ONE always had doubts about the reduction in poverty levels, from 64 per cent in 2001 to 30pc in 2014, being uniform across the country. Now the discrepancies between urban and rural areas and within metropolitan centres as revealed in a new World Bank report should serve as an eye-opener to anyone in a position of authority.

The report, titled When Water Becomes a Hazard: A Diagnostic Report on the State of Water Supply, Sanitation and Poverty in Pakistan and its Impact on Child Stunting, finds large “spatial disparities in poverty levels” and “in the pace of poverty reduction”. Over the past decade and a half, “Khyber Pakhtunkhwa saw the largest decline in poverty, followed by Punjab and Sindh” but in Balochistan, the poorest province in the country, the poverty rate in 2014 was a hefty 57pc.

Neither this nor the finding that rural areas lag behind the urban parts in terms of both poverty and access to basic services (education and health) should cause as much surprise as the disclosure about pockets of high poverty inside well-off districts, and that “districts that host large cities like Lahore, Rawalpindi and Faisalabad have much higher levels of within-district inequality than smaller districts”.

The failure to manage fecal sludge or waste water poses a grave threat to public health in rural Pakistan.

The focus of the report is on “the relationship between poverty, access to water and sanitation, and the nutritional status of children — especially child stunting” and it brings out the havoc that is being caused by the non-availability of safe water for drinking and other purposes. After noting a substantial reduction in open defecation — from 29pc in 2004-05 to 13pc in 2014-15 — due to increased access to water, sanitation and hygiene (WASH) facilities throughout the country, the report dwells on the gigantic failure to prevent water pollution. The rural areas have much less access to WASH facilities than their urban compatriots, and “the public sector provides virtually no piped water or sanitation in rural areas”.

The failure to manage fecal sludge or waste water poses a grave threat to public health in rural Pakistan. About 42pc of households in rural Punjab, 60pc in rural KP and 82pc in rural Sindh and Balochistan have no drainage system worth the name. “Untreated fecal waste water seeps into groundwater aquifers or drains into surface water, polluting both. Fecal sludge also contaminates the soil.”

The report concludes: “Lack of investment in fecal waste management, combined with the expansion of low-quality toilets, is the most critical determinant of weak nutritional outcomes in Pakistan.”

One factor of the poor WASH infrastructure in rural Pakistan highlighted in the report is the ­preferential allocation of resources to provincial capitals from 2004 to 2015. The total per capita ­allocation for Lahore was almost 18 times higher than the average for all other districts in Punjab combined. Meanwhile, Karachi received almost 100 times more in per capita terms than the other districts of Sindh.

The report makes a number of salutary recommendations that both the federal and provincial governments should seriously ponder over, because the inequalities between urban and rural areas and within urban settlements are perhaps the ­single biggest problem in the country. The ­recommendations are as follows:

— “Policy emphasis needs to shift from a focus on improving access to improving the quality and safety of WASH infrastructure and the safe management of human waste.”

— “Institutional structure at the provincial and local governments should be matched with their responsibilities for service delivery, and the lack of institutional coordination mechanisms and ­short-term planning horizons should be remedied.”

— “Improve technical capacity within providing agencies.”

— “Monitor the [WASH] sector and develop performance assessment metrics.”

— “Improve water quality on an urgent basis.”

— “Improve the targeting of resources to communities most in need and raise annual national spending on the sector to 1.4pc of GDP.”

While one should like to thank the World Bank for reminding us of the hazards to children’s health and the dangers of bringing up a generation that will be mentally and physically incapable of taking the nation forward, or even meeting the challenges of living in the modern world, the theme and findings of the report are not unfamiliar to us. Quite a few Pakistani economists and social activists have, at different times and in different ways, drawn attention to the grim consequences of both inter- region and intra-region inequalities, and called for special efforts for the uplift of the rural masses.

The proposition that there is a strong correlation between urbanisation and poverty reduction and improvement in access to water, sanitation and hygiene arrangements is not new either. Many decades ago, the level of development by a state began to be measured in terms of the access of its population, including those living outside cities, to urban facilities, ie safe water for drinking, electricity, schools near the homestead, minimum essential health cover and opportunities for gainful work. This model has often been recommended for Pakistan as it promises a decline in the birth rate, infant and maternal mortality, and in migration to cities.

However, there is a limit to which urbanisation and improved service delivery can enable the people of Pakistan to reduce poverty and overcome the hazards to people’s well-being caused by the absence of or inadequacies in water, sanitation and hygiene management.

In order to ensure that the entire population of the country can be rid of poverty and can overcome the hazards of consuming contaminated water, it will be necessary to liberate the people of the hydra-headed curse of an iniquitous land ownership pattern, feudal culture and patriarchy. Without a meaningful advance in these directions, a substantial part of the Pakistani population will remain condemned to increasing poverty, to living in urban slums, to non-realisation of women’s potential to contribute to progress, and to stunting in children.

Published in Dawn, November 15th, 2018