livelihoods and other domains make them a cornerstone of rural development. More importantly, sanitation and hygiene are central to what poverty is, in rural Sindh, today, and why it occurs.

Against this backdrop, the question is: what does it take to convince the Sindh government to launch widespread sanitation interventions, and hygiene promotion programmes, in rural Sindh?

F.H.M. Karachi

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