In Pakistan, water and sanitation-related diseases account for 60 per cent of the total child mortality cases. Of these, diarrhoeal diseases alone are estimated to kill more than 200,000 children under five years of age every year. The annual mortality rate for children under five years old was estimated to be 117 deaths per 1,000 children in 1990-91. Though the numbers have reduced to 75 deaths for every 1,000 live births in 2007, according to Pakistan Millennium Development Goal Report (PMDGR) 2010, the figure is still unacceptably high.

Unsafe drinking water, inadequate sanitation and poor hygiene are the underlying causes of diarrhoea in children, mainly in the lower income groups. The combination of unsafe water consumption with poor hygiene practices causes diseases, which further exacerbate their economic conditions, due to high cost of medical aid.

Access to sanitary latrines at household levels is very low throughout the country. According to estimates, only 42 per cent people have access to safe latrines throughout Pakistan (65 per cent urban and 30 per cent rural).

Access to safe drinking water is also a critical health issue in the country. The projected population growth for the next ten years — from over 160 million to 221 million people — will exert further pressure on water demand, making access to safe water even more of a challenge.

Data indicate that just 65 per cent of the population has access to clean drinking water and that urban access to potable water is significantly higher than rural access — 85 per cent urban and 55 per cent rural.

Delivery of potable water supply is constrained by the inability of taluka/tehsil municipal administrations (TMAs), which are now responsible for providing safe water and to manage sustainable water systems in their respective jurisdictions.

Poor hygiene practices, such as lack of hand washing with soap at multiple critical times are common phenomena in the country, dangerously so in rural areas. Besides, there is a lack of awareness about what ‘clean’ water means. For instance, most believe that if water is clear and odourless it is suitable for drinking. This misconception could present a barrier for the acceptance of household water treatment methods or community water filtration plants. Until recent years, environmental health programmes have not given behaviour change the importance it is due.

Research has shown that mere access to water and sanitation may bring little or no behaviour change impact. Only a combination of clean water, improved sanitation and hygiene behaviours can ensure that in due course, the impact will appear in the district, national, and international statistics.

Even in developed urban areas, with organised administrative structures, resources and high water coverage, the quality of water can be so poor that waterborne epidemics are common. For instance, in Lahore and Karachi, the most developed cities in Pakistan, more than 40 per cent of the water supply is unfiltered, 60 per cent of industrial effluents are untreated, and groundwater sources are being contaminated by human waste and pollution.

However, there is a mounting concern about, and response to, the rapidly aggravating crisis regarding safe water and sanitation.

Halving the proportion of people without access to safe water by 2015 is the 10th MDG target. Access to clean drinking water, particularly to the poorest of the poor, remains a daunting challenge, especially at a time when the country is reeling under virulent water scarcity and rising surface water contamination. The country is also daunted by low coverage of safe drinking water supply, which is a major cause of waterborne diseases.

According to the PMDG 2010 report, water supply coverage has increased to 65 per cent in 2008-09 from 53 per cent in 1990. However, the target set for 2015 regarding the water supply reach is 93 per cent; this is hard to achieve without huge investment in water supply infrastructure. Development experts believe that given the current trends and the country’s current financial woes it is impossible to meet the target.

Although the country’s sanitation situation has increased by 100 per cent to 63 per cent in 2008-09 from 30 per cent in 1990, it is a long way from the target of 90 per cent access to safe sanitation to be met by 2015.

Limited resources and poor financial outlook for Pakistan in the next couple of years, make meeting the MDG targets a daunting challenge to the country. However, the government must endeavour and utilise all energies and financial resources towards achieving these goals because their attainment would certainly improve the country’s socio-economic face.

Many development experts believe that these challenging goals, particularly ‘Eradicating Extreme Poverty and Hunger’ as well as ‘Reducing Child Mortality’ can be met by pursuing an agenda of rapid inclusive economic growth, introducing concrete reforms, continuity and sustainability of policies and programmes and increased participation of the communities in the overall development process.