Water and Sanitation

Water for People’s Well-Being. (2013). Human Development in South Asia 2013: Water for Human Development. MahbubulHaq Human Development Centre.
The second chapter in the report emphasizes on the importance of clean water and sanitation for human development, with the arguments that they reduce income poverty and child mortality, break life-cycle disadvantages, enhance female education and free girls’ and women’s time from collecting water from long distances. While in the rural areas, poor human health is due to lack of necessary sanitation facilities and sometimes access to water at all, in urban areas population growth and urbanization contributes to poor human health, more so because of increasing water demand and water pollution. Furthermore, women feel the impact of these impediments more. Thus, using an integrated gender-sensitive approach to development, especially in line with the human development paradigm, can have a positive impact on the sustainability and effectiveness of water interventions in addition to water conservation. The chapter also points out that the actual financial and technical resources budgeted and utilized have varied substantially. The deficit in financing in the water and sanitation sector has resulted in lower coverage. Thus, it recommends that there should be provision for water as a human right in the legislation. There is also need for regulation and equity through pricing and subsidies so that the poor have access to this basic right.

Sanitation and Water for All. (2012). Pakistan Sector Status Report.
According to the report, 100-150 children die every day because of diarrhoeal related illnesses, despite the fact that many of these deaths can be prevented by adequate sanitation, safe drinking water and improved hygiene. Half of the rural population is without adequate sanitation and Pakistan is off-track to meet the projected MDG target of 67%. While the basic framework exists in order to improve the current dismal conditions in water and sanitation, the fact remains that there are some critical bottlenecks, which need to be addressed in order to meet MDG targets. These bottlenecks include institutional arrangements with overlapping of roles and responsibilities and weak coordination mechanisms; dysfunctional water supply schemes; ageing infrastructure; poor water quality from polluted and contaminated sources; and inadequate solid waste management. Thus, the report suggests taking action by developing a National Sector Action Plan comprised of Provincial Action Plans to effectively implement national policies on sanitation and drinking water. It also suggests prioritizing Sanitation and Drinking Water within MTDF, MTEF and enhance by 2015, the sectoral allocation for water supply and sanitation by 1% of overall PRSP. It further recommends establishing a national monitoring framework for sanitation and drinking water based on provincial monitoring frameworks.
http://www.un.org.np/sacosan/uploads/document/file/Water and Sanitation Sector Review Report 2012_20121130024145.pdf

State Of Water & Sanitation In Punjab Position Paper. (2011). Punjab Urban Resource Centre.
This paper analyzes the existing water and sanitation scenario in Punjab. It reviews the legislative, policy and institutional framework, statistical data, and significant issues in the sector and provides possible solutions to improve the state of affairs in water and sanitation sector. Key findings of the paper reflect that in Punjab provision of water from improved sources is not an issue as this is available to about 97% of the population. The issue is of quality as 49% of the water is contaminated due to poor sanitation arrangements. The situation of sanitation is worse in villages and small towns, as they have poor solid waste management systems. However, unsafe drainage and disposal of wastewater is predominant in both urban and rural settlements. Furthermore, regulatory framework for industrial, hospital and other waste management is too weak to enforce compliance. Therefore, the paper recommends that in order to improve the quality of water, more investment should be made in sanitation rather than in water, as improved sanitation will improve its quality. Water utilities should also improve chlorination facilities to ensure safe water supply. Moreover, maintenance of services can be transferred to the communities by formulating community organizations, which will further reduce the financial burden on WASA.
http://purclahore.org/images/documents/Position Paper-Web.pdf

The economic impacts of inadequate sanitation in Pakistan.(2011). Water and Sanitation Program. World Bank.
The study empirically estimates the economic impacts of current poor sanitationconditions in Pakistan as well as the economic benefits of options for improved conditions. It provides policy makersat both national and local levels with evidence to justify larger investments
in improving the sanitation conditions in the country. According to the report, the current status of sanitation and poor hygiene practices has led to significant public costs, such as premature deaths and economic and financial costs due to diseases attributable to poor sanitation. Furthermore, national figures hide rural-urban disparities. Furthermore, health impacts accounted for the vast majority of total economic costs. They occur due to premature mortality, loss of productivity due to illness or costs of treatment. Therefore, priority treatment needs to be given to the issue of poor sanitation at all administrative levels—local, provincial, and national—and investments should be made to build moderately improved and hygienic latrines in both urban and rural areas. Special treatment and attention are needed in the areas where the poor population lives and in rural areas, where children are more at risk from diarrhea and malnutrition. Furthermore, education and awareness campaigns are needed at all levels, particularly in schools, to promote personal hygiene.

Gupta, Anjali Sen. (2010).Water and sewerage services in Karachi: Citizen Report Card – sustainable service delivery improvements. Water and Sanitation Program, World Bank.
This report discusses the key findings and recommendations emerging from a pilot Citizen Report Card (CRC) on water, sanitation, and sewerage services in Karachi. This initiative comes, on one hand, in the wake of deteriorating services and dysfunctional governance structures and, on the other, an emergent consensus to bring in far-reaching institutional reforms that should move beyond financial and technical imperatives. However, what distinguishes a CRC from a regular survey is the post-survey strategy to build upon the ‘symptoms’ provided by the CRC, and design effective and focused responses. The findings of the CRC shows that Karachi W&SB’s services were found to be satisfactory and above average by 6.5 percent of the users and that both users and utility staff want improvement in systems and services. Thus, by assembling a set of credible and objective benchmarks, the CRC has provided a forum for different stakeholders to converge around issues and explore solutions and reforms. Furthermore, CRC studies are also a means for testing out different options that citizens wish to exercise, individually or collectively, to tackle current problems. Thus, CRC can be used for other services as well.

Jehangir Khan, F., &Javed, Y. (2007). Delivering Access to Safe Drinking Water and Adequate Sanitation in Pakistan. Working Papers & Research Reports, 30, PIDE.
The current study considers the redefined improved facility concept underlining improved access to safe water source and hygiene levels in sanitation. It attempts to assess the access to safe drinking waterand adequate sanitation facilities in all the provinces of Pakistan by the year 2015. To calculate the coverage projections with respect to expenditure, the study used the Pakistan Social Living-standard Measure (PSLM), 2004-05, and Pakistan Integrated Household Survey (PIHS), 2001-02, survey results. Projections based on respective actual elasticity show that a total number of approximately 38.5 million people lacked access to safe drinking water source and 50.7 million people lacked access to improved sanitation in 2004-05. The study also highlights that the national water and sanitation policies documents provide a 
broader framework of action. However, these policies need to be pro- poor and must be revised after every five years including an independent mid-term and post evaluation. It also suggests that the government should support cost effective and low cost maintenance WATSAN schemes. Moreover, offering subsidies to households underlining treatment of drinking water at consumer/household level should be considered instead of spending a lot of money in complex and costly schemes.

Nanan, D., White, F., Azam, I., Afsar, H., &Hozhabri, S. (2003).Evaluation of a water, sanitation, and hygiene education intervention on diarrhoea in northern Pakistan.Bulletin of the World Health Organization, 81(3), 160-165.
This study examines the Water and Sanitation Extension Programme (WASEP) of the Aga Khan Development Network (AKDN), which it undertook in selected villages in Northern Areas and Chitral in northern Pakistan. The aim was to improve potable water supply at village and household levels, sanitation facilities and their use, and awareness and practices about hygiene behaviour. The WASEP intervention seemed to account for an estimated 25% reduction in the incidence of diarrhoea in children. In addition, younger children, girls, and children of younger mothers were associated with a higher likelihood of diarrhoea. These findings are important in terms of refining the approach to future water, sanitation, and hygiene initiatives in northern Pakistan. The integrated approach adopted by WASEP, which incorporates engineering solutions with appropriate education to maximize facility usage and improve hygiene practices, is a useful example of how desired health benefits can be obtained from projects of this type. Although the evaluation was made at an interim point of a scheduled five-year implementation plan, some sites had not completed the programme, and unexpected funding difficulties were experienced, the findings indicate that WASEP positively influenced the health status of villages served by the project, by reducing the incidence of diarrhoeal disease.

Luby et al. (2001).A low-cost intervention for cleaner drinking water in Karachi, Pakistan.International Journal of infectious diseases, 5(3), 144-150.
This pilot study investigates an inexpensive, home-based water decontamination and storage system in a low-income neighborhood of Karachi.The preferred method to provide quality drinking water in Karachi would be to develop and maintain effective municipal water purification and delivery system and an effective sanitary sewerage system. However, the population growth rate of Karachi, the massive investment required to improve the poor quality and condition of the existing water distribution and sanitary system, make a central solution to cleaner water unlikely in the short or intermediate term. Thus, according to the study, use of a plastic water storage vessel with home chlorination potentially offers an inexpensive, sustainable means to achieve cleaner water. In this RCT, hypochlorite solution was distributed to families in small reusable plastic bottles, with each bottle containing sufficient hypochlorite that when added to the 20-l vessel it reliably produced residual free chlorine without unpalatable over-chlorination. While there is possible slightly increased risk of malignancy with long-term exposure to chlorination byproducts, untreated water with heavy microbial contamination presents a much higher risk of death from diarrheal disease, especially among children under 5 years of age in these communities. Thus, the study recommends use of this in-house treatment of water as a short-term solution.