Sanitation and Water for All (SWA) PAKISTAN Sector Status Report Investing Wisely SANITATION AND WATER Saving Lives

Transcription

1 Sanitation and Water for All (SWA) PAKISTAN Sector Status Report 2012 Investing Wisely SANITATION AND WATER Saving Lives

2 Contents List of Tables and Figures... 5 Preface... 6 Executive Summary... 7 Introduction... 7 Current Situation... 7 Urgent Need for Action... 7 Enablers... 7 Bottlenecks... 8 Taking Action... 8 Current Situation Population Health Education Poverty Urbanization Economic Growth Drinking Water Sanitation Sector Financing Sector Financing - Provincial Situation Provincial Finance Commission External Donor Coordination and Sector Wide Approach Estimating Cost for Water Supply and Sanitation Urgent Need for Action Health Impacts Economic Impacts Enablers Policies National Sanitation Policy (2006) National Drinking Water Policy (2009) Overview of Financial Planning and Budgeting Examples of Best Practice Changa Pani Programme (CPP) - Government Orangi Pilot Project

3 Lodhran Pilot Project (LPP) Community Led Total Sanitation (CLTS) Pakistan Approach to Total Sanitation (PATS) North Sindh Urban Services Corporation (NSUSC) Water and Sanitation Extension Programme (WASEP) Citizen Report Card Formalizing Rural Water Supply Billing Systems Converting Waste into Resource - Waste Management Industry Intersectoral Collaboration Opportunities Education Health Bottlenecks Institutional Arrangements Water and Sanitation Agencies Operation and Maintenance Urban Water Supply and Sewerage Schemes Rural Water Supply and Sewerage Schemes Equity and Inclusion Quality Waste Waste Water Solid Waste Monitoring Definitions and Information Management Institutional Mechanisms for Monitoring Climate Change Disaster Risk Reduction Vulnerability to Climate Change Taking Action Catalyzing Actions Institutional Arrangements Operation and Maintenance - Urban Operation and Maintenance - Rural Monitoring Sectoral Financing Human Resource Development Partnerships

4 Climate Change Research Bibliography Acronyms Annexure 1 - Methodology Background Scope and Purpose Process Stakeholders Consulted Annexure 2 Costing

5 List of Tables and Figures Table 1: Growing Population in Cities Table 2: Current Access Rates for Drinking Water and Sanitation Table 3: PRSP Budgetary Expenditures of FY , FY and FY Table 4: External Assistance to the Sector Table 5: Estimating Resource Needs for MDG Targets for Drinking Water Table 6: Estimating Resource Needs for MDG Targets for Sanitation Table 7: Estimating Resource Gap for MDG Targets for Water (100%) and Sanitation (67% both urban and rural) Coverage Table 8: Institutional Framework for Drinking Water and Sanitation Table 9: Summary of WASAs Table 10: Bacterial Contamination Levels of Water Sources of 23 Cities of Pakistan Table 11: Per Capita Availability of Water Table 12: Status of Waste Water and Treatment in Major Cities of Pakistan Table 13: Water Supply Costing Balochistan Table 14: Water Supply Costing Khyber Pakhtunkhwa Table 15: Water Supply Costing Punjab Table 16: Water Supply Costing Sindh Table 17: Water Supply Costing Summary Table 18: Sanitation Costing Balochistan Table 19: Sanitation Costing Khyber Pakhtunkhwa Table 20: Sanitation Costing Punjab Table 21: Sanitation Costing Sindh Table 22: Sanitation Costing Summary Figure 1: Trends in Access to Sanitation Figure 2: Drinking Water and Sanitation Sectoral Expenditure Decadal Trend Figure 3: Sectoral Expenditure to GDP ratio Figure 4: Access to Sanitation and Sectoral Public Expenditure Figure 5: Drinking Water and Sanitation Allocations as Proportion of Provincial ADP Figure 6: Provincial Allocations for Drinking Water and Sanitation in ADPs Figure 7: Drinking Water and Sanitation 3 Years Trend of Total Sectoral Budget as Proportion (%) of Total Provincial PRSP Allocation Figure 8: Drinking Water and Sanitation 3 Years Trend of Sectoral Development Budget as Proportion (%) of Total Provincial PRSP Development Allocation Figure 9: Schematic Diagram Illustrating Major Institutional Gaps

6 Preface Improving the quality of life of all people, especially those that are underprivileged and underserved, those that are vulnerable, is the fundamental principle upon which modern day development is based. It is not only about poverty reduction, but rather about improving human security, empowering people and enhancing opportunities so that they can make choices in life. There is probably no greater basic human need and fundamental right than access to safe drinking water and adequate sanitation. Today, Pakistan stands among many other nations looking ahead at the 2015 horizon by which time it should have achieved its Millennium Development Goals targets. Recent national statistics indicate that Pakistan is well on track to meet its drinking water targets, but still considerably short of the sanitation targets. As Pakistan grapples with several development priorities in a resource constrained environment, allocating adequate resources for each priority becomes a daunting task for any government. This report provides the discerning reader with an overview of the situation of drinking water and sanitation in Pakistan. It highlights some of the many achievements and successes contributed to by both government and other development actors, tries to bring home some of the key bottlenecks from a myriad of sector challenges that Pakistan faces and is likely to encounter, and suggests a plausible way forward while keeping in mind social, economic and demographic realities. This report is not meant as a detailed sector review and analysis, or a comprehensive critical appraisal of the sector, as each chapter and section is a volume of study in itself. Indeed, several detailed treatises and excellent works have been written on various topics, some of which are noted in the bibliography. It has been developed as a background study to provide an overview of the sector in preparation for the high level meeting of Sanitation and Water for All (SWA) planned for April SWA is an international alliance which seeks for prioritization of sanitation and water in development plans of country s especially those that are off-track to meet their MDG targets. It is hoped that the report will also serve a greater purpose of raising awareness amongst policy and decision makers, sector professionals and frontline practitioners, development organizations, corporate sector and academia, and facilitate Pakistan on its development trajectory. 6

7 Executive Summary Introduction Pakistan is a signatory to the Millennium Development Goals and has a commitment and obligations to the MDG targets relating to Sanitation and Water. This report has been developed as a background study to provide an overview of the sector in preparation for the high level meeting of Sanitation and Water For All planned for April Sanitation and Water for All is an international alliance, which seeks for prioritization of sanitation and water in development plans of country s especially those that are off-track to meet their MDG targets. Current Situation Pakistan has formulated its National Environment Policy (2005), National Sanitation Policy (2006), National Drinking Water Policy (2009) and National Climate Change Policy (2012). These provide the necessary legal support for the implementation of different government initiatives coupled with interventions in the sector. There is a country commitment to implement the Pakistan Approach to Total Sanitation as committed at SACOSAN IV. Recent survey data indicates that the proportion of population using improved sanitation increased from 37% in 2000 to 48% in and flush latrines increased from 45% in 2001 to 66% in Despite the strains on economy imposed by the massive earthquake in 2005, the internal displacement of 3 million people in 2009 and the deluge of floods in 2010 and 2011, Pakistan not only sustained its commitment but also increased its public spending for sanitation and drinking water five fold in terms of public expenditure and about 300% in real terms since Urgent Need for Action children die every day because of diarrhoeal related illnesses many of these deaths can be prevented by adequate sanitation, safe drinking water and improved hygiene million people are affected by diarrhoeal related illnesses annually. Half of the rural population is without adequate sanitation and Pakistan is off-track to meet the projected MDG target of 67%. The economic impact of poor sanitation and hygiene results in an annual loss of 3.94% or more of the GDP. Demographic transitions over the last 30 years have led to a marked increase in urban and periurban populations, compounded by on-going conflicts and humanitarian crises, which has an enormous impact on planning for sanitation and drinking water services. Pakistan falls within the highly vulnerable zones of climate change and its inextricable link and need to develop its adaptive capacity, resilient water and sanitation systems and disaster risk reduction. Enablers Some of the key enablers for water and sanitation include national environmental policy, national sanitation policy, national drinking policy, supported by Pakistan Environmental Protection Act 1997, national standards for drinking water and a national behavioral change communication strategy. There are several examples of best practices for drinking water and sanitation services both in urban and rural settings in the country. These exemplify various sustainable demonstration approaches ranging from government led programmes to revenue generating public-private 7

8 partnerships. The Lady Health Workers programme in health and School Health Programme in education provides scope for intersectoral collaboration. Bottlenecks The main bottlenecks identified include institutional arrangements with overlapping of roles and responsibilities and weak coordination mechanisms; high non-revenue water; dysfunctional water supply schemes; ageing infrastructure; water and sanitation driven by political interests which may not match equity and inclusion priorities; poor water quality from polluted and contaminated sources; inadequate waste water treatment; high dependency on ground water which is depleting; and inadequate solid waste management. Institutional platforms for monitoring of sanitation and drinking water exist like management information system, multiple indicator cluster surveys and Pakistan social and living standards measurement surveys. However, there is an urgent need to align information needs of water and sanitation with and strengthen existing structures and systems of data collection at the provincial level. Climate change poses one of the most significant and impending threats to water and sanitation in Pakistan. Resilience of water and sanitation systems and disaster risk reduction is critical to build adaptive capacity. Taking Action 1. Develop a National Sector Action Plan comprised of Provincial Action Plans to effectively implement national policies on sanitation and drinking water as well as behavioral change by December 2013; 2. Prioritize Sanitation and Drinking Water within a Sector Wide Approach in Poverty Reduction Strategy Paper III, Medium Term Development Framework and Medium Term Expenditure Framework; 3. Enhance by 2015, the sectoral allocation for water supply and sanitation by 1% of overall PRSP allocation to partially meet the resource gap of US$ 600 million for global MDGs target of sanitation and drinking water; 4. Conduct a sector capacity development needs assessment and develop a human resource and leadership development plan for sanitation and drinking water sector by December 2012; 5. Establish a national monitoring framework for sanitation and drinking water based on provincial monitoring frameworks, and strengthen national and provincial information management systems, including those for health and education for improved and coordinated monitoring of sanitation and water by 2013; 6. Constitute a special Task Force on up scaling rural sanitation based on the Pakistan Approach to Total Sanitation by December 2012; 8

9 8. Constitute a special Task Force on Peri-urban/Urban challenges and Climate Change in relation to sanitation and drinking water to document and formulate guidelines for best practice for incorporating into the national and provincial action plans by December 2012; 9. Constitute a WASH specific Task Force on Disaster Preparedness and Response as well as Disaster Risk Reduction by December Set up a research working group to identify research priorities in the sector 9

10 CURRENT SITUATION 10

11 Current Situation Population Pakistan s population growth rate has shown a steady decline from 2.7% in 1998 to the rate of 2% in 2011 (Social Indicators of Pakistan 2011). It has an estimated population close to 177 million and it is projected to reach over 350 million by 2050 (D Nayab: Demographic dividend or demographic threat in Pakistan. PIDE, 2006). Nearly 50% of Pakistan s population is under 20 years, and about 68% is under 30 years - this constitutes a youth bulge, which is expected to dominate the population for another years. The size, growth and age distribution demands a high and sustained GDP growth as soon as possible. Health Health indicators in Pakistan have witnessed relative improvements in the context of South Asia, but remain far from satisfactory. Pakistan ranks 125 th in the Human Development Index with a maternal mortality of 276, infant mortality of 63, Under 5 mortality rate of 89 and skilled birth attendance at 39% (Economic Survey of Pakistan ). There has been a significant reduction in public spending on health nutrition from 0.72% of GDP in to 0.23% in (Economic Survey of Pakistan ). Education Pakistan ranks 119 out of 127 countries on the Education For All development index (Education For All Global Monitoring Report 2011). Pakistan has a Net Enrolment Rate of 56% for both genders (aged 5-9 years), while rural net enrolment rates for girls aged 5-9 years are 48% compared to boys at 57%. Urban net enrolment rates are 67% and 65% for boys and girls respectively. 68% of all primary level enrolments are government schools, with 46% for urban and 79% for rural (Pakistan Social and Living Standards Measurement Survey ). The transition from primary to secondary education is low. About 15% of children in the years age group drop out before completing primary school. The private sector has come to play a significant role in the delivery of education services. The sector has expanded rapidly from 3,300 institutions in 1998 to over 90,000 in It now caters for about 40% of total enrolment. According to Pakistan Education Statistics ( ) of missing facilities in government primary and middle schools in , 33% were without drinking water, while 36% had no latrines. 35% of government primary schools did not have safe drinking water and 38% did not have adequate latrine facilities (Pakistan Social and Living Standards Measurement Survey ). 11

12 Poverty In the last decade between , unemployment has risen from 3 million to 5.5 million, while per capita income growth has fallen from 7% to under 0.5% (Pakistan: Framework for Economic Growth, 2011). Although Pakistan has made significant progress in human development and poverty reduction over the past three decades, it is considered relatively slow over a long horizon. Social and economic exclusion has resulted in multiple deprivations for more than 50% of Pakistan s population. This situation has only been worsened by the recent deluge of floods in 2010 and In the period of July-April , the inflation rate was reported at 14.1%. The highest rate of inflation was observed in the food group at 18.4% (Economic Survey of Pakistan ). Urbanization With an increasing population, Pakistan is the fifth most populous country in the world and second largest in South Asia. Pakistan s urbanization is expected to reach over 50% by 2025 (Pakistan: Framework for Economic Growth, 2011). However, actual urbanization is probably much higher since the definitions used in Pakistan are administrative rather than density based. By employing an amended definition, estimates of actual urbanization at present place 50% in cities. While increasing urbanization is considered useful for economic growth in Pakistan, where cities produce up to 80% of GDP, rising urban poverty, quantitative shortage, inequitable coverage and poor quality of service delivery lead to further degradation of the urban environment. 12

13 Table 1: Growing Population in Cities City with more than 1 million population Population 2030 ( 000) Karachi Lahore Faisalabad 6192 Rawalpindi 4149 Multan 3025 Hyderabad 3005 Gujranwala 3143 Peshawar 2778 Islamabad 3175 Quetta 2038 Sargodha 1074 Bahawalpur 1903 Sialkot 1087 Larkana 1174 Sheikhupura 1019 (Source: Pakistan: Framework for Economic Growth, 2011) 13

14 Economic Growth The new Pakistan Framework for Economic Growth 2011 has identified six critical changes: Strengthen the Medium-Term Development Framework (MTDF) and the Medium-Term Expenditure Framework (MTEF) for setting medium-term priorities in line with growth strategy and reforms agenda Support a unified results-based budget preparation process Decentralise responsibility for projects to line ministries Redefine the Planning Commission s role and processes in respect of major capital projects Establish a results-based monitoring and evaluation system. Planning Commission should lead the reform and change process through identification and advocacy of critically required changes in policies. An important constraint on GDP growth is the deterioration in the physical environment. The World Bank has estimated that the mean annual cost of environmental degradation is approximately 6% of GDP. The highest cost is from inadequate water supply, sanitation and hygiene, followed by agricultural soil degradation, indoor air pollution, and urban air pollution (Pakistan Strategic Country Environmental Assessment World Bank 2006). Drinking Water The Pakistan Social and Living Standards Measurement survey revealed that about 91% of the population had access to improved drinking water, with 94% for urban and 90% for rural (PSLM ). The Joint Monitoring Programme (JMP) recently launched its 2012 report in which it reported a national figure of 92% with 96% for urban and 89% for rural. The report also noted that this indicated that 28% of the 2010 population gained access to improved drinking water since % of rural populations were still using surface water. Both surveys do not address the issue of quality of drinking water which is an area of critical concern. This is discussed further in the report. Sanitation In the same survey of Pakistan Social and Living Standards Measurement of , 66% of the population was found to be using flush toilets, with 15% using non-flush toilets. Urban rates for flush toilets were 96%, while rural rates were 51%. The population with no toilets accounted for 18%. However, according to the JMP 2012 report, 48% were using improved sanitation (72% urban and 34% rural), while 23% were still practicing open defecation. The variations are due to the different definitions used in the surveys. Further, the JMP 2012 report used regression analysis based on PSLM data. The surveys shown in Table 2 provide information about access but not about utilization. 14

15 Table 2: Current Access Rates for Drinking Water and Sanitation PSLM % JMP 2012 % Indicator Urban Rural Total Indicator Urban Rural Total Drinking Water Drinking Water Tap Water Total Improved Hand Pump Piped on Premise Motor Other Pump Improved Dug Well Unimproved Others Surface Sanitation Sanitation Flush Improved Non Flush Shared No Toilet Other Open Defecation (Source: PSLM , JMP 2012) 15

16 Figure 1: Trends in Access to Sanitation (Source: Own compilation from PIHS report and PSLM report ) The timeline in Fig 1 demonstrates that there has been a significant reduction over 10 years from 50% in 2001 to 18% in 2011 for the proportion of the population that does not have access to a toilet. Similarly, the population using a flush latrine has risen from 48% in 2001 to 81% in Sector Financing The financial layout for Drinking Water and Sanitation for the period is Rs 8 billion for Public Sector Development Programme (PSDP) and Rs. 38 billion for outside PSDP and including Annual Development Programme (ADP). Rs. 2 billion are donor funded which gives a total sector financing layout of about Rs. 48 billion over a five year period (Poverty Reduction Strategy Paper II). The total sector financing is about Rs. 28 billion (PRSP - II Period Progress Report FY 2008/09 - FY 2010/11) with a 3:1 water to sanitation expenditure ratio. This constitutes about 0.16% of the 2010 GDP (PRSP - II Period Progress Report FY 2008/09 - FY 2010/11. Government of Pakistan, Finance Division, 2012). In 2011, US$ 14 million were injected into the sector from external aid following the floods (data obtained from National Disaster Management Authority). These were targeted for the early recovery phase. In 2009/10, there was an overall increased public spending of 24% over the budgeted amount of Rs. 20 billion, and in 2010/11 an increase of 20% over the budgeted amount of Rs. 23 billion (PRSP - II Period Progress Report FY 2008/09 - FY 2010/11. Government of Pakistan, Finance Division, 2012). According to PRSP II, Millennium Development Goals (MDG) costing estimates for for drinking water (100% access by 2015) and sanitation (80% access by 2015) were estimated at Rs 68 billion (Poverty Reduction Strategy Paper II). Based on PRSP II estimations, there is therefore, an annual resource gap of Rs. 40 billion. 16

17 Figure 2: Drinking Water and Sanitation Sectoral Expenditure Decadal Trend (Source: Authors compilation, PRSP - II Period Progress Report FY 2008/09 - FY 2010/11) Error! Reference source not found. illustrates a five-fold increase in overall sectoral expenditure and about four fold increase in development expenditure. Using the GDP deflator values for 2004 and 2011, the overall increase in real terms is about three fold (State Bank s Annual Report, The State of Pakistan s Economy ). Development expenditure meand any expenditure on development projects or any expenditure on new construction, whether of entirely new works or additions and alterations to existing works. It also includes all repairs to newly purchased or previously abandoned buildings or works required for bringing them into use and means expenditure on operations undertaken to maintain in proper condition buildings and works in ordinary use. Current expenditure means any expenditure that is not development. There was a 15% increase in PRSP budgetary expenditures for the sector in over , and a 12% increase in over (PRSP - II Period Progress Report FY 2008/09 - FY 2010/11. Government of Pakistan, Finance Division, 2012). Balochistan achieved a 39% and 64% increase respectively in the same reporting periods. 17

18 The sectoral contribution of water supply and sanitation in PRSP expenditures for FY , FY and FY was 2.27%, 2.29% and 2.29% respectively. All sectoral expenditure was under pro-poor allocation. Furthermore, there was a positive deviation of 215.5% in FY and 152.9% in FY for development expenditure in the sector (PRSP - II Period Progress Report FY 2008/09 - FY 2010/11. Government of Pakistan, Finance Division, 2012). Table 3: PRSP Budgetary Expenditures of FY , FY and FY (Billion Pakistani Rupees) FY FY FY Punjab Sindh KPK Bal Punjab Sindh KPK Bal Punjab Sindh KPK Bal Total Current Development (Source: Adapted from PRSP - II Period Progress Report FY 2008/09 - FY 2010/11. Government of Pakistan, Finance Division, 2012) Table 3 indicates an increasing spend in the sector in most provinces. Punjab and Balochistan have shown the maximum increases in the sector. In FY , there was an actual sectoral spend of Rs billion against a budget of Rs billion resulting in a 24% deviation, while in , there was an actual spend of Rs billion against a budget of Rs billion resulting in a 20% deviation (PRSP - II Period Progress Report FY 2008/09 - FY 2010/11. Government of Pakistan, Finance Division, 2012). Figure 3: Sectoral Expenditure to GDP ratio 18

19 (Source: PRSP - II Period Progress Report FY 2008/09 - FY 2010/11. Government of Pakistan, Finance Division, 2012) Error! Reference source not found. illustrates a trend whereby public expenditure to GDP ratios effectively doubled from its projected ratios in each of the three financial years. Figure 4: Access to Sanitation and Sectoral Public Expenditure (Source: Authors compilation, based on PRSP reports, PSLM and JMP surveys and Sacosan IV country report) Error! Reference source not found. clearly demonstrates a marked improvement in access to ssanitation rates with increased public expenditure in the sector. Sector Financing - Provincial Situation Internal In the provincial Annual Development Programmes for , the highest proportion of the total provincial ADP budget is seen in FATA (about 7.7% allocated to water and sanitation). The average provincial proportionate allocation to drinking water and sanitation is about 5%. 19

20 Figure 5: Drinking Water and Sanitation Allocations as Proportion of Provincial ADP (Source: Authors compilation, based on provincial ADPs of ) Error! Reference source not found. illustrates that provinces have allocated an average of 5% of their annual development programme budget to drinking water and sanitation. FATA tops the list at 7.7% while AJK and Sindh are below 3%. However, there is indication that the Chief Minister of Sindh is planning to launch a major waer and sanitation programme for the province and this provisional allocation may change. Figure 6: Provincial Allocations for Drinking Water and Sanitation in ADPs (Source own computation from provincial ADPs of ) Error! Reference source not found. shows the amount of budget allocated by the various provinces for drinking water and sanitation in their annual development programme. Punjab has the maxium allocation of Rs 10 billion, while KPK and Sindh are just under Rs. 4 billion. FATA and Balochistan have allocated about Rs. 1 billion each. 20

21 Figure 7: Drinking Water and Sanitation 3 Years Trend of Total Sectoral Budget as Proportion (%) of Total Provincial PRSP Allocation (Source own computation from PRSP - II Period Progress Report FY 2008/09 - FY 2010/11) Error! Reference source not found. illustrates provincial trends of proportion of PRSP budgets allocated to drinking water and sanitation. Balochistan demonstrates the highest allocation as a proportion of total provincial PRSP allocation (about 6%-7%). Figure 8: Drinking Water and Sanitation 3 Years Trend of Sectoral Development Budget as Proportion (%) of Total Provincial PRSP Development Allocation (Source: Authors compilation, based on PRSP - II Period Progress Report FY 2008/09 - FY 2010/11) Error! Reference source not found. illustrates provincial trends of proportion of PRSP development budgets allocated to drinking water and sanitation. Punjab demonstrates the highest sustained trend of increasing sectoral development expenditure in its PRSP development allocations from 9% to 12% between 2009 and

22 Provincial Finance Commission In wake of the Devolution Of Powers Plan and its subsequent implementation through Local Government Ordinance 2001 vide section 120-B, the Provincial Finance Commission (PFC) was established to allocate financial resources to the Districts from Provincial Allocable Amount on the basis of: 1) Population 2) Backwardness 3) Lag in infrastructure Equity being the spirit behind the institution of PFC, the weightage usually given to the above three parameters is 60%, 20% and 20% respectively under the PFC Awards. The need analysis for development and non-development requirements of the Districts is evaluated periodically. The management of financial resources placed at the disposal of the District Government and their further allocation and re-allocation is the jurisdiction of the Finance and Planning Office at the district level. There is an officially conformed system of reconciliation of all receipts and expenditure updated through various performa under Fiscal Transfer Rules. 22

23 External Japan predominates in providing over 50% of the total external assistance allocated for drinking water and sanitation for Pakistan in FY Table 4: External Assistance to the Sector Donor External Assistance Commitment (Million US$) % of total external assistance to water supply and sanitation ADB 38 5% China % France % IBRD 50 6% IDA 0.5 0% IDB % Japan % Total % (Source; Authors compilation, sector-wise commitments and disbursements of foreign economic assistance , Economic Affairs Division) Commitments for sectoral external assistance for water and sanitation account for 4% (US$ 778 million Table 4) of overall external assistance (US$ 19.4 billion) (Sector-wise commitments and disbursements of foreign economic assistance , Economic Affairs Division). For planned disbursements for , the sectoral disbursement accounts for about 4% (US$ 17 million) of the total planned disbursements (US$ 414 million). 70% of the commitment for the sector remains undisbursed. Focus areas for external assistance ADB - Sindh cities improvement programme China - Urban infrastructure development package, Azad Jammu and Kashmir France - Water treatment plant in Lahore; water resources for Faisalabad IBRD - Punjab Municipal Services Improvement Programme IDA - Punjab Municipal Services Improvement Programme 23

24 IDB - Reconstruction of rural housing Japan - water system in Faisalabad, water supply Abbottabad, sewerage and drainage system Lahore, and water supply system Faisalabad Donor Coordination and Sector Wide Approach Sector Wide Approach (SWAp) is an approach to international development that "brings together governments, donors and other stakeholders within any sector. It is characterized by a set of operating principles rather than a specific package of policies or activities. The approach involves movement over time under government leadership towards: broadening policy dialogue; developing a single sector policy (that addresses private and public sector issues) and a common realistic expenditure programme; common monitoring arrangements; and more coordinated procedures for funding and procurement" (World Health Organization, World Health Report 2000). Pakistan has national sanitation and drinking water policies, and the provinces are in transition phases of finalizing their provincial policies and action plans. Pakistan Approach to Total Sanitation (PATS) provides an overall framework for addressing the needs of Sanitation in the country. However, there is still need to develop a broader framework outlining the needs of the Water and Sanitation Sector, investment needs, monitoring processes and coordinated efforts. There is a range of donors and partners working for Water and Sanitation in Pakistan who share information with each other on need basis. National and Provincial Steering Committees for Drinking Water and Sanitation were established but they are not very active. In the absence of an overarching sectoral programme framework, it becomes challenging to determine performance and contribution of the sector especially in terms of priorities and plans. There is therefore a need to strengthen the component of information sharing on periodic basis and development of joint programmes as done in case of the education sector in Pakistan. This will initiate the process of developing SWAp for Water and Sanitation.. Key characteristics of the SWAp should include: i) the partner government clearly leads and owns the programme; and ii) a common effort by external partners to support that programme, including provision of all or a major share of funding for the sector, in support of the government's unified policy and expenditure programme. Over time, some SWAps progress towards using government procedures for implementation and the disbursement of funds. In practice, most programmes are in the process of drawing in diverse channels of funding, making the coverage of the sector more comprehensive, bringing ongoing projects into line with sector priorities, developing common procedures and placing increased reliance on government for management. Where SWAps are appropriate, they can help to promote greater local involvement, accountability and capacity in partner countries. 24

25 Estimating Cost for Water Supply and Sanitation The estimated costing for urban and rural water supply and sanitation was done using the following assumptions: Population growth rate 2% Using provincial per capita estimations for water supply schemes and rural sanitation after discussion with PHED departments Per capita cost of water supply scheme (average urban and rural) Rs 4000 Per capita cost of rural sanitation scheme with treatment (average urban and rural) Rs 4000 Developing back-end provincial estimations using PSLM data for % households with flush toilets and improved water. Estimating resource requirements for external infrastructure costs to meet access gap separately for urban and rural Apportioning resource requirements for 100% improved water coverage and 67%, 80% and 100% sanitation scenarios over 3 years Back-end provincial estimations were done for Balochistan, Khyber Pakhtunkhwa Punjab and Sindh, from which consolidated tables were developed The costing is an underestimate as cost estimates are an average figure which may vary dpending on population served, actual costs of hardware etc. Furthermore, the overall resource gap does not include FATA, AJK and Gilgit Baltistan as PSLM data for these was not available GDP estimations based on current nominal GDP of Rs 18 billion (US$ 200 billion at 1US$ = Rs 90) for 2010/11 (PRSP II Progress Report FY to FY ) 25

26 Table 5: Estimating Resource Needs for MDG Targets for Drinking Water Pakistan 2012* Total Population (million) Total Urban Rural Per Capita Investment Rs 4000 Investment Required (Rs billion) Urban Rural Total (Source: Authors compilation, based on PSLM reports, discussions with provincial PHE departments) The source tables for costing are presented in Annexure 2. 26

27 Table 6: Estimating Resource Needs for MDG Targets for Sanitation INVESTMENT FOR SANITATION POPULATION* Total- PKRs Total Urban Rural INVESTMENT IN PKRS BILLION Urban Rural Total 67% % % % % % % % % * Population estimates do not include FATA, AJK and Gilgit Baltistan as PSLM data for these is not available (Source: Authors compilation, based on PSLM reports, discussions with provincial PHE departments) The source tables for costing are presented in Annexure 2. 27

28 Table 7: Estimating Resource Gap for MDG Targets for Water (100%) and Sanitation (67% both urban and rural) Coverage Pakistan 2012* Total Current and Projected Sectoral Expenditure in Rs billion (if current levels sustained) Current and Projected Expenditure Resource needs for Water (100% coverage) Resource needs for Sanitation (67% coverage) Total Resource Needs Resource gap Resource gap as proportion of GDP (2010) Table 7 illustrates a conservative resource gap of about Rs 22 billion annually. An increment in sectoral public expenditure equivalent to about 0.12% of GDP would be required annually to achieve the MDG targets of 100% for water and 67% for improved sanitation. The source tables for costing are presented in Annexure 2. 28

29 URGENT NEED FOR ACTION 29

30 Urgent Need for Action Health Impacts Pakistan has a high Under 5 mortality rate of 86.5 per The Pakistan Demographic and Health Survey 2006 found that 22% of children under five years of age had an episode of diarrhoea during the two-week period preceding the survey, and 3% had diarrhoea with bloody stool. The survey also found that children aged 6-11 months were the most vulnerable and were three times more likely to have had diarrhoea than children aged months. 11% of all deaths in children under 5 years of age and 18% of all child deaths were due to diarrhoea. Acoording to the Pakistan Social and Living Standards Measurement survey , 11% of children under 5 years had diarrhea within 30 days preceding the survey. Based on data available, an estimated 35,000 to 55,000 children die annually in Pakistan due to diarrhea (Pakistan Strategic Country Environmental Assessment World Bank 2006; Pakistan Demographoc and Health Survey ). This means that children die every day because of diarrhoea. An estimated 25 million children and 50 million adults suffer from diarrhoeal morbidity annually in Pakistan. A further 27,000 people die from Typhoid/paratyphoid related diarrhoea, while 1.35 million have Typhoid/paratyphoid morbidity. Diarrhoea results in an estimated 2.5 million Disability Adjusted Life Years (DALYs) in Pakistan (Pakistan Strategic Country Environmental Assessment World Bank 2006). Pakistan is also one of the priority countries for control of Neglected Tropical Diseases (WHO Report on Neglected Tropical Diseases 2010), especially Trachoma, which is an avoidable blinding condition that is perpetuated in poor communities with inadequate water, poor sanitation especially open defecation, overcrowding and dry and dusty environments. A district based prevalence of Trachoma survey is currently underway to identify priority districts with high prevalence of active and blinding trachoma. The outbreaks of Dengue in Punjab and other provinces are a wake up call. Dengue flourishes in small water collections in and around the house, in particular in drinking water vessels. Piped drinking water can prevent the exacerbations from Dengue. In Punjab, over 12,000 people were infected and close to 300 people died from Dengue. Hospital beds were full of infected patients. The recent resurgence of polio in Pakistan, especially following the floods suggests pollution of water reservoirs as one causative factor. Pakistan may be left as the last global outpost in the 30

31 control of polio. Hepatitis A and E are now endemic due to contamination of drinking water by faecal matter (Malik IA et al, 1996). Economic Impacts The cost of diarrhoeal health impacts is determined using the human capital approach since both diarrhoeal and typhoid mortality predominantly affects children. The cost of morbidity includes the cost of illness (medical treatment, medicines, and value of lost time). About 50% of these costs are associated with the value of time lost to illness (including care giving), and another 50% are from cost of treatment and medicines (Pakistan Strategic Country Environmental Assessment World Bank 2006). 2.5 million DALYs are lost annually from diarrhoeal mortality and morbidity associated with inadequate water, sanitation and hygiene. The annual economic loss was estimated at Rs. 114 billion by the World Bank in 2006 (Pakistan Strategic Country Environmental Assessment World Bank 2006). Cost and impact analysis of water supply and environmental sanitation in Pakistan done by the Pakistan Institute of Development Economics in 2002 revealed that if water supply facilities are available to 90% of households and latrine facilities available to at least 60% of households in villages, the Benefit to Costs ratio is 2.7 at 6% discount rate and 1.75 at 12% discount rate. Recent data from the Economics of Sanitation Initiative supported by WSP suggests that the economic impact of poor sanitation and water in Pakistan may be as high as 3.94% of GDP (Pakistan Briefing: Economic impact of water and sanitation. Sanitation and Water for All, 2012). A report from the World Bank on water and sanitation to reduce child mortality (Water and sanitation to reduce child mortality, World Bank 2011) found that 25 deaths or more per 1000 children born could be prevented by investing in water and sanitation infrastructure. This difference accounts for about 40 percent of the gap between current child mortality rates and the 2015 target set in the Millennium Development Goals. For Pakistan, the cost per Life Year Saved relative to GDP per capita (in 2007) is about 20% which is highly cost-effective. The report also found that the average cost per life-year saved ranges between 65 and 80 percent of developing countries annual gross domestic product per capita. The results suggest that 31

32 investment in water and sanitation is a highly cost-effective policy option, even when only the mortality benefits are taken into consideration. Taking into account the additional expected benefits, such as reduced morbidity, time spending, and environmental hazards, would further increase the benefit-cost ratio. The WHO estimates that the return on US$1 investment is in the range US$5 to US$36, with a global average of US$8 (Economic and health effects of increasing coverage of low cost household drinking water supply and sanitation interventions to countries off-track to meet MDG target 10. World Health Organization, 2007). Using meta-analysis, a reduction in diarrhoea frequency include: Improved hygiene - 37% reduction Improved sanitation - 32% reduction Improved water supply - 25% reduction Improved water quality - 31% reduction Multiple - 33% reduction Economic benefits that arise from water and sanitation improvements include: Direct economic benefits of avoiding diarrhoeal disease - less expenditure on treatment of diarrhoeal disease and related health seeking costs Indirect economic benefits related to health improvement - value of avoided days lost at work or school, impact on school attendance of girls, avoided time lost of caretaker of sick children, and economic contribution of a saved life due to diarrhoeal disease Non-health benefits related to water and sanitation improvement - time savings related to water collection or accessing sanitary facilities; benefits to agriculture and industry of improved water supply; more efficient management of water resources A per capita annual economic benefit of at least US$15 is achieved, if universal coverage for combined water and sanitation interventions is done (Economic and health effects of increasing coverage of low cost household drinking water supply and sanitation interventions to countries offtrack to meet MDG target 10. World Health Organization, 2007). 32

33 33

34 ENABLERS 34

35 Enablers Policies One of the key enablers for drinking water and sanitation is the presence of policies and strategies. These include the national environment policy (2005), national sanitation policy (2006) and more recently the national drinking water policy (2009). The National Environment Policy provides a broad framework for addressing environment related issues such as pollution of fresh water bodies and coastal waters, air pollution, lack of proper waste management, etc, and to ensure effective management of environmental resources. The main goal of the policy is to protect, conserve and restore the environment in order to improve the quality of life through sustainable development. This policy has acted as a precursor for the development the national sanitation policy and national drinking water policy. In 2012, a new national climate change policy has been developed. The combination of these three later policies will probably supercede the national environment policy. National Sanitation Policy (2006) The policy provides broad framework and guidelines to all governments to enhance and support sanitation coverage in the country through the formulation of sanitation strategies, plans and programmes for improving the quality of life of people and providing a healthy work environment. The policy aims at safe disposal of excreta, liquid and solid waste. In cities and towns, the policy places responsibility on city governments, development authorities, Tehsil Municipal Authorities, private land developers and cantonment boards. In rural areas, for settlements above 1000 persons, a component sharing model is proposed, while for those less than 1000 persons, a Total Sanitation Model is prescribed. Joint sanitation planning by stakeholders is advised, and guidelines indicated for quality and monitoring. National Drinking Water Policy (2009) The goal of the policy is to provide adequate quantity of safe drinking water to improve the quality of life by reducing incidence of death and illness caused by water borne diseases at an affordable cost and in an equitable, efficient and sustainable manner by The policy guidelines include increasing access particularly for unserved and under-served areas, protecting and conserving water resources, water treatment and safety so that it complies to quality standards, use of appropriate technologies, community participation and empowerment, raising public awareness especially water safety, conservation and hygiene, building institutional and community capacities, promoting public-private partnerships, and operational research to promote best practice. The policy makes special reference to emergency preparedness, coordinated planning and implementation, guidelines for monitoring, and alludes to enactment of a water act. At least two of the provinces have taken the national policies as guidelines and developed their own policies and strategies. The Government of Punjab has framed an Urban Water and Sanitation 35

36 Policy (2007), while the Government of Balochistan framed a draft Provincial Sanitation Strategy and Action Plan. In 2010, the government released the national drinking water quality standards, which supplements the national drinking water policy. Figure 9: Schematic Diagram Illustrating Major Institutional Gaps Fig 9 illustrates that while there is a preponderance of policies, strategies and standards, there are institutional gaps in terms of action plans, regulations and legislations to enforce implementation of policies and standards. It is clear that various policy frameworks, guidelines and standards exist and provide an enabling platform, at least in theory. In practice, however, several inconsistencies are noted which render the enabling potential ineffectual. These factors are summarised in the diagram below. There is lack of any exclusive legislation that covers water supply and sanitation. Furthermore, the coverage of effluent quality and its disposal under the Environmental Protection Act (1997) is patchy and fragmented. There is no legislation that adequately covers policy formulation, water regulation, 36

37 water quality, water and sanitation tariffs, coordination mechanisms between key stakeholders, and development of water supply schemes. The functions, administration and financial management of the offices of Local Government and Rural Development Department, Urban Development, Public Health Engineering Department and Housing and Physical Planning Department at the regional, zonal, circle, divisional, district, Tehsil and lower levels are entrusted to the Tehsil/Taluka Municipal Administration, along with the employees working in these offices. The Water and Sanitation Agencies coming under the control of the District Government functioning in a Tehsil/Taluka are decentralized to the concerned Tehsil/Taluka Municipal Administration. The Water and Sanitation Authority or similar authorities functioning in a City District and coming under the control of a City District are decentralized to the City District Administration or to towns in a City District. Table 8 below summarizes the institutional framework for drinking water and sanitation. It provides an overview of roles and responsibilities of various institutional levels of administration. 37

38 Table 8: Institutional Framework for Drinking Water and Sanitation ACTs Policies and Strategies Provincial District Tehsil/Taluka Municipal Administration Town Municipal Administration Union Council Pakistan Environmental Protection Act (1997) National Environmental Protection Policy National Sanitation Policy National Drinking Water Policy National Climate Change Policy Provincial Government Responsible for offices of departments decentralized to it, and has a Zila Council (also included in a city district) Responsible for spatial plans, execute and manage development plans, enforce municipal laws and regulations Prepare spatial plans for the Tehsil/Taluka in collaboration with Union Councils, including plans for land use, zoning and functions for which the Tehsil/Taluka Municipal Administration is responsible Reviews and approves annual development plans and budget proposals of Union Administration, mobilizes community involvement Pakistan Environmental Protection Council approves policies and provides guidelines, while Pakistan Environmental Protection Agency prepares policies, reports, standards and responsible for enforcement National Drinking Water Quality Standards National Behaviour Change Communication Strategy Formulating provincial policies and legislations Execution of national policies Preparing action plans and resourcing them Development of master plans, land use, zoning, rules, byelaws, urban design, integrated water reservoirs, treatment plants and sanitation services etc Water supply, control, development of water sources, other than systems maintained by the Union and Village Councils; sewerage, sewage and sewage treatment and disposal; storm water drainage; sanitation and solid waste collection and sanitary disposal of solid, liquid, industrial and hospital wastes Water supply distribution other than integrated systems maintained by City District; sewerage system other than integrated systems maintained by City District excluding sewerage treatment and disposal; solid waste collection and conveyance to transfer stations designated by the Town but excluding treatment and disposal of wastes Collect, maintain statistical information, consolidate village and neighborhood development needs; identify deficiencies service delivery make recommendations for improvement; provide, maintain public sources of drinking water, wells, water pumps, tanks, ponds and other works for the supply of water (Source Own computation and adaptation from review of various documents) 38

39 Overview of Financial Planning and Budgeting Budget making is an annual process. It has various key steps which are similar for federal, provincial and district levels. Month Federal Provincial District September Call letter from Finance Division sets out policy priorities. Call letter from Finance Division for current expenditure estimates, and from Planning Commission for PSDP Call letter from Finance Department for current expenditure estimates, and from Planning and Development for ADP Call letter from Finance and Planning Office sets out policy priorities Finance Division prepares revenue and expenditure estimates Finance Department prepares revenue and expenditure estimates Finance and Planning Office prepares revenue and expenditure estimates Ministry s prepare revenue and expenditure estimates on incremental basis Departments prepare revenue and expenditure estimates on incremental basis Line offices prepare revenue and expenditure estimates on incremental basis January Ministry s submit revenue and expenditure estimates to Finance Division and development expenditures (PSDP) to Planning Commission Departments submit revenue and expenditure estimates (current) to Finance Department and development expenditures (ADP) to Planning and Development Department Invite CCB led development proposals March Revised estimates submitted by Ministry s to Finance Division Revised estimates submitted by departments to Finance Department Revised estimates submitted by line offices to Finance and Planning Office Priorities Committee chaired by Planning Commission reviews proposals Meeting chaired by Planning and Development Department reviews proposals Finance and Planning Office reviews proposals April Submits proposals for discussion to Annual Plan Coordination Committee (APCC) 39

40 Month Federal Provincial District May Appropriations Committee chaired by Finance Division discusses and finalizes sector allocations Meeting chaired by Finance Department discusses and finalizes sector allocations Meeting chaired by Finance and Planning Office prepares draft budget including proposed budget and CCB schemes June Executive Committee of NEC (ECNEC) chaired by Finance Minister, approves large federal and provincial projects on recommendation of Central Development Working Party (CDWP) National Economic Council (NEC) chaired by Prime Minister. Sets economic and budgetary priorities for the country. Federal budget proposals presented, provincial budgets also discussed Provincial Cabinet meets to consider and approve budget proposals Debate and assent to the finance bill as per Article 120 to 124 of the Constitution and the rules of procedure of the provincial assembly Submits budget to District Council June Annual Budget Statement submitted to National Assembly in accordance with Article 120 of Constitution. Laid before Assembly in the form of a Finance Bill. Similar process but with provincial assembly Authentication of the Schedule of Authorized Expenditure by the Chief Minister Once debated and approved by Assembly, signed by Head of Government, after which it becomes the Finance Act for the fiscal year (Source: Adapted from Ahmad D, Asif A: A guide to underataking the budget in Pakistan, PIPS 2007; Briefing paper for Pakistan Provincial Legislators: Provincial Budget Process, PILDAT 2004 ; Report on provincial budget analysis and budget conferences in Pakistan. Participatory Development Initiatives and Actionaid International, 2009) 40

41 Examples of Best Practice Changa Pani Programme (CPP) - Government The Government of Punjab has taken an integrated approach for the provision of water supply and sanitation through community participation on the basis of Internal and External Component Sharing Model, which is articulated in the community participation dimension of the Punjab Urban Water and Sanitation Policy. The CPP aims to design and implement a water supply and sanitation programme, initially for providing an efficient, reliable, affordable and environmentally sustainable system in a poor peri urban area of Lahore, Badar Colony UC 60 Lahore for 2800 households with 21,000 population. This model is based on the developmental philosophy of the Orangi Pilot Poject (OPP), which was translated in Punjab by the Urban Unit Planning and Development Department in collaboration with Anjuman Samaji Behbood Faisalabad. The intervention focusses on environmental education, health promotion programme and a community mobilization component. The government is taking a lead in rolling out the CPP. The internal and external institutional design and enabling policy context on which this programme is based provides some key learning for the government, water utilities (WASAs) and international development actors working in developing countries, especially the public sector water utilities in Pakistan and in the region. The purpose of this initiative is to bring about a cumulative impact on low-income communities and develop a replicable model in Punjab in light of the National Sanitation Policy. This approach is now being further replicated in Faisalabad and Sahiwal. Orangi Pilot Project The Orangi Pilot Project (OPP) started in 1981 under the leadership of Dr Akhtar Hameed Khan. It has demonstrated how community empowerment and active collaboration among different groups and service providers including government agencies can facilitate low cost improved water and sanitation services. The OPP has helped bring low-cost sanitation solutions to households in the densely populated Orangi squatter settlement of Karachi, Pakistan. By building up local NGOs that can plan and finance community latrines and house drains, the OPP has been able to create sufficient demand to oblige the municipal authorities of Karachi to contribute funding for more sewers. The OPP has now supplied quality sewerage to over 90% of the households in Orangi. The OPP is proof that we must not underestimate the effectiveness of collaboration between local community groups and governmental authorities. The example from Orangi shows that cost sharing is an important component of any development initiative. Lodhran Pilot Project (LPP) Low Cost Sanitation Model of LPP is based upon a component sharing approach. It is primarily a replica of OPP's model but LPP has extended it in rural areas of Punjab with some enhancements. There are two major components in this model - Internal Component and External Component. The internal component comprises of household latrine, household connection through T-Hodi and lane sewer and this component is the responsibility of the community. The external Component consists 41

42 of main sewer; disposal works and treatment plant and this component is constructed by the relevant government department or donor agency. LPP supported the Community-Led Total Sanitation approach in Bahawalpur, Rahim Yar Khan, Lodhran and Kasur districts. LPP raised awareness among rural communities to cease open defecation, adopt primary health and hygiene practices and promote a healthy and pleasant environment. A Water and Environmental Sanitation (WES) Committee is formed in each village which comprises of 25 community members. This committee plays a vital role to impart awareness education to the community. LPP builds capacity of the WES Committee as well as concerned departments like TMAs, Union Councils, CBOs/NGOs etc. LPP uses some motivational tools for mobilizing the community members to stop defecating in the open environment. Community Led Total Sanitation (CLTS) CLTS approach was first introduced in Pakistan at a national level workshop held in Bhurban in 2004 with the support of WSP - South Asia. Dr Kamal Kar, presented the approach and shared the experiences from other countries in Asia. The literature on CLTS was distributed to the interested people. A Mardan based local NGO, the Integrated Regional Support Programme (IRSP), supported by UNICEF, took on the approach with interest and enthusiasm. Later on, this approach was taken up further and Takht Bhai Municipal Administration was involved as a partner. RSPN has played an important role in scaling up CLTS in more than 20 districts with assistance from UNICEF and WSP. CLTS is an effective approach for triggering action to change defecation behaviors at the community level and to create demand for improved sanitation facilities. The steps identified under CLTS include: Pre-triggering: selecting a community and developing a better-defined sense of the community Triggering: educating the community regarding the consequences of living in a fecally contaminated environment. Some of the triggering activities include defecation area transect, mapping of defecation areas, calculations of faeces and medical expenses, triggering disgust and indignation. Post-triggering: once the communities typically pledge to improve their sanitation by either becoming open-defecation free or by adopting improved sanitation technologies, there is a danger that these pledges do not come to fruition without follow-up work. Pakistan Approach to Total Sanitation (PATS) Under the policy instruments provided in the National Sanitation Policy of 2006, it is mentioned that a Total Sanitation model for the provision of sanitation will be formalized and the procedures and regulations for its implementation will be developed. The Ministry of Environment set up a Core Group in August 2008 to propose a Pakistan-specific model to achieve total sanitation in the country. This Core Group proposed PATS in PATS uses "triggering" as an entry point and puts a larger focus on behavioural change toward sanitation and hygiene. It uses communication as a strategic tool to bring about change in behaviour for sustainable sanitation improvements in communities. PATS emphasizes the need for creating a 42

43 market for sanitation hardware and trained masons so that changed behaviour results in improved sanitation indicators. Communities are at the centre of the planning process for collective action, behaviour change, application of triggers, follow-ups, certification, and market development. PATS discourages direct subsidies and calls for a database for results-based monitoring. PATS encourages the use of principles rather than methodology-based approaches, thus allowing the federal and provincial governments greater programming flexibility to engage in meaningful discourse and exchange of experience adapting context specific solutions as well as the across provinces. North Sindh Urban Services Corporation (NSUSC) The Sindh Cities Improvement Investment Programme (the Investment Programme or SCIP) aims to improve water supply, wastewater management, and solid waste management (SWM) services in clusters of secondary cities in Sindh Province, thus enhancing the urban environment, public health, and economic opportunities for an estimated 4 million urban residents of participating secondary cities. This will be achieved through an integrated program of physical and nonphysical investments in institutional reforms and priority infrastructure rehabilitation and improvements. North Sindh Urban Services Corporation (NSUSC) has been established under the Companies Ordinance 1984 for the secondary cities of Northern Cluster of Sindh Province initially focusing on six districts. This Urban Services Corporation aggregates participating TMA's water supply, waste water and solid waste management operation in a single institution to leverage economies of scale, introduce new skills and management, and increase focus on operations, maintenance and financial management. Water and Sanitation Extension Programme (WASEP) The Water and Sanitation Extension Programme (WASEP), initiated in 1997 by the Aga Khan Planning and Building Services, Pakistan (AKPBSP), aims at providing infrastructure services. Specific programme objectives focus on improving environmental health of local communities through provision of safe water and sanitation facilities to local communities in Northern Pakistan and Sindh. WASEP's integrated intervention package includes: 1. Community mobilization and participation 2. Potable water supply infrastructure 3. Water quality management 4. Gray water drainage infrastructure 5. Household sanitation infrastructure; and 6. Health and hygiene education As part of the Terms of Partnership, the community takes the responsibility for operation and maintenance of the scheme once the infrastructure is installed, and contributes towards a cash fund. 43

44 WASEP's approach therefore, not only provides physical infrastructure, but also promotes sanitation and environmental health practices, while ensuring long-term sustainability of the infrastructure. This integrated intervention model has been transferred successfully to several remote, unserved, rural areas of Pakistan, facilitating participation of women in conservative settings. WASEP has successfully managed to build a culture of "payment for water use" using innovative techniques to ensure stability. Citizen Report Card The Karachi Water and Sewerage Board (KW&SB) has evolved over time from the Karachi Joint Water Board Ordinance 1949, the Karachi Joint Water Board constituted in 1953, after which the project execution was entrusted to the Karachi Development Authority (established in 1957), while distribution and retailing of treated water remained with the Karachi Municipal Corporation (KMC), some 22 other independent agencies and bulk users. A Karachi Water Management Board was created in 1981 and given water distribution responsibility for the metropolitan area and enhanced powers of cost recovery. In 1983, KW&SB was created within KMC, and was assigned responsibilities for water supply and sanitation services within Karachi. In 1996, KW&SB Act was enforced which separated KW&SB from KMC. In 2001, after the Sindh Local Government Ordinance, KW&SB was now merged into the new setup of the city district government. However, KW&SB still continues to function under the 1996 Act. A project designed to test the feasibility of using a Citizens Report Card was undertaken in collaboration with KW&SB and supported by WSP to gain insights about perceptions and attitudes of citizens towards services, and identify local issues pertaining to water and sanitation in Karachi. A quantitative survey of 4500 households was conducted in 9 towns of Karachi covering the north, south, central, north east, and south west areas of the city representing low, middle and high income groups. Eight themes were analyzed: Availability, access and use of services Reliability of services Perceptions on water quality Costs incurred by customers Interactions with KW&SB Transparency in service provision Satisfaction with services Priority areas for improvement Key findings revealed that KW&Sbs services were found satisfactory and above average by 6.5% of users, and that both users and utility staff want improvement in systems and services. The project has built in a strong demand side advocacy component and a supply side willingness to reform. 44

45 Formalizing Rural Water Supply Billing Systems Rural communities have generally considered the provision of safe drinking water the responsibility of the public sector rather than their own. This poses several challenges, not the least of which is the cost-effectiveness and sustainability of water supply schemes. The Punjab Community Water Supply & Sanitation Project, supported by Asian Development Bank, has tested an innovative approach of making communities pay for the water they drink by introducing a formal mechanism for water metering in rural water supply schemes in some marginalized rural communities in Punjab. The model was piloted in a small village of Varo in the district of Chakwal. Communities were mobilized and introduced to the advantages of water metering, particularly as they concern water conservation and reduction of household expenditures. The project assisted the community in procuring dry water meters from the nearby city of Lahore and trained a person among the villagers as a plumber. This person was made responsible for proper installation of the water meters. The total cost of installation per household ranged between PRs.1,200-1,600, inclusive of the meter cost. Once the water meters were installed, the community designated office bearers who became responsible for bill collection and the operation and maintenance of the scheme. The bill was collected from each household based on the units consumed, with the price per unit determined by dividing total monthly operating expenses by total number of water units used. The project proved to be a great success. The approach was replicated in two more villages in Chakwal. Majority of communities followed what villagers in Varo did; however the residents of village Balkasar proved to be more innovative when it came to collection methods. The Balkasar community reached an arrangement with the local bank to deposit their bills directly to the bank. The bank charges Rs. 5 per bill as a service charge and the community has also imposed a fine of Rs. 20 per month on late submission of bills. For chronic defaulters, the penalty was disconnection. The concept that was initially applied in three villages of district Chakwal proved to be a winner. It is now being replicated in fifteen more villages of district Chakwal on community demand. Converting Waste into Resource - Waste Management Industry Private sector firms have initiated projects based on organic and in-organic waste management. Organic waste is used to produce organic fertilizer. Inorganic waste is first sorted into paper, plastic, tin, etc, and it is then sold to respective industries where it is recycled to make products such as; Plastic Wood and Tetra Sheets. In Pakistan there is immense potential to convert waste into resource for the economy. In this regard, some NGOs (e.g. Gul Bahao and Pakistan Environment Welfare and Waste Recycling Trust - PEWWRPT) and private firms (e.g. Farooq Compost Fertilizer Corporation and Shanghai Shun Gong Environmental Protection Limited) have already stepped into the industry. These organizations collect waste and reprocess it to produce fertilizer, plastic bottles, and tetra packs. A private firm has established a recycling facility in Lahore where it is engaged to produce a refusederived fuel (RDF) based on the concept of waste-to-energy. Similarly an NGO in Karachi 45

46 encourages people to sell their waste to them and prepares soil-conditioning fertilizer. Another NGO is engaged in collecting urban waste in major cities of the country. It squeezes waste in order to dry it and finally produces waste pellets from it. The extracted liquid from organic waste is sold in market as liquid plant nutrient. In Lahore, the city district government has formed the Lahore Waste Management Company that is collaborating with Turkey on a waste disposal system for the city. 46

47 Intersectoral Collaboration Opportunities Education The National Sanitation Policy 2006 of Pakistan recommends a sanitation training/awareness raising programme at all educational and teachers training institutes. The National Education Policy 2009 lays emphasis on a school health programme along with health education. With the support of United Nations Programme for Pakistan, the school health initiative has been piloted in selected districts of four provinces, and school health education materials have been developed. The materials include the importance of hand washing and clean drinking water. However, these training materials have not been institutionalized in pre-service and in-service teachers training curriculum as envisaged in both national policies. Similar kinds of successful experiences and demonstrations have been made by other INGOs and National NGOs of Pakistan but these have rarely been scaled up. The Ministry of Environment initiated work with Ministry of Education to develop standards for water and sanitation to be included in the curriculum and training programme but progress was halted after the devolution of both ministries to the provinces. In Punjab, the provincial government launched a school health programme with deployment of 2500 health and nutrition supervisors (HNS) responsible for initial health screening of students in schools along with health education. Each HNS is responsible for primary and elementary schools located in a union council. In Balochistan province, the health education material has been produced in collaboration with the provincial Curriculum Wing of Education. Health Clean drinking water and sanitation is one of the eight basic components of Primary Health Care (PHC). The Government of Pakistan has been supporting the National Programme for Family Planning and Primary Health Care with deployment of 100,000 Lady Health Workers (LHWs) across the country with a key focus on the rural population. A LHW is responsible for population or nearly households. She visits 5-6 households each day to provide necessary health education in the areas of family planning, reproductive health, infectious diseases and child health issues. She generates a monthly progress report of her work, which feeds into the National Health Management Information System (NHMIS). The knowledge about hand washing and sanitation is provided in the training conducted for LHWs at the time of induction and later on during the refresher courses. The experiences of many of the early recovery programmes demonstrated that LHWs could play a significant role in creating demand for the construction of latrines. Recent experience from Faisalabad has shown that awareness raising campaigns run by LHWs have helped to improve sanitation and health for both farmers and consumers (Mobilizing Lady Health Workers for safer food in Faisalabad, Pakistan International Water Management Institute 2011). There is need to review the current training material and techniques for improved sanitation imparted to the LHWs. An alignment will not only help institutionalize sanitation in the primary health care programme but also strengthen the surveillance for diarrhoea. 47

48 BOTTLENECKS 48

49 Bottlenecks Institutional Arrangements Two key events have influenced the development, management, fragmentation and overlap of roles and responsibilities in the water and sanitation sector in the last twelve years. Water and Sanitation as sectoral subjects are not specified in the Federal or Concurrent Lists of the Constitution of Pakistan. This implies that they are provincial subjects and the responsibility of provincial governments. Following the Local Government Ordinance of 2001, provincial governments devolved authority for water supply and sanitation service provision to the district and tehsil local governments, but retained responsibility for policy making. The current state of affairs reveals a mix of service providers with unclear roles and responsibilities. At the urban level, water supply and sanitation services are simultaneously handled by the respective development authority, water and sanitation authority (WASA), tehsil municipal administration, cantonment board, and private land developer. This results in ad-hoc sanitation planning, loss of revenues from non-revenue water, blurred zones of responsibility, overlapping of roles and responsibilities, and complicates monitoring and reporting. Responsibilities for operation and maintenance and water quality are ill-defined. Furthermore, on the one hand there is an increase in urban and peri-urban populations, while on the other the administrative definition of rural area is still applied to some settlements which by all standards and definitions are now clearly urban, for example Sialkot and Bahawalpur. This results in even more blurred roles and responsibilities of duty bearers. The second event was the 18 th constitutional amendment in which the Ministry of Environment, among other ministries at Federal level, which was the lead ministry for water and sanitation was devolved to the provinces, but the responsibility for the national drinking water and national sanitation policies handed over to the Ministry of Disaster Management. At the federal level, the planning commission is the vanguard for national development planning through their poverty reduction strategy papers and medium term development frameworks. The provinces have planning and development departments that undertake macro planning for water and sanitation in the province. The coordination and representational role that had been the responsibility of the former Ministry of Environment ceased to exist with the result that there is ambiguity about a national motif upon which national policy and action planning can take place. The Ministry of Disaster Management has been given the role of facilitation, coordination and representation. 49

50 Water and Sanitation Agencies (Adapted from Ahmad ZS: Sector survey on water supply planning in Pakistan. JICA, 2009) Gujranwala WASA (GWASA) GWASA is currently working with a total staff of 448 against the approved strength of 638. As such, about 30% different slots are vacant. GWASA is seriously constrained for qualified staff. There are only five graduate engineers to look after the technical affairs of utility. The low quality of human resource and allied inefficiencies apparently mar quality of service delivery. GWASA has reported a very high percentage of non-revenue water of about 58 %. This is mainly due to illegal connections, insufficient recovery (only 40 % of the billed amount) and inadequacy of recording water generation, consumptions and system losses. The operating ratio for GWASA is also high (1.61) due to low recovery and high operational cost. As an average utility is suffers a short fall of Rs. 62 million per annum in operating expenses only. GWASA does not have development plans based on current trends and future land use patterns. GWASA has identified 5 water supply projects which are proposed to be implemented in short term during next 2 to 3 years. The total estimated cost of identified projects is Rs. 467 million. Multan WASA (MWASA) The approved staff strength of MWASA is 1,547 of varying cadres. Currently, MWASA is working with a total staff of 1,037; including regular employees (504), staff on contract (517) and also some on deputation (16). About 37% slots are still vacant. There is an independent water supply directorate headed by one Director and assisted by 3 senior engineers of deputy director ranks. MWASA has reported the figure of 30 % as non-revenue water. The operating ratio for MWASA is very high (1.5) due to low recovery and high operational cost. Faisalabad WASA (FWASA) FWASA is currently working with a total staff of 2,091. These include 1,405 regular, 293 on contract while 393 are employed on work charge basis. It has been reported that around 250 sanctioned / budgeted seats of varying cadres are lying vacant due to multiple reasons including budgetary constraints. FWASA has reported non revenue water of about 24% on account of system losses through leakages and pilferage of water through illegal connections. FWASA is maintaining a relatively good operating ratio (0.99). 50

51 Rawalpindi WASA (RWASA) RWASA is currently working with 1,020 staff of varying cadres. Of these, more than 750 staff are responsible for the development, operation and maintenance of water supply system. RWASA has reported 37 % unaccounted for water and 39% non-revenue water. RWASA shares similar reasons of high value of non revenue water that includes illegal connections, insufficient water recovery and inadequacy of recording water consumptions and system losses. Hyderabad WASA (HWASA) HWASA is currently working with a total staff of 2,463. These include 366 regular, 648 on contract / work charge basis and 1,449 workers on work charge basis. In addition to this strength, 67 officials including 17 officers are also working for water supply and sanitation related works in "Directorate of Water Supply and Sewerage Project" under Hyderabad Development Authority. HWASA has reported non-revenue water as 60% and unaccounted for water as 30%. Table 9: Summary of WASAs Population in service area (millions) Water supply coverage % Average hours water availability per day Current water demand (MGD) Actual water production capacity (MGD) Number water connections Non revenue water % GWASA MWASA FWASA RWASA HWASA CDA % 65% 53% 70% 95% 95% % 30% 24% 39% 60% 40% (Source: Ahmad ZS: Sector survey on water supply planning in Pakistan. JICA, 2009) Table 9 summarizes the current situation of different WASAs and highlights the deficit in production capacity versus demand, and the significant proportion of non-revenue water. 51

52 Operation and Maintenance Urban Water Supply and Sewerage Schemes Operation and maintenance water supply and sewerage (WSS) schemes is one of the main bottlenecks impeding progress in the sector. Given the demographic transition towards urbanization, the urban water supply and sanitation sector is a critical component of the broader sector. Rapid urbanization has given birth to several small towns with 50, ,000 inhabitants. Urban WSS can be viewed in the context of large cities with populations ranging from 1.9 to 9 million, intermediate cities with populations between 250,000 to 800,000, and smaller urban settlements between 25,000 and 250,000 populations. In Punjab, for instance, 5 large cities have Water and Sanitation Authorities (WASAs). These include Lahore, Faisalabad, Multan, Gujranwala and Rawalpindi. All other areas have Tehsil Municipal Administrations including cities like Sialkot and Bahawalpur which have populations of more than half a million. Under the Local Government Ordinance 2001, PHED was responsible for development of new urban WSS schemes, which on completion are to be handed over to TMAs for operation and maintenance. The urban WSS schemes face several problems. These range from frequent blockage of sewers due to inadequate maintenance, to uncontrolled raw sewage generated by the households of low income areas that flows either directly into residential lanes, or into small open or covered drains, or into sewers along these lanes, or accumulates to form ponds, or percolates into shallow groundwater contaminating the aquifer often used by households for their water supply. Before devolution, Town Municipalities / Committees were responsible for WSS functions of their respective towns. However, after devolution, TMAs were made responsible for water and sanitation functions of urban as well rural areas falling under the whole tehsil without building appropriate management structures, human resource development, and strengthening technical, managerial and financial capacities. Since the TMAs are not involved in the planning of WSS schemes, there is a reluctance to take these up from PHED once completed, some of which according to TMAs have technical flaws. The inability of the TMAs to maintain and operate WSS schemes due to financial and capacity issues compounded by the challenge of coordination between TMAs and PHED remains a major bottleneck. Rural Water Supply and Sewerage Schemes Rural water supply schemes have traditionally funded by provincial governments through their Annual Development Programmes. PHED has been responsible for planning, designing and execution of these schemes. Up to the early 1990s, the operation and maintenance was also the responsibility of PHED on completion and the costs were provided by the provincial governments. However, after 1991, the responsibility for operation and maintenance of new schemes was wholly and solely handed over to the communities. The provincial governments continued to bear the cost 52

53 of major repairs up to early Presently, rural water supply schemes are being maintained by User Committees / Community Based Organizations on self-help basis. Various studies and situation analysis reports have shown that about a third or more of rural water supply schemes are dysfunctional or non-functional (National Water Quality Monitoring Programme, Water Quality Status in Pakistan, Phase I-V, , Pakistan Council of Research in Water Resources). Some of the main reasons for this e.g. in Punjab are: Source failure - 25% Major defects in machinery / rising main / distribution network - 24% No payment of WAPDA dues or disconnection - 17% Theft of major components like electric motor, transformer - 9% Community conflict, poor service delivery, poverty - 25% (Source: Adapted from National Water Quality Monitoring Programme, Water Quality Status in Pakistan, Phase I-V, , Pakistan Council of Research in Water Resources) The causes of dysfunction or non-function may be classified as technical reasons (half the cases) and financial and management or social in a quarter of cases each. The TMAs do not have sufficient capacity to operate and maintain rural water supply schemes. Presently, the PHED Technical and Community Development staff provide technical and management support to Community Based Organizations (CBOs) who are operating & maintaining functional rural water supply schemes on self-help and self-financing basis. While the provincial governments are investing substantial amounts in development of new rural water supply schemes, there is a pressing need to rehabilitate dysfunctional schemes where feasible, and ensure that there is adequate administrative, financial and technical support to communities for completed schemes. 53

54 Equity and Inclusion There is insufficient information available on inequity mapping which serves as a major impediment in planning water supply and sanitation schemes in areas that are most in need. A national workshop on gender mainstreaming in WASH, held in recognition of the National Year of Environment in 2009 in collaboration with Ministry of Environment, UNICEF, UN Habitat, UNIFEM and PIEDAR, found that current programming and budgeting practices in the public sector are not gender sensitive. Access and utilization data is not disaggregated by gender. The forum recommended gender mainstreaming in water and sanitation policies, programmes and projects (Proceedings of National Workshop on Gender Mainstreaming in WASH, 2009). Equity is recognizing that people are different and need different support and resources to ensure their rights are realized. The measures must often be taken to compensate for specific discrimination and disadvantages to ensure fairness. At a local level this means looking at relative disparities or disadvantages within families and communities, understanding exactly what barriers are faced by disadvantaged people in accessing services, and developing ways to overcome these barriers. At national level it means understanding the dynamics that result in certain advantages over others or certain sections of the population enjoying greater political influence, etc (Framework for equity and inclusion. WaterAid 2010). Inclusion is about a holistic way of working for development interventions. The process of inclusion is not just about improving access to services, but also supporting people including those who are discriminated against and marginalized to engage in wider processes to ensure that their rights and needs are recognized (Framework for equity and inclusion. Wateraid 2010). Groups that are likely to be marginalized and therefore need a special focus in WASH programmes: 54

55 Women Children Older people People with disabilities People living in chronic poverty Minorities and indigenous people People with chronic illness, HIV AIDS Equity and Inclusion are interrelated and interlinked. The discussions with stakeholders revealed that decisions about WASH are guided and influenced by political priorities prevailing at the time. The wish list of WASH prepared on the basis of information shared by the districts or local bodies of government institutes is not followed in many instances and even the master plans are not adhered to. The information about the coverage and access of WASH is available at the provincial level but it is rarely linked with equity indicators. This process can be strengthened by: Conducting an equity based district-wise mapping of Pakistan for WASH would be desirable to identify the pockets and places in need of WASH but are currently disadvantaged Improving the understanding of the political leadership and government institutions about equity and inclusion issues Quality While survey statistics present an optimistic picture about access to improved water sources in line with MDG targets, both in urban and rural areas, the safety and quality of drinking water paints a contrasting and highly worrisome scenario. Studies done by the Pakistan Council of research in Water Resources (PCRWR) on drinking water quality monitoring in the country revealed that the water resources of Pakistan are facing four major water quality tribulations: bacteriological contamination (68%); arsenic (24%); nitrate (13%); and fluoride (5%) (National Water Quality Monitoring Programme, Water Quality Status in Pakistan, Phase I-V, , Pakistan Council of Research in Water Resources). Examination of 357 diverse water sources revealed that only 13% were found safe, while the remaining 87% were unsafe for drinking purposes. The water samples collected from 23 surface water bodies were all bacteriologically contaminated (National Water Quality Monitoring Programme, Water Quality Status in Pakistan, Phase I-V, , Pakistan Council of Research in Water Resources). Results from the above surveys of the rural water quality monitoring of 48 tehsils out of 64 to be monitored showed, that % water samples are bacteriologically unsafe for drinking. The situation is further compounded by ageing infrastructure, especially those where GI pipes have been used which have useful life of less than 20 years. 55

56 73% of 74 brands of commercially available bottled drinking water were found to be safe (Bottled Water Quality, Quarterly Report Oct-Dec 2011, Pakistan Council of Research in Water Resources). The principal source of drinking water for the majority of people in Pakistan is groundwater. According to the Pakistan Strategic Country Environmental Assessment Report 2006, the per capita water availability in Pakistan decreased from 5,000 in 1951 to 1100 cubic meter per annum by These estimates suggest that there is a high likelihood that the country will slip below the limit of 1000 cubic meters of water per capita per year from 2010 onwards. The situation could get worse in areas situated outside the Indus basin where the annual average is already below 1000 cubic meters of water per head (State of Environment Report, 2005). About 80% of Punjab has fresh groundwater, but in Sindh, less than 30% of groundwater is fresh. In Khyber Pakhtunkhwa (KPK), increasing abstraction has resulted in wells now reaching into the saline layers. Balochistan has saline groundwater. The proportion of the rural population that depends on a dug well or a river, canal or stream ranges from 7% in Punjab, 18% in Sindh, 35% in KPK and 67% in Balochistan (Pakistan Social and Living Standards Measurement Survey ). Uncontrolled extraction of groundwater and extended dry periods has also caused its depletion and drying up of some of the sources. In Islamabad, the water table has dropped some 50 feet between 1986 and 2001, while in Lahore the drop has been about 20 feet between 1993 and Estimates show that without an artificial recharging, groundwater in the sub basin of Quetta would be exhausted by 2016 (State of Environment Report, 2005). The Planning Commission in its Ten Year Perspective Development Plan , estimates that the water demand (including drinking water) by 2025 will be 135 million acre feet (MAF) against a water availability of 104 MAF, leaving the country with a shortfall of 31 MAF. 56

57 Table 10: Bacterial Contamination Levels of Water Sources of 23 Cities of Pakistan City Bacterial Contamination Level % City Bacterial Contamination Level % Islamabad 40-74% Sargodha 75-92% Faisalabad 38-79% Khuzdar % Bahawalpur 52-76% Loralai % Gujranwala 29-71% Quetta 48-68% Gujrat % Ziarat 100% Kasur 40-50% Mingora 40-70% Lahore 37-63% Mardan 75-83% Multan 31-87% Peshawar 31-77% Rawalpindi 53-87% Abbottabad 55-73% Sheikhupura 27-55% Hyderabad % Sialkot 40-70% Karachi % Sukkur 67-83% (Source : National Water Quality Monitoring Programme, Water Quality Status in Pakistan, Phase I- V, , Pakistan Council of Research in Water Resources) Table 10 illustrates the very high level of bcterial contamination found in water sources of 23 major citiesin the country. It highlights the issue of inadequate waste water treatment and contamination of water reservoirs. Table 11: Per Capita Availability of Water Year Population in millions Per Capita Availability in cubic meters (Source: Vision Planning Commission, 2007, Government of Pakistan) Table 11 summarizes the rapidly declining per capita availability of water. If urgent measures are not taken, Pakistan will move from the water stressed country to a water scarce one within the next two decades. 57

58 Waste Waste Water (Adapted from State of Environment Report 2005) It is estimated that only 8% of urban wastewater is treated in municipal treatment plants. In Pakistan, only 1% of wastewater is treated by industries before being discharged directly into rivers and drains. There is very little separation of municipal wastewater from industrial effluent in Pakistan. Both flow directly into open drains, which then flow into nearby natural water bodies. There is no regular monitoring programme to assess the water quality of the surface and groundwater bodies. By 2003, about 5.6 million tonnes of fertilizer and 70 thousand tonnes of pesticides were being consumed in the country every year. Pesticide use is increasing annually at a rate of about 6%. Pesticides, mostly insecticides, sprayed on the crops mix with the irrigation water, which leaches through the soil and enters groundwater aquifers. In 107 samples of groundwater collected from various locations in the country between 1988 and 2000, 31 samples were found to have contamination of pesticides beyond FAO/WHO safety limits. As there has been a four-fold or more increase in the use of pesticide use in the country since 1990, the contamination levels are likely to have increased significantly. It is estimated that 40 million residents depend on irrigation water for their domestic use, especially in areas where the groundwater is brackish. The associated health risks are grave, as bacteriological contamination of irrigation water often exceeds WHO limits even for irrigation. Reuse of irrigation water is minimal in Pakistan, as the return flows are negligible. The Indus River system carries around 33 million tons of salt, which flows through its waters, but only about 8 million tons of slat flows into the sea. The balance remains on land, which contributes to increases in areas affected by soil salinization (Water demand supply gaps in South Asia, and approaches to closing the gaps. Water and Security in South Asia, 2004). 58

59 Table 12: Status of Waste Water and Treatment in Major Cities of Pakistan City Urban Population (1998 census) millions Total waste water produced 10 6 m 3 / year % of total % of treated Lahore Faisalabad Gujranwala Rawalpindi Receiving water body River Ravi, irrigation canals, vegetable farms River Ravi, River Chenab, vegetable farms SCARP drains, vegetable farms River Soan, vegetable farms Sheikhupura SCARP drains Multan River Chenab, irrigation canals, farms Sialkot River Ravi, irrigation canals, farms Karachi Arabian Sea River Indus irrigation Hyderabad canals, SCARP drains Peshawar Kabul River Other Total Urban (Source: Master plan for urban waste water (municipal and industrial) treatment facilities in Pakistan 2002) Solid Waste (Adapted from State of Pakistan s Economy, Special Section 1: Waste Management) According to various studies conducted on waste management in the country, about 54,888 tons of solid waste is generated daily in urban areas of Pakistan and 60 percent of it is collected by the municipal authorities. However, according to official estimates, 30-50% of the solid waste generated within most cities is not collected. Around 250,000 tons of medical waste is annually produced from all sorts of health care facilities. Some hospitals and municipalities burn their waste, which results in the production of large amount of highly toxic gases. In addition, bio-non degradable solid wastes including hospital and industrial wastes are found lying in heaps. Open dumps of waste serve as breeding grounds for flies and mosquitoes creating health 59

60 hazards. In Pakistan currently there are three primary ways of disposing waste - landfill, size reduction and screening. The Ministry of Environment undertook a study during 1996 on "Data Collection for Preparation of National Study on Privatization of Solid Waste Management in Eight Selected Cities of Pakistan" according to which, the rate of waste generation on average from all type of municipal controlled areas varied from kg/capita/day to kg/capita/day or from kg/house/day to 4.29 kg/house/day in all selected cities (Draft Guideline for solid waste management. Pakistan Environmental Protection Agency, 2005). According to the Pakistan Environment Protection Agency (Guidelines for Solid Waste Management, 2005), solid waste generation from 8 cities (Gujranwala, Faisalabad, Karachi, Hyderabad, Peshawar, Bannu, Quetta and Sibi) amounted to 10,413 tons per day or over 3.6 million tons per year. Waste collection estimates for the same cities ranged from 51-69% - in other words, almost half the solid waste generated remained lying in heaps. The study projected that by 2014, there would be an estimated solid waste production of 71,018 tons per day or million tons per year. In urban areas, 39% of household garbage is collected by the municipality services, 17% by private, while in 44% there is no system. 97% of rural areas have no garbage collection system (Social Indicators of Pakistan, 2011) Several legal rules and institutional framework deal with solid waste management in the country. These include Pakistan Environmental Protection Act (PEPA) 1997, the National Environmental Quality Standards (NEQS), Hazardous Substances Rules of 1999, Guidelines for Hospital Waste Management 1998, Hospital Waste Management Rules 2005, Hazardous Substances Rules 2003, and several other regulations, rules and standards. Before promulgation of the local government in 2001, the provincial Public Health Engineering Department (PHED) was responsible for the development and maintenance of water and sanitation services including solid waste management. Under the recently prevailing system of local government, it is the responsibility of Town/Tehsil Municipal Administration (TMAs); however the siting of disposal facilities is primarily the function of the Zila Council. Paid sanitary workers are employed by TMAs to sweep the streets and collect the trash at a specified place from where it is taken to the dumping site by the municipal carrier. In addition, the private sector is also involved in waste management activities in the country. They may be divided into formal and informal categories. The formal sector consists of organizations and non-government organizations (NGOs). The informal sector is significant in size as it consists of thousands of itinerant traders (called kabarias or kabari-wallas) spread throughout the cities who are engaged in collection of waste material of different kinds. Unplanned urbanization, poor sanitation and drainage system, inadequate human and capital resources for collecting waste, unavailability of official dumping sites, absence of weigh bridges for exact measurement of waste coming at sites, and almost negligible presence of recycling processes have negatively impacted waste management in the country 60

61 Monitoring Definitions and Information Management Pakistan as a signatory to Millennium Development Goals is responsible for providing information about MDG 7 " Environmental Sustainability" that relates to access to drinking water and improved sanitation services. In absence of any regulatory body or recognition of Drinking Water and Sanitation as a sector, there is no structured approach for monitoring and evaluation (M&E) of WASH sector. It is driven either by the coverage and access of WASH or investment and disbursements made in the sector. Presently, there are three reports/sources that provide information about access to water and improved sanitation. These are Pakistan Social and Living Standards Measurement Survey (PSLM), Multiple Indicator Cluster Survey (MICS) and Joint Monitoring Programme (JMP) of WHO and UNICEF. At the national level in Pakistan, the Pakistan Bureau of Statistics conducts PSLM on periodic basis. The latest PSLM is available on the website but the whole report has not yet been released. MICS is done by provincial bureau of statistics with the support of Planning and Development Department in respective provinces. The MICS results have not been revealed for last few years, although it is planned for 2012 in some provinces. The Development Statistics Report of the provinces also provides information about water schemes. The JMP for Drinking Water and Sanitation is the official United Nations mechanism tasked with monitoring progress towards the MDG targets relating to drinking-water and sanitation (MDG 7, Target 7c), which is to: "Halve, by 2015, the proportion of people without sustainable access to safe drinking-water and basic sanitation". Apparently, there are some differences about the data of coverage and access generated by all these three sources, mostly because of varying definitions used by the different survey modalities. Some efforts have been made on the part of the bureau of statistics to align its data collection methods with defined parameters of JMP to bring consistency in the reporting, there is still considerable need to strengthen the capacities and orientation of the bureau of statistics at the federal and provincial levels about different definitions and data collection approaches. 61

62 The development of Management Information System for Drinking Water and Sanitation has started and is in the piloting and testing stage in Punjab and AJK where data entry is under process. Currently, it is not possible to ascertain the collective outputs of Water and Sanitation work done by different stakeholders across the country. Thus, there is need to develop consistent Monitoring and Reporting formats, and district, provincial and national hubs should be established for information collection and dissemination. GIS mapping is being used in some provinces to map zones of responsibilities, service utilization, revenue collection etc. This option can play a significant role for improving monitoring and evaluation systems. Institutional Mechanisms for Monitoring At the provincial level, planning and monitoring are not mutually reinforcing at present. The provincial mechanisms for planning and budgeting are underpinned by the following: Comprehensive Development Strategy (CDS) Medium Term Development Framework (MTDF) Medium Term Budget Framework (MTBF) Medium Term Expenditure Framework (MTEF) Output Based Budgeting (OBB) or Results Based Financing (RBF) Annual Development Programme (ADP) Post Crisis Needs Assessment (PCNA) where it applies Each province has, at varying degrees of development, a monitoring framework. This is supported by a Development Project Management System (DPMS). There is a whole directorate for monitoring and evaluation called Directorate General Monitoring and Evaluation (DGME) (Khyber Pakhtunkhwa Monitoring and Evaluation Report ). The DGME may have offices at divisional level, but does not have enough presence at district level. Development projects are routinely developed using standard PC-1 formats from the Planning Commission. Once a project is approved, it has a project completion PC-IV that projects are obliged to fill at the end of the project. 62

63 However, there is also a PC-V that is meant to be completed post-project completion and is an institutional monitoring mechanism. Unfortunately, hardly any project completes a PC-V. This is a major deficiency in the project management cycle. Presently, there is limited or no coordination between development of an ADP with the CDS, MTDF, MTBF, MTEF, OBB and the PCNA. For monitoring of drinking water and sanitation indicators to be institutionalized, it is essential that monitoring of the sector is contextualized within the broader monitoring framework of the province and that key stakeholders like the bureau of statistics, DGME, planning, reforms and those involved with management information systems facilitate information management for drinking water and sanitation. Climate Change The Maplecroft Vulnerability Index to Climate Change (2010) rates Pakistan in the top 16 countries classified as extreme risk. The index evaluates 42 social, economic and environmental factors to assess national vulnerabilities across three core areas. These include exposure to climate related natural disasters and sea-level rise; human sensitivity, in terms of population patterns, development, natural resources, agricultural dependency and conflicts; and adaptive capacity of a country s government and infrastructure to combat climate change. Pakistan is located in the South Asian region that has recently been categorized as the world's most climate-vulnerable region by Maplecroft. The projections for future increases in temperature are predicted to be higher for Pakistan compared to global trends and this is confirmed by both national and international studies of future climate change in Pakistan. The Indus basin, which is the major source of water supply in Pakistan, depends heavily on glaciers in the Western Himalayas and the Karakoram. These glaciers are melting rapidly. The melting of these glaciers has been projected to increase the flow of water in the rivers. This, combined with an increase in precipitation and flash storms, are predicted to result in increased incidents of flooding. According to the International Panel on Climate Change, glacier melt in the Himalayas is projected to increase flooding within the next two to three decades. The recent flooding in Pakistan - resulting in an inundation of more than a quarter of the total land area in Pakistan and affecting close to a twenty million people and causing 1700 deaths - is the most recent as well as the most shocking manifestation of the dire consequences of climate change in the region. Apart from flooding, droughts are also predicted for Pakistan in future years. Once the Himalayan glaciers retreat due to melting in a couple of decades, water shortages are likely to take place having dire consequences for the agricultural sector and food production. Agriculture is the mainstay of Pakistan and the country has one of the highest ratios of irrigated croplands in the South Asian region with four-fifths of its total crop land being currently irrigated. Overall, according to the WHO categorization of regions vulnerable to climate change, Pakistan falls in the region with one of the highest number of deaths attributed to climate change (40-80 per million) after Sub-Saharan Africa. Increase in temperature and heat waves are likely to increase the risk of heat related morbidity and mortality particularly amongst the older population groups and the urban poor. In South Asia, heat 63

64 waves are most likely to occur in the rural areas affecting mostly the elderly population and outdoor workers. Rising temperatures and humidity levels are also likely to increase the transmission of vector-borne diseases such as Malaria, Dengue Fever, Yellow Fever and Encephalitis. Increase in temperature along with a decline in precipitation is likely to put a strain on the availability of water supply in Pakistan. Pakistan's agriculture is heavily dependent on water. Constraints in the availability of water in the future are very likely to prevent the intensive use of land leading to a reduction in crop production. Already, Pakistan's agriculture remains far below its potential. The increase in temperature is predicted to reduce the supply of water thereby constraining crop production and shortening the growing season of crops. This is predicted to have significant repercussions on food insecurity in the region which is reported to have increased in the past number of years in Pakistan. Malnutrition, particularly among children under five years of age is a serious health issue, with nearly one half of them estimated to be below their weight for age. Disaster Risk Reduction As disasters cannot be eliminated, coping with the consequences is reality for a large part of the world population (Reference Note Water Supply and Sanitation Collaborative Council 2009). In the last decade of the 20th century almost two billion people one-third of humanity were affected by natural disasters, 86% of them by floods and droughts (Celebrating Water for Life the International Decade for Action An Advocacy Guide. WHO 2005). Each disaster can pose its unique set of threats. Flooding for example, increases the ever-present health threat from inadequate drinking water and sanitation systems, and water supplies can become contaminated by lack of sanitary facilities as well as household or industrial waste. These factors all aggravate the situation for vulnerable people, and the largest sufferings originate from common illnesses, such as diarrhoea, made life threatening by crisis conditions. Thus, three top priorities in emergency response, and even during the development interventions, are provision of clean drinking water or purification mechanisms, construction of sanitation infrastructure and conduction of hygiene training. The inclusion and adaption of disaster risk reduction in planning of infrastructure and institutional elements of drinking water supply, and sanitation system is not important from mainstreaming perspective but also from strengthening the sustainability and reducing the vulnerability especially to the place prone to disasters (Reference Note Water Supply and Sanitation Collaborative Council 2009). UN-Water has compiled a summary of water hazards, many of which are potentially threatening sustainable functioning of water supply and sanitation systems (Water hazard risks. UN- Water series Vol.1, 2005). The Hyogo Framework for Action developed by the United Nations International Strategy for Disaster Reduction (ISDR) for aims to build the resilience of nations and communities to disasters. In the report Words into Action, the example of Colombia highlights the positive impact of inter-institutional cooperation on WASH issues (Words into action: a guide for implementing the Hyogo Framework, ISDR 2007). The WASH cluster working with National and Provincial Disaster Management Authorities of Pakistan reviewed existing knowledge and explored gaps related to disaster risk reduction. This created awareness and increased political commitment to integrate these issues into the water and sanitation sector but these are mainly driven from emergency perspectives. There is a dire need of developing resilience capacities both in the public and private sectors to ensure effective disaster risk reduction strategies and processes as part of a government-led long-term development agenda. 64

65 Establishment of of a taskforce or working group in Pakistan would be desirable for identification of strategic entry points for disaster risk reduction and management in WASH programmes. Vulnerability to Climate Change Analysis of the recent evidence emerging from flood affected areas regarding the health, water and sanitation repercussions are of serious concern: Health facilities and sanitation infrastructure was severely damaged Access to safe water and sanitation was severely curtailed thereby increasing the vulnerability of people to infectious and water borne diseases such as diarrhoea, typhoid, intestinal worms and hepatitis. In many cases water pipes were contaminated with sewage water and the use of toilets in most flood affected districts dropped by 50 percent The incidence of cholera, malaria and polio increased over the past one year in Pakistan A ranking of agro-ecological zones in Pakistan according to their vulnerability to climate change shows the following (Malik SM et al: A study of the effects of climate change on human health in Pakistan. 2010): Balochistan is the most vulnerable region with high sensitivity and low adaptive capacity. The major threats posed by climate change in Balochistan include droughts and increase in mean temperature Low-intensity Punjab (mostly consisting of South Punjab) is the next most vulnerable region. The region is prone to floods as well as rise in temperature. The region has a high degree of sensitivity and low adaptive capacity Cotton/Wheat Sindh is the third most vulnerable region. It is vulnerable to both floods and droughts. The degree of sensitivity is high. However the coping capacity falls in the 'medium' rank. The rain-fed (Barani) Punjab has a high degree of exposure to climate change due to its greater variability in precipitation, but relatively better adaptive capacity In a situation where Pakistan is ploughing through a state of development deficiency, building its adaptive capacity to climate change is challenging to say the least. However, the formulation of the 65

66 new national climate change policy 2012 is an encouraging step. Decadal forecasts of increasing floods and droughts suggest that mitigation planning for 2030 and 2050 needs to begin now. Data from the Intergovernmental Panel on Climate Change (The cost to developing countries of adapting to climate change. World Bank 2010) suggests that in South Asia, regional countries need to invest at least 0.2% of their GDP on building their adaptive capacity. It is vital that water and sanitation programmes incorporate adaptation measures to climate change. 66

67 TAKING ACTION 67

68 Taking Action Catalyzing Actions Sector Wide Approach prioritize sanitation and drinking water within a sector wide approach in Poverty Reduction Strategy Paper III, Medium Term Development Framework and Medium Term Budget Framework; the SWAp will enable incorporation of the principles of sector policies into sector development plans of different agencies responsible for water management and solid waste Sector Plan develop a National Sector Action Plan comprised of Provincial Action Plans to effectively implement national policies on sanitation and drinking water as well as behavioral change by December 2013 Task Forces 1. Constitute a special Task Force on up scaling rural sanitation based on the Pakistan Approach to Total Sanitation by December 2012; 2. Constitute a special Task Force on Peri-urban/Urban challenges and Climate Change in relation to sanitation and drinking water to document and formulate guidelines for best practice for incorporating into the national and provincial action plans by December Constitute a WASH specific Task Force on Disaster Preparedness and Response as well as Disaster Risk Reduction by December 2012 Institutional Arrangements Institutional roles and responsibilities following the 18 th Amendment need to be clarified and well defined. Suggested roles include: Federal - facilitate information sharing and cross-provincial learning of best practice; develop a country plan comprised of provincial action plans; develop guidelines and standards; representational responsibility and promote research Provincial - develop provincial legislations, policies, regulatory frameworks, strategies and action plans; streamline master planning and coordination mechanisms and information pathways; mobilize resources; plan for human resource development District - become the planning and implementation platform (district boards) for drinking water and sanitation programmes through district based participatory planning, monitoring and execution; conduct equity mapping to prioritize areas most in need; revenue generation; ensure quality; waste disposal Tehsil - operate the service delivery arm of the sector; manage operation and maintenance; human resource management; coordinate monitoring Union Councils - collect information; specific focus on social mobilization 68

69 Operation and Maintenance - Urban Formalize agreements between Local Government, District Government and TMA concerned before the start of each urban water supply or sewerage/drainage scheme, for handing over to and subsequent maintenance by the TMA on its completion Ensure a thorough costing for operation and maintenance including staff requirements and handing over transition costs at the time of preparation of PC-I to minimize post-transfer issues Develop a transition and handover plan (as part of the PC-1) of about six months for each completed scheme in which PHED should operationalize the scheme for at least six months with the active participation of TMA staff who will be responsible for it subsequently TMA and PHED should formulate a joint monitoring and review mechanism for on-going and new schemes Operation and Maintenance - Rural Suggested options for sustainability of Rural Water Supply Schemes: Revolving Fund Plan and incorporate a seed fund at the time of developing the proposal. The seed fund shall be managed by the community based organization who shall be responsible for generating revenue from the community members and recycling it for maintenance, repairs, replacement of hardware, utility costs etc. Modalities to manage the revolving fund can be developed in collaboration with Executive Engineers and Community Development Officers. Community contribution for a backup fund is also suggested Municipal responsibility Capacities of the TMA or respective Union Council can be strengthened in operation and maintenance to provide support to rural water supply schemes, but will incur additional ongoing cost Public private partnership Outsourcing options e.g. to contractors may be considered in consultation with Local Government and Planning and Development departments Monitoring The following strategic actions are suggested to improve monitoring: Definitions Hold standardization of terminologies and indicators used to monitor drinking water and sanitation interventions technical meetings between Pakistan Bureau of Statistics, Provincial Bureau of Statistics, organizations responsible for social and living standards measurement, multiple indicators cluster, demographic health surveys, and technical experts to develop a minimum set of drinking water and sanitation indicators that shall be incorporated in population surveys, statistical data, and international communications. Organizations may add other indicators as appropriate to their respective needs 69

70 Monitoring Mechanism Establish a national monitoring framework for sanitation and drinking water based on provincial monitoring frameworks, and strengthen national and provincial information management systems, including those for health and education for improved and coordinated monitoring of sanitation and water by This may require alignment with provincial monitoring frameworks, establishing a provincial coordination cell, strengthening of data collection and information pathways, building capacities of monitoring structures e.g. DGME Promote completion of PC-V for post-completion performance of schemes Sectoral Financing Presently, the public spending for drinking water and sanitation averages at below 0.2% of GDP, and about 5% of provincial Annual Development Programmes. The following actions are suggested: Allocation - Enhance by 2015, the sectoral allocation for water supply and sanitation by 1% of overall PRSP allocation to partially meet the resource gap of US$ 600 million for global MDGs target of sanitation and drinking water External assistance - mobilize an additional US$ 200 million annually over and above current and projected commitments to achieve national MDGs targets of sanitation and water supply Costing analyses suggest that provincial allocations need to be doubled to at least 10% of the ADP, and overall sector investment to at least 0.3% of GDP. The investment may need to be increased incrementally to raise it from its current 0.16% to 0.3%. The public spending ratio for drinking water and sanitation is 3:1. It is suggested that this be changed to a 50%:50% spend ratio to intensify and accelerate efforts to promote access to improved sanitation. Human Resource Development Conduct a sector capacity development needs assessment and develop a human resource and leadership development plan for sanitation and drinking water sector by December 2012 Conduct a situation analysis of existing training centres for drinking water and sanitation to assess facilities, availability of faculty, and curricula Define a package of training needs for various cadres in the sector, for both public and private sector, including short term and long term courses Modernize training curricula and develop provincial human resource development and deployment plans and also align with vocational training and enterprise development Establish/strengthen provincial training institutes for human resource development, develop training manuals and task oriented training 70

71 Partnerships Undertake a mapping of government, international non-government, national nongovernment, district based civil society, international development partners working in the sector and develop district based activity maps to determine overlaps and opportunities for synergy Develop partnership protocols that are aligned with and support provincial action plans to implement sector policies Foster an engagement policy with the private sector to enhance private investment, improve quality of services, revenue collection and enhance access Climate Change Ensure that drinking water and sanitation is adequately reflected and incorporated in national and provincial strategies and action plans for climate change Assess the current adaptive capacity of water and sanitation systems to the effects of climate change and develop a phased plan for climate proofing plan of infrastructure Forecast and allocate resources to build the adaptive capacities on a district-wise basis Research Set up a Research Working Group to identify research priorities and develop a research master plan Establish a research and advocacy fund for drinking water and sanitation and invite research proposals on priority themes Promote research and development for innovative technology 71

72 BIBLIOGRAPHY 72

73 Bibliography Ahmad D, Asif A: A guide to understanding the budget in Pakistan, PIPS 2007 Ahmed A, Iftikhar H, Chaudhry GM: Water resources and conservation strategy of Pakistan, 2008 Analytical review of the PSDP portfolio. Planning Commission, Government of Pakistan, 2011 Annual Development Programme Azad Jammu and Kashmir Annual Development Programme FATA Annual Development Programme Gilgit Baltistan Annual Development Programme Khyber Pakhtunkhwa Annual Development Programme Punjab Annual Development Programme Sindh Balochistan Public Sector Development Programme Bottled Water Quality, Quarterly Report Oct-Dec 2011, Pakistan Council of Research in Water Resources Briefing paper for Pakistan Provincial Legislators: Provincial Budget Process, PILDAT 2004 Celebrating Water for Life the International Decade for Action An Advocacy Guide. WHO 2005 Compendium on Environment Statistics of Pakistan Federal Bureau of Statistics, Government of Pakistan Cost and impact analysis of water supply and environmental sanitation in Pakistan. Pakistan Institute of Development Economics Country Report Progress of Pakistan towards the MDGs (Sanitation) for SACOSAC IV, 2011 D Nayab. Demographic dividend or demographic threat in Pakistan. Pakistan Institute of Development Economics, Working Papers, No 10, 2006 Delivering access to safe drinking water and adequate sanitation in Pakistan. Pakistan Institute of Development Economics, 2007 Disaster Risk Reduction Emergency Response for WASH, WSSCC Reference Note February 2009 Drinking water - equity, safety and sustainability. UNICEF and WHO, 2011 Early recovery water, sanitation and hygiene (WASH) strategy. National Disaster Management Authority, Government of Pakistan, 2010 Economic and health effects of increasing coverage of low cost household drinking water supply and sanitation interventions to countries off-track to meet MDG target 10. World Health Organization,

74 Economic Survey of Pakistan Economic Advisor s Wing, Finance Division, Government of Pakistan Education For All Global Monitoring Report 2011 Establishment of water supply and sanitation coordination cell. Concept Paper. Ministry of Environment, 2010 Framework for equity and inclusion. Wateraid 2010 Guideline for solid waste management (draft). Pakistan Environmental Protection Agency, 2005 Greater Karachi Sewerage Plan S III, 2007, City District Government, KW&SB Karachi Solid Waste Management (2006) - Karachi Master Plan 2020 Khyber Pakhtunkhwa Monitoring and Evaluation Report Linking poverty reduction and water management. Poverty Environment Partnership, 2006 Making water a part of economic development - the economic benefits of improved water management and services. Stockholm International Water Institute, 2005 Malik IA, Tariq WZ: Hepatitis E in Pakistan. EMHJ 2, 1: , 1996 Malik SM, Awan H, Khan NU: A study of the effects of climate change on human health in Pakistan - Evidence based policy advocacy. Sightsavers 2010 Mobilizing Lady Health Workers for safer food in Faisalabad, Pakistan International Water Management Institute 2011 Murtaza G, Zia MH: Individual's capacity development on the safe use of wastewater in agriculture in Pakistan. Institute of Soil and Environmental Sciences, University of Agriculture, Faislabad, 2011 National Drinking Water Policy, 2009 National Environmental Policy, 2005 National Sanitation Policy, 2006 National Water Quality Monitoring Programme, Water Quality Status in Pakistan, Phase I-V, , Pakistan Council of Research in Water Resources National workshop on gender mainstreaming in WASH. PIEDAR in collaboration with UNICEF, UN Habitat and UNIFEM 2009 Off-track, off-target - why investment in water, sanitation and hygiene is not reaching those who need it most. WaterAid 2011 Pakistan Briefing: Economic impact of water and sanitation. Sanitation and Water for All, 2012 Pakistan Demographic and Health Survey National Institute of Population Studies, Pakistan and Macro International Inc., USA Pakistan Economic Survey

75 Pakistan Framework for Economic Growth Planning Commission, Government of Pakistan Pakistan Household Integrated Economic Survey Pakistan Social and Living Standards Measurement Survey Pakistan Bureau of Statistics Pakistan Strategic Country Environmental Assessment. Vol II: The cost of environmental degradation in Pakistan - An analysis of physical and monetary losses in environmental health and natural resources. World Bank, 2006 Pakistan s waters at risk. Water and health related issues in Pakistan and key recommendations. WWF, 2007 Poverty Reduction Strategy Paper II - Finance Division, Government of Pakistan Progress on drinking water and sanitation 2012 update. UNICEF and WHO, 2012 PRSP - II Period Progress Report FY 2008/09 - FY 2010/11. Government of Pakistan, Finance Division, 2012 Report on provincial budget analysis and budget conferences in Pakistan. Participatory Development Initiatives and Actionaid International, 2009 Report of Working Group on Environment - Tenth Five Years People s Plan Ministry of Environment Safe drinking water supply, sanitary latrines coverage, and waste management in Pakistan. Desk review and meta-analysis, UNICEF, 2002 Scanning the 2020 horizon. An analysis of trends and scenarios in the water, sanitation and hygiene sector. IRC International Water and Sanitation Centre, 2011 School health programme: A strategic approach for improving health and education in Pakistan. Ministry of Education and UNESCO, 2010 Sector survey on water supply planning in Pakistan. Zahid Shakeel Ahmad, JICA, 2009 Social Indicators of Pakistan Government of Pakistan, Statistics Division, Federal Bureau of Statistics State of the Environment Report (draft) Government of Pakistan, Ministry of Environment Statistical Supplement, State Bank s Annual Report, The State of Pakistan s Economy State of water and sanitation in Punjab - Position paper. Punjab Urban Resource Centre, 2011 Ten Year Perspective Development Plan , Government of Pakistan, Planning Commission The cost to developing countries of adapting to climate change. Consultation Draft. World Bank 2010 The state of Pakistan s economy - Waste management: recent developments in Pakistan, 2009 Vision Planning Commission, 2007, Government of Pakistan 75

76 Vision the resilience of water supply and sanitation in the face of climate change. WHO and DfID, 2009 Water demand supply gaps in South Asia, and approaches to closing the gaps. Water and Security in South Asia, 2004 Water hazard risks. UN-Water series Vol Water quality interventions to prevent diarrhoea: Cost and cost-effectiveness. WHO, 2008 Water and sanitation to reduce child mortality - The Impact and Cost of Water and Sanitation Infrastructure. The World Bank, Development Economics Project Group, 2011 Water and sewerage services in Karachi. Citizen Report Card: Sustainable service delivery improvements. Water and Sanitation Program, 2010 Water in a changing world: United Nations World Water Report 3, UNESCO, 2009 Water, sanitation and hygiene. UNICEF Annual Report, 2010 Words into action: a guide for implementing the Hyogo Framework. ISDR 2007 Working to overcome the global impact of Neglected Tropical Diseases. WHO,

77 ACRONYMS 77

78 Acronyms ADP Annual Development Programme CDS CLTS CPP DALYS GDP HDI HLM HNS JMP KPK LG LHW LPP MDGs MICS MoDM MTDF MTEF NEQS NGO OBB OPP PATS PCNA PCRWR PEPA PHED PRSP Comprehensive Development Strategy Community Led Total Sanitation Changa Pani Programme Disability Adjusted Life Years (DALYS) Gross Domestic Product Human Development Index High Level Meeting Health and Nutrition Supervisor Joint Monitoring Programme Khyber Pakhtunkhwa Local Government Lady Health Worker Lodhran Pilot Project Millennium Development Goals Multiple Indicators Cluster Survey Ministry of Disaster Management Medium-Term Development Framework Medium - Term Expenditure Framework National Environmental Quality Standards Non Governmental Organizations Output Based Budgeting Orangi Pilot Project Pakistan Approach to Total Sanitation Post Crisis Needs Assessment Pakistan Council of Research in Water Resources Pakistan Environmental Protection Act Public Health Engineering Department Poverty Reduction Strategy Paper 78

79 PSDP PSLM RBF RDF RSPN SWA UNICEF WASA WASH WHO WSP Public Sector Development Programme Pakistan Social and Living Standards Measurement Survey Result Based Financing Refuse-Derived Fuel Rural Support Programme Network Sanitation and Water for All United Nations Children Fund Water and Sanitation Agency Water, Sanitation and Hygiene World Health Organization Water and Sanitation Programme 79

80 ANNEXURES 80

81 Annexure 1 - Methodology Background Sanitation and Water for All (SWA) is an alliance of national governments, donors, civil society organizations and other development partners and water and sanitation agencies working together to increase political prioritization, increase resource allocation and improve the efficiency of resource use and strengthen the evidence base for the water supply and sanitation sector. Its aim is to ensure that all people have access to basic sanitation and safe drinking water. It is particularly concerned with those countries where the needs are greatest and are off-track to achieve MDGs with current rate of progress. SWA provides a framework for action at global and national level to ensure greater effectiveness of funding - a plus for both donors and recipients. SWA is making the financing of water and sanitation more sustainable and more effective, yielding greater value for money and saving lives in the process. Pakistan is a member of the SWA Steering Committee The second SWA High Level Meeting (HLM) will be held in Washington D.C. on 20 April The Ministers of Finance from countries most in need of improved sanitation and hygiene are expected to participate in the meeting. The Government of Pakistan will also participate in the HLM. Scope and Purpose The scope and purpose of this study are two fold: Undertake a brief critical review of the WASH sector Propose a brief strategy that will underpin a statement of commitments to be presented by the Minister for Finance at the HLM Process The methodology adopted was divided into three phases: Phase 1 Undertake a desk review of available information on WASH in Pakistan Visit provinces jointly with Ministry of National Disaster Management official and meet with key public sector officials and technical persons to understand approaches, limitations and frontline challenges Meet with sector organizations and professionals to obtain their perspective 81

82 Phase 2 The information obtained from the desk review and individual and organizational consultations was divided into strategic themes for further analysis and drawing out points of significance. Phase 3 The themes that emerged from the analysis were grouped as follows: Those that represented a topline perspective in terms of socio-economic indicators, WASH indicators and sector financing - describe the current situation Those that provide a health and economic perspective - highlight an urgent need for action Those that summarized policy and institutional frameworks and reflected some good practices in the sector - considered as enablers Those that emerged as key sector challenges - classified as bottlenecks Those that constituted strategic actions - presented as taking action Those that were distilled into a topline strategy map A supportive but not exhaustive bibliography is presented at the end, which may help point the direction for further study and analysis. Stakeholders Consulted Amjad Hussein, Assistant Coordinator, Local Government, Khyber Pakhtunkhwa Asad Aslam Khan, Vice Chancellor, King Edward Medical University Lahore Bahramand Khan, Superintendent Engineer, PHED, Khyber Pakhtunkhwa Faheem Akhtar Junejo, Director General (M&E), Local Government, Government of Sindh Farhan Sami, Country Team Leader, WSP, World Bank Islamabad Fawad Saeed, Senior GIS Specialist, The Urban Unit, P&D Government of Punjab Imran Shami, Programme Manager, Plan Pakistan Irfan Saeed Alrai, WES Specialist, UNICEF Pakistan Jawed Ali Khan, Director General, Ministry of Disaster Management Islamabad Javed Ahmed, Project Director, Safe Drinking Water, PHED Balochistan Kamran Naeem, Programme Manager, UN Habitat Khizar Hayat Gondal, Secretary, LG&CD Government of Punjab Laeeq Ahmed, Additional Secretary, PHED, Government of Sindh M Hafeez, Programme Manager, Wateraid Pakistan M Irfan Tariq, Director (Environment), Ministry of Disaster Mnagement M Rafique Tahir, Joint Secretary- Education, CAD Islamabad 82

83 Mian S Shafi, Unit Head, Urban, Water and Emergency, Asian Development Bank Resident Mission Pakistan Mohammad Nadeem, General Manager CPI, Pakistan Poverty Alleviation Fund Mustafa Talpur, Advocacy Manager, Wateraid Pakistan Nadeem Irshad Kayani, Programme Director, Directorate of Staff Development Lahore Nafees Ahmed Shaikh, Superintending Engineer, PHED, Government of Sindh Nasir Javed, Project Director, The Urban Unit, P&D Government of Punjab Nazir Ahmed Wattoo, President, Anjuman Samaji Behbood Faisalabad Rizwan Baig, Programme Manager, Muslimaid Pakistan S M Kaleem Makki, Secretary, PHED, Government of Sindh Saleem Gillani, Senior Programme Officer, JICA Pakistan Salman Yusuf, Deputy Secretary, HUD & PHE Department, Government of Punjab Shakeel Qadir Khan, Secretary Law and Order FATA, former Chief Economist Khyber Pakhtunkhwa Sheikh Mehmood ul Hassan, Secretary Local Government Balochistan Sheikh Nawaz Ahmed, Deputy Secretary Public Health Engineering Department Balochistan Sher Hasan, WATSAN Specialist, Concern Worldwide Simone Klawitter, Chief WASH, UNICEF Pakistan Sohail Akhtar Shehzad, Chief Urban Development and IT, P&D Department Government of Punjab Suhail Aamir, Secretary, HUD & PHE Department, Government of Punjab Syed Ayub Qutub, Executive Director, PIEDAR Pakistan Zahid Shakeel Ahmad, Water Supply Consultant 83

84 Annexure 2 Costing Table 13: Water Supply Costing Balochistan Balochistan Total Population (million) Total Urban Rural Per Capita Investment 4000 Water Supply Coverage Target (percentage) Urban Rural Investment Required (Rs. billion) Urban Rural Total (Source: PSLM data and provincial PHED average costs) 84

85 Table 14: Water Supply Costing Khyber Pakhtunkhwa KPK Total Population (million) Total Urban Rural Per Capita Investment 4000 Water Supply Coverage Target (percentage) Urban Rural Investment Required (Rs. billion) Urban Rural Total (Source: PSLM data and provincial PHED average costs) 85

86 Table 15: Water Supply Costing Punjab Punjab Total Population * (million) Total Urban Rural Per Capita Investment 4000 Water Supply Coverage Target (percentage) Urban Rural Investment Required (Rs. billion) Urban Rural Total (Source: PSLM data and provincial PHED average costs) 86

87 Table 16: Water Supply Costing Sindh Sindh Total Population (million) Total Urban Rural Per Capita Investment 4000 Water Supply Coverage Target (percentage) Urban Rural Investment Required (Rs. billion) Urban Rural Total (Source: PSLM data and provincial PHED average costs) 87

88 Table 17: Water Supply Costing Summary Investment Summary for Water Supply for 100% coverage Pakistan Total Population (million) Total Urban Rural Per Capita Investment 4000 Investment Required (Rs. billion) Urban Rural Total This does not include population or cost estimates for AJK, FATA and Gilgit Baltistan as PSLM data was not available for these. 88

89 Table 18: Sanitation Costing Balochistan Sanitation Sector Investment Requirements For Balochistan Province Balochistan Total Population (million) Total Urban Rural Per Capita % Sanitation Coverage Target (percentage) Urban Rural Investment Required (Rs. billion) Urban Rural Total % Sanitation Coverage Target (percentage) Urban 89

90 Rural Investment Required (Rs. billion) Urban Rural Total % Sanitation Coverage Target (percentage) Urban Rural Investment Required (Rs. billion) Urban Rural Total Source: PSLM data and provincial PHED average costs) 90

91 Table 19: Sanitation Costing Khyber Pakhtunkhwa Sanitation Sector Investment Requirements For KPK Province KPK Total Population (million) Total Urban Rural Per Capita % Sanitation Coverage Target (percentage) Urban Rural Investment Required (Rs. billion) Urban Rural Total % Sanitation Coverage Target (percentage) Urban

92 Rural Investment Required (Rs. billion) Urban Rural Total % Sanitation Coverage Target (percentage) Urban Rural Investment Required (Rs. billion) Urban Rural Total Source: PSLM data and provincial PHED average costs) 92

93 Table 20: Sanitation Costing Punjab Sanitation Sector Investment Requirements For Punjab Province Punjab Total Population (million) Total Urban Rural Per Capita % Sanitation Coverage Target (percentage) Urban Achieved Rural Investment Required (Rs. billion) Urban Rural Total % Sanitation Coverage Target (percentage) Urban Achieved

94 Rural Investment Required (Rs. billion) Urban Rural Total % Sanitation Coverage Target (percentage) Urban Rural Investment Required (Rs. billion) Urban Rural Total Source: PSLM data and provincial PHED average costs) 94

95 Table 21: Sanitation Costing Sindh Sanitation Sector Investment Requirements For Sindh Province Sindh Total Population (million) Total Urban Rural Per Capita % Sanitation Coverage Target (percentage) Urban Achieved Rural Investment Required (Rs. billion) Urban Rural Total % Sanitation Coverage Target (percentage) Urban Achieved

96 Rural Investment Required (Rs. billion) Urban Rural Total % Sanitation Coverage Target (percentage) Urban Rural Investment Required (Rs. billion) Urban Rural Total Source: PSLM data and provincial PHED average costs) 96

97 Table 22: Sanitation Costing Summary INVESTMENT FOR SANITATION POPULATION Total - PKRs Total Urban Rural INVESTMENT IN PKRS BILLION Urban 67% % % Rural % % % Total 67% % % This does not include population or cost estimates for AJK, FATA and Gilgit Baltistan as PSLM data was not available for these. 97

98 United Nations Children s Fund Pakistan Country Office/WASH 90 Margala Road, F-8/2 Tel: Avicenna Consulting Pvt Ltd 18-B Kaghan Road, F-8/4 Islamabad Tel: