Poor Sanitation is Stunting Children in Pakistan – new World Bank Report

ISLAMABAD, November 13, 2018 – The alarming state of water supply and sanitation in Pakistan is creating major health hazards for the entire population and young children are particularly at risk, says a new World Bank report.

When Water Becomes a Hazard: The State of Water Supply, Sanitation and Poverty in Pakistan and its Impact on Child Stunting states that Pakistan has made significant progress on reducing poverty, improving dietary diversity and reducing open defecation. Despite this, critical markers of child health – rates of diarrhea and stunting – still do not show any real improvement.

The report finds that bacterial contamination of surface and ground water is on the rise because of the lack of treatment of human waste. Rural areas where the majority of poor households reside are the worst affected. Contamination levels are much higher in poorer and more rural districts and there is virtually no treatment of water at the household level. Fecal waste is also finding its way into surface soil and into the water used for crop irrigation. This is turn contaminates food supplies which find their way into urban centers posing health hazards for millions of city dwellers. Young children are most at risk due to diarrhea as well as growth faltering due to environmental enteropathy, which limits the absorption of nutrients even during periods when the child shows no signs of diarrhea—eventually leading to stunting.

“This report provides timely evidence and clear policy advice on the importance of safe water and sanitation for addressing malnutrition”, says Illango Patchamuthu, World Bank Country Director for Pakistan. “Stunting is a serious problem in Pakistan. It severely impacts the learning of children which puts them at a permanent disadvantage in the age of the knowledge economy. This requires urgent attention to the treatment of water and investment in the management of fecal waste”.

Given the gravity of the problem and the levels of investment required, the report recommends a targeted and multi-tiered approach. Investments in fecal waste management systems as well as in the provision of safe drinking water need to begin on an urgent basis but these will take time to reach scale. In the meantime, there are a number of relatively low-cost interventions that can be started immediately and at scale, to protect young children. These include efforts to encourage the point of use treatment of water and community and neighborhood-based interventions to contain exposure to fecal waste so that the oral-fecal route for the transmission of disease can be weakened, if not broken.

“There are huge disparities across the country in the quality of water and sanitation infrastructure. Rural areas across Pakistan have seen little or no investment in publicly provided piped drinking water, sewer connections or the treatment of human waste”, says Dr. Ghazala Mansuri, the author of the report. “But even the most developed urban areas are not immune. Untreated waste water is mixed with ground and surface water to irrigate crops, so these pathogens also find their way to urban households. The key issue is that in such a context no one is protected”.

Targeting available resources to the poorest and least well served districts would not only maximize the direct impact of public spending, it would also reduce the negative spillovers created by poor quality sanitation and water to neighboring non-poor areas creating a virtuous win-win cycle for all.

“Pakistan’s long-term aim must be adequate and safe piped water supply with metering and realistic tariffs”, says Farhan Sami, also an author of the report. “To accomplish this, we will need to safely move fecal waste away from human settlements and treat it adequately”.