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Sanitation and Water for All (SWA) PAKISTAN Sector Status Report 2012 Investing Wisely SANITATION AND WATER Saving Lives
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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 .......................................................................................................................... 11

Population ................................................................................................................................... 11

Health ......................................................................................................................................... 11

Education .................................................................................................................................... 11

Poverty ........................................................................................................................................ 12

Urbanization ................................................................................................................................ 12

Economic Growth ........................................................................................................................ 14

Drinking Water ............................................................................................................................ 14

Sanitation .................................................................................................................................... 14

Sector Financing ......................................................................................................................... 16

Sector Financing - Provincial Situation ..................................................................................... 19

Provincial Finance Commission ............................................................................................... 22

External ................................................................................................................................... 23

Donor Coordination and Sector Wide Approach .......................................................................... 24

Estimating Cost for Water Supply and Sanitation ........................................................................ 25

Urgent Need for Action ................................................................................................................. 30

Health Impacts ............................................................................................................................ 30

Economic Impacts ....................................................................................................................... 31

Enablers ........................................................................................................................................ 35

Policies........................................................................................................................................ 35

National Sanitation Policy (2006)................................................................................................. 35

National Drinking Water Policy (2009) ......................................................................................... 35

Overview of Financial Planning and Budgeting ............................................................................ 39

Examples of Best Practice ........................................................................................................... 41

Changa Pani Programme (CPP) - Government ........................................................................... 41

Orangi Pilot Project ..................................................................................................................... 41

3

Lodhran Pilot Project (LPP) ......................................................................................................... 41

Community Led Total Sanitation (CLTS) ..................................................................................... 42

Pakistan Approach to Total Sanitation (PATS) ............................................................................ 42

North Sindh Urban Services Corporation (NSUSC) ..................................................................... 43

Water and Sanitation Extension Programme (WASEP) ............................................................... 43

Citizen Report Card ..................................................................................................................... 44

Formalizing Rural Water Supply Billing Systems ......................................................................... 45

Converting Waste into Resource - Waste Management Industry ................................................. 45

Intersectoral Collaboration Opportunities .................................................................................. 47

Education .................................................................................................................................... 47

Health ......................................................................................................................................... 47

Bottlenecks ................................................................................................................................... 49

Institutional Arrangements ........................................................................................................... 49

Water and Sanitation Agencies ................................................................................................... 50

Operation and Maintenance ........................................................................................................ 52

Urban Water Supply and Sewerage Schemes ......................................................................... 52

Rural Water Supply and Sewerage Schemes .......................................................................... 52

Equity and Inclusion .................................................................................................................... 54

Quality ......................................................................................................................................... 55

Waste .......................................................................................................................................... 58

Waste Water ............................................................................................................................ 58

Solid Waste ............................................................................................................................. 59

Monitoring ..................................................................................................................................... 61

Definitions and Information Management .................................................................................... 61

Institutional Mechanisms for Monitoring....................................................................................... 62

Climate Change ............................................................................................................................. 63

Disaster Risk Reduction .............................................................................................................. 64

Vulnerability to Climate Change .................................................................................................. 65

Taking Action ................................................................................................................................ 68

Catalyzing Actions ....................................................................................................................... 68

Institutional Arrangements ........................................................................................................... 68

Operation and Maintenance - Urban ........................................................................................... 69

Operation and Maintenance - Rural ............................................................................................. 69

Monitoring ................................................................................................................................... 69

Sectoral Financing ...................................................................................................................... 70

Human Resource Development .................................................................................................. 70

Partnerships ................................................................................................................................ 71

4

Climate Change .......................................................................................................................... 71

Research ..................................................................................................................................... 71

Bibliography .................................................................................................................................. 73

Acronyms ...................................................................................................................................... 78

Annexure 1 - Methodology ........................................................................................................... 81

Background ................................................................................................................................. 81

Scope and Purpose ..................................................................................................................... 81

Process ....................................................................................................................................... 81

Stakeholders Consulted .............................................................................................................. 82

Annexure 2 – Costing ................................................................................................................... 84

5

List of Tables and Figures Table 1: Growing Population in Cities ............................................................................................. 13

Table 2: Current Access Rates for Drinking Water and Sanitation .................................................. 15

Table 3: PRSP Budgetary Expenditures of FY 2010-11, FY 2009-10 and FY 2008-09 ................... 18

Table 4: External Assistance to the Sector ...................................................................................... 23

Table 5: Estimating Resource Needs for MDG Targets for Drinking Water ..................................... 26

Table 6: Estimating Resource Needs for MDG Targets for Sanitation ............................................. 27

Table 7: Estimating Resource Gap for MDG Targets for Water (100%) and Sanitation (67% both urban and rural) Coverage .............................................................................................................. 28

Table 8: Institutional Framework for Drinking Water and Sanitation ................................................ 38

Table 9: Summary of WASAs ......................................................................................................... 51

Table 10: Bacterial Contamination Levels of Water Sources of 23 Cities of Pakistan ...................... 57

Table 11: Per Capita Availability of Water ....................................................................................... 57

Table 12: Status of Waste Water and Treatment in Major Cities of Pakistan ................................... 59

Table 13: Water Supply Costing Balochistan .................................................................................. 84

Table 14: Water Supply Costing Khyber Pakhtunkhwa ................................................................... 85

Table 15: Water Supply Costing Punjab ......................................................................................... 86

Table 16: Water Supply Costing Sindh ........................................................................................... 87

Table 17: Water Supply Costing Summary ..................................................................................... 88

Table 18: Sanitation Costing Balochistan ........................................................................................ 89

Table 19: Sanitation Costing Khyber Pakhtunkhwa ......................................................................... 91

Table 20: Sanitation Costing Punjab ............................................................................................... 93

Table 21: Sanitation Costing Sindh ................................................................................................. 95

Table 22: Sanitation Costing Summary ........................................................................................... 97

Figure 1: Trends in Access to Sanitation ......................................................................................... 16

Figure 2: Drinking Water and Sanitation Sectoral Expenditure Decadal Trend ................................ 17

Figure 3: Sectoral Expenditure to GDP ratio ................................................................................... 18

Figure 4: Access to Sanitation and Sectoral Public Expenditure ..................................................... 19

Figure 5: Drinking Water and Sanitation Allocations as Proportion of Provincial ADP 2011-12 ....... 20

Figure 6: Provincial Allocations for Drinking Water and Sanitation in ADPs 2011-12 ...................... 20

Figure 7: Drinking Water and Sanitation 3 Years Trend of Total Sectoral Budget as Proportion (%) of Total Provincial PRSP Allocation .................................................................................................... 21

Figure 8: Drinking Water and Sanitation 3 Years Trend of Sectoral Development Budget as Proportion (%) of Total Provincial PRSP Development Allocation ................................................... 21

Figure 9: Schematic Diagram Illustrating Major Institutional Gaps .................................................. 36

6

Preface Improving the quality of life of all people, especially those that are underprivileged and under-served, 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 2012. 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.

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 2012. 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 2009-2010 and flush latrines increased from 45% in 2001 to 66% in 2010-2011.

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 2005.

Urgent Need for Action

100-150 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. 60-75 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 peri-urban 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

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;

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 2012

10. Set up a research working group to identify research priorities in the sector

10

CURRENT SITUATION

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 30-35 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 125th 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 2010-11).

There has been a significant reduction in public spending on health nutrition from 0.72% of GDP in

2000-2001 to 0.23% in 2010-2011 (Economic Survey of Pakistan 2010-11).

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 2010-11).

The transition from primary to secondary education is low. About 15% of children in the 10-18 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 2009. It now caters for

about 40% of total enrolment.

According to Pakistan Education Statistics (2010-11) of missing facilities in government primary and

middle schools in 2010-2011, 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 2010-11).

12

Poverty

In the last decade between 2001-2009, 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 2011.

In the period of July-April 2010-2011, 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 2010-11).

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.

13

Table 1: Growing Population in Cities

City with more than 1 million population

Population 2030 (‘000)

Karachi 27993

Lahore 14626

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)

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 2010-2011 revealed that about

91% of the population had access to improved drinking water, with 94% for urban and 90% for rural

(PSLM 2010-11).

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 1995. 5%

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 2010-2011, 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 2009-10 data. The surveys shown in Table 2 provide

information about access but not about utilization.

15

Table 2: Current Access Rates for Drinking Water and Sanitation

PSLM 2010-2011 % JMP 2012 % Indicator Urban Rural Total Indicator Urban Rural Total Drinking Water

Drinking Water

Tap Water 58 19 32 Total Improved

96 89 92

Hand Pump 8 38 28 Piped on Premise

58 23 36

Motor Pump

28 27 27 Other Improved

38 66 56

Dug Well 1 6 4 Unimproved 4 6 5 Others 6 10 9 Surface 0 5 3

Sanitation Sanitation Flush 96 51 66 Improved 72 34 48 Non Flush 3 22 15 Shared 6 6 6 No Toilet 2 27 18 Other 18 26 23

Open Defecation

4 34 23

(Source: PSLM 2010-11, JMP 2012)

16

Figure 1: Trends in Access to Sanitation

(Source: Own compilation from PIHS 2001-02 report and PSLM report 2010-11)

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 2011.

Sector Financing

The financial layout for Drinking Water and Sanitation for the period 2010-2015 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 2010-2011 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 2011-2012 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.

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 2010-11).

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 2009-10 over 2008-09,

and a 12% increase in 2010-11 over 2009-10 (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.

18

The sectoral contribution of water supply and sanitation in PRSP expenditures for FY 2008-09, FY

2009-10 and FY 2010-11 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 2009-10 and

152.9% in FY 2010-11 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 2010-11, FY 2009-10 and FY 2008-09

(Billion Pakistani Rupees)

FY 2010-11 FY 2009-10 FY 2008-09

Punjab Sindh KPK Bal Punjab Sindh KPK Bal Punjab Sindh KPK Bal

Total 15.2 4.6 2.8 5.2 12.4 6.4 3.1 3.1 11.5 5.5 2.6 2.2

Current 5.1 0.9 0.8 2 4 0.7 1.4 0.9 3.4 0.7 1.2 1.4

Develop-ment

10.1 3.7 2 3.2 8.4 5.7 1.7 2.2 8.1 4.8 1.4 0.8

(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 2009-10, there was an actual sectoral spend of Rs. 25.4 billion against a budget of Rs. 20.4

billion resulting in a 24% deviation, while in 2010-11, there was an actual spend of Rs. 28.5 billion

against a budget of Rs. 23.6 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

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 2011-12, 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%.

20

Figure 5: Drinking Water and Sanitation Allocations as Proportion of Provincial ADP 2011-12

(Source: Authors compilation, based on provincial ADPs of 2011-12)

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 2011-12

(Source – own computation from provincial ADPs of 2011-12)

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.

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 2011.

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.

23

External

Japan predominates in providing over 50% of the total external assistance allocated for drinking

water and sanitation for Pakistan in FY 2011-12.

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 300 39%

France 150 19%

IBRD 50 6%

IDA 0.5 0%

IDB 132 17%

Japan 108 14%

Total 778.5 100%

(Source; Authors compilation, sector-wise commitments and disbursements of foreign economic assistance 2011-12, 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 2011-12, Economic Affairs Division). For planned

disbursements for 2011-12, 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

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.

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 2010-11 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 2008-09 to FY 2010-11)

26

Table 5: Estimating Resource Needs for MDG Targets for Drinking Water

Pakistan 2012* 2012 -2013

2013 -2014

2014 -2015

Total

Population (million)

Total 172.9 176.42 180.03 183.71

Urban 55.3 56.44 57.59 58.76

Rural 117.57 119.97 122.42 124.93

Per Capita Investment Rs 4000

Investment Required (Rs billion)

Urban 4.71 4.81 4.91 14.44

Rural 16.51 16.84 17.19 50.53

Total 21.22 21.65 22.10 64.97

(Source: Authors compilation, based on PSLM reports, discussions with provincial PHE departments)

The source tables for costing are presented in Annexure 2.

27

Table 6: Estimating Resource Needs for MDG Targets for Sanitation

INVESTMENT FOR SANITATION

POPULATION* 2012-2013 2013-2014 2014-2015 Total- PKRs

Total 176.42 180.03 183.71

Urban 56.44 57.59 58.76

Rural 119.97 122.42 124.93

INVESTMENT IN PKRS BILLION

Urban

67% 0.41 0.42 0.43 1.26

80% 1.86 1.90 1.94 5.70

100% 6.56 6.69 6.80 20.05

Rural

67% 28.12 28.69 29.29 86.10

80% 48.83 49.82 51.11 149.76

100% 81.23 82.88 83.90 248.02

Total

67% 28.54 29.11 29.71 87.36

80% 50.69 51.72 53.05 155.46

100% 87.79 89.57 90.71 268.07

* 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.

28

Table 7: Estimating Resource Gap for MDG Targets for Water (100%) and Sanitation (67% both urban and rural) Coverage

Pakistan 2012* 2012 -2013 2013 -2014 2014 -2015 Total

Current and Projected Sectoral Expenditure in Rs billion (if current levels sustained)

Current and Projected

Expenditure 28.5 28.5 28.5 28.5 85.5

Resource needs for Water (100%

coverage) 21.22 21.65 22.1 64.97

Resource needs for Sanitation (67% coverage)

28.54 29.11 29.71 87.36

Total Resource Needs

49.76 50.76 51.81 152.33

Resource gap 21.26 22.26 23.31 66.83

Resource gap as proportion of GDP (2010)

0.12 0.12 0.13

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.

29

URGENT NEED FOR ACTION

30

Urgent Need for Action

Health Impacts

Pakistan has a high Under 5 mortality rate of 86.5 per 1000. 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 48-59 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 2010-11, 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 2006-07). This means that 100-150 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

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

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 off-

track to meet MDG target 10. World Health Organization, 2007).

33

34

ENABLERS

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 2025.

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

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,

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.

38

Table 8: Institutional Framework for Drinking Water and Sanitation

ACTs Pakistan Environmental Protection Act (1997)

Pakistan Environmental Protection Council approves policies and provides guidelines, while Pakistan Environmental Protection Agency prepares policies, reports, standards and responsible for enforcement

Policies and Strategies

National Environmental Protection Policy National Sanitation Policy National Drinking Water Policy National Climate Change Policy

National Drinking Water Quality Standards National Behaviour Change Communication Strategy

Provincial Provincial Government

Formulating provincial policies and legislations Execution of national policies Preparing action plans and resourcing them

District

Responsible for offices of departments decentralized to it, and has a Zila Council (also included in a city district)

Development of master plans, land use, zoning, rules, bye-laws, urban design, integrated water reservoirs, treatment plants and sanitation services etc

Tehsil/Taluka Municipal Administration

Responsible for spatial plans, execute and manage development plans, enforce municipal laws and regulations

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

Town Municipal Administration

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

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

Union Council

Reviews and approves annual development plans and budget proposals of Union Administration, mobilizes community involvement

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)

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

April

Priorities Committee chaired

by Planning Commission

reviews proposals

Meeting chaired by Planning

and Development Department

reviews proposals

Submits proposals for

discussion to Annual Plan

Coordination Committee

(APCC)

Finance and Planning

Office reviews proposals

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.

Once debated and approved

by Assembly, signed by Head

of Government, after which it

becomes the Finance Act for

the fiscal year

Similar process but with

provincial assembly

Authentication of the

Schedule of Authorized

Expenditure by the Chief

Minister

(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)

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

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 2010. 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

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.

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.

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 refuse-

derived fuel (RDF) based on the concept of waste-to-energy. Similarly an NGO in Karachi

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.

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 1000-1200 population or nearly 125-150 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.

48

BOTTLENECKS

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 18th 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.

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).

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

GWASA MWASA FWASA RWASA HWASA CDA

Population in service area (millions)

1.6 1.9 2.8 2.1 1.7 1.5

Water supply coverage %

28% 65% 53% 70% 95% 95%

Average hours water availability per day

14-16 6-8 6 6-8 2-3 2-3

Current water demand (MGD)

64 170 130 44 60 80

Actual water production capacity (MGD)

29 104 45 42 60 68

Number water connections

30125 36396 107805 88710 115918 57930

Non revenue water %

58% 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.

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 50,000-100,000 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

53

of major repairs up to early 2000. 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, 2001-2006, 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, 2001-2006, 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.

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:

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, 2001-2006, 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, 2001-2006, 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 80-85 % 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.

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 2006. 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 2010-11).

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 2001.

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 2001-11, 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.

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 62-100%

Bahawalpur 52-76% Loralai 73-100%

Gujranwala 29-71% Quetta 48-68%

Gujrat 56-100% 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 73-100%

Sialkot 40-70% Karachi 61-100%

Sukkur 67-83%

(Source : National Water Quality Monitoring Programme, Water Quality Status in Pakistan, Phase I-V, 2001-2006, 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

1951 34 5300 1971 65 2700 1981 84 2100 1991 115 1600 2000 148 1200 2013 207 850 2025 221 659

(Source: Vision 2030. 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.

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).

59

Table 12: Status of Waste Water and Treatment in Major Cities of Pakistan

City

Urban Population

(1998 census) millions

Total waste water

produced

106 m

3 / year

% of total % of

treated Receiving water body

Lahore 5 287 12.5 0.01

River Ravi, irrigation canals, vegetable farms

Faisalabad 2 129 5.6 25.6

River Ravi, River Chenab, vegetable farms

Gujranwala 1 71 3.1 0

SCARP drains, vegetable farms

Rawalpindi 1.4 40 1.8 0 River Soan, vegetable farms

Sheikhupura 0.9 15 0.7 0 SCARP drains

Multan 1 66 2.9 0 River Chenab, irrigation canals, farms

Sialkot 0.7 19 0.8 0 River Ravi, irrigation canals, farms

Karachi 9.3 604 26.3 15.9 Arabian Sea

Hyderabad 1 51 2.2 34

River Indus irrigation canals, SCARP drains

Peshawar 0.9 52 2.3 36.2 Kabul River

Other 19.5 967 41.8 0.7 0

Total Urban 43 2301 100 7.7 0

(Source: Master plan for urban waste water (municipal and industrial) treatment facilities in Pakistan 2002)

Solid Waste

(Adapted from State of Pakistan’s Economy, 2009. 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

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 0.283 kg/capita/day to 0.613 kg/capita/day or from 1.896 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 25.921 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

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 2010-2011 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.

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 2010-2011). 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.

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

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 2005-2015. 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 2005-2015 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.

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

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.

67

TAKING ACTION

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 2012

3. 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 18th 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

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

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 2013. 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

71

Partnerships

• Undertake a mapping of government, international non-government, national non-

government, 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

72

BIBLIOGRAPHY

73

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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 2011-12 Azad Jammu and Kashmir

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Annual Development Programme 2011-12 Khyber Pakhtunkhwa

Annual Development Programme 2011-12 Punjab

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Balochistan Public Sector Development Programme 2011-12

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 2005-2015. An Advocacy Guide. WHO 2005

Compendium on Environment Statistics of Pakistan 2010. Federal Bureau of Statistics, Government of Pakistan

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Disaster Risk Reduction Emergency Response for WASH, WSSCC Reference Note February 2009

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Early recovery water, sanitation and hygiene (WASH) strategy. National Disaster Management Authority, Government of Pakistan, 2010

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Greater Karachi Sewerage Plan S III, 2007, City District Government, KW&SB

Karachi Solid Waste Management (2006) - Karachi Master Plan 2020

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Linking poverty reduction and water management. Poverty Environment Partnership, 2006

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77

ACRONYMS

78

Acronyms ADP Annual Development Programme

CDS Comprehensive Development Strategy

CLTS Community Led Total Sanitation

CPP Changa Pani Programme

DALYS Disability Adjusted Life Years (DALYS)

GDP Gross Domestic Product

HDI Human Development Index

HLM High Level Meeting

HNS Health and Nutrition Supervisor

JMP Joint Monitoring Programme

KPK Khyber Pakhtunkhwa

LG Local Government

LHW Lady Health Worker

LPP Lodhran Pilot Project

MDGs Millennium Development Goals

MICS Multiple Indicators Cluster Survey

MoDM Ministry of Disaster Management

MTDF Medium-Term Development Framework

MTEF Medium - Term Expenditure Framework

NEQS National Environmental Quality Standards

NGO Non Governmental Organizations

OBB Output Based Budgeting

OPP Orangi Pilot Project

PATS Pakistan Approach to Total Sanitation

PCNA Post Crisis Needs Assessment

PCRWR Pakistan Council of Research in Water Resources

PEPA Pakistan Environmental Protection Act

PHED Public Health Engineering Department

PRSP Poverty Reduction Strategy Paper

79

PSDP Public Sector Development Programme

PSLM Pakistan Social and Living Standards Measurement Survey

RBF Result Based Financing

RDF Refuse-Derived Fuel

RSPN Rural Support Programme Network

SWA Sanitation and Water for All

UNICEF United Nations Children Fund

WASA Water and Sanitation Agency

WASH Water, Sanitation and Hygiene

WHO World Health Organization

WSP Water and Sanitation Programme

80

ANNEXURES

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 2012. 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

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

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

84

Annexure 2 – Costing

Table 13: Water Supply Costing Balochistan

Balochistan 2012 2012-2013 2013-2014 2014-2015 Total

Population (million)

Total 9.06 9.24 9.42 9.61

Urban 2.89 2.95 3.01 3.07

Rural 6.16 6.28 6.4 6.54

Per Capita Investment 4000

Water Supply Coverage Target (percentage)

Urban 96 97.33 98.66 99.99

Rural 53 68.67 84.34 100

Investment Required (Rs. billion)

Urban

0.16 0.16 0.16 0.48

Rural

3.94 4.01 4.10 12.05

Total

4.09 4.17 4.26 12.53

(Source: PSLM 2010-11 data and provincial PHED average costs)

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Table 14: Water Supply Costing Khyber Pakhtunkhwa

KPK 2012 2012-2013 2013-2014 2014-2015 Total

Population (million)

Total 23.77 24.25 24.74 25.24

Urban 7.6 7.76 7.91 8.07

Rural 16.16 16.49 16.82 17.16

Per Capita

Investment 4000

Water Supply Coverage Target (percentage)

Urban 96 97.33 98.66 100

Rural 77 84.67 92.34 100

Investment Required (Rs. billion)

Urban

0.41 0.42 0.43 1.26

Rural

5.06 5.16 5.26 15.48

Total

5.47 5.58 5.69 16.75

(Source: PSLM 2010-11 data and provincial PHED average costs)

86

Table 15: Water Supply Costing Punjab

Punjab 2012 2012-2013 2013-2014 2014-2015 Total

Population * (million)

Total 97.87 99.88 101.92 104.01

Urban 31.31 31.95 32.61 33.28

Rural 66.56 67.92 69.32 70.74

Per Capita

Investment 4000

Water Supply Coverage Target (percentage)

Urban 92 94.67 97.34 100

Rural 96 97.33 98.66 100

Investment Required (Rs. billion)

Urban

3.41 3.48 3.55 10.45

Rural

3.61 3.69 3.76 11.06

Total

7.03 7.17 7.32 21.51

(Source: PSLM 2010-11 data and provincial PHED average costs)

87

Table 16: Water Supply Costing Sindh

Sindh 2012 2012-2013 2013-2014 2014-2015 Total

Population (million)

Total 42.20 43.07 43.95 44.85

Urban 13.50 13.78 14.06 14.35

Rural 28.69 29.28 29.88 30.49

Per Capita

Investment 4000

Water Supply Coverage Target (percentage)

Urban 96 97.33 98.66 100 -

Rural 90 93.33 96.66 100

Investment Required (Rs. billion)

Urban

0.73 0.75 0.76 2.24

Rural

3.90 3.98 4.06 11.94

Total

4.63 4.73 4.82 14.19

(Source: PSLM 2010-11 data and provincial PHED average costs)

88

Table 17: Water Supply Costing Summary

Investment Summary for Water Supply for 100% coverage

Pakistan 2012 2012-2013 2013-2014 2014-2015 Total

Population (million)

Total 172.9 176.43 180.03 183.71

Urban 55.3 56.44 57.59 58.76

Rural 117.57 119.97 122.42 124.93

Per Capita Investment 4000

Investment Required (Rs. billion)

Urban

4.72 4.81 4.91 14.44

Rural

16.51 16.84 17.19 50.54

Total

21.22 21.65 22.10 64.97

This does not include population or cost estimates for AJK, FATA and Gilgit Baltistan as PSLM data

was not available for these.

89

Table 18: Sanitation Costing Balochistan

Sanitation Sector Investment Requirements For Balochistan Province

Balochistan 2011-2012 2012-2013 2013-2014 2014-2015 Total

Population (million)

Total 9.06 9.25 9.42 9.61

Urban 2.89 2.95 3.01 3.07

Rural 6.16 6.28 6.4 6.54

Per Capita 4000

67% Sanitation Coverage Target (percentage)

Urban

0 0 0

Rural 16 33 50 67

Investment Required (Rs. billion)

Urban

0.0 0.0 0.0 0.0

Rural

4.27 4.35 4.45 13.1

Total

4.27 4.35 4.45 13.1

80% Sanitation Coverage Target (percentage)

Urban

90

Rural 16 37 58 80

Investment Required (Rs. billion)

Urban

Rural

5.28 5.38 5.76 16.4

Total

5.28 5.38 5.76 16.4

100% Sanitation Coverage Target (percentage)

Urban 84 89 94 100

Rural 16 44 72 100

Investment Required (Rs. billion)

Urban

0.59 0.60 0.74 1.9

Rural

7.03 7.17 7.32 21.5

Total

7.62 7.77 8.06 23.5

Source: PSLM 2010-11 data and provincial PHED average costs)

91

Table 19: Sanitation Costing Khyber Pakhtunkhwa

Sanitation Sector Investment Requirements For KPK Province

KPK 2011-2012 2012-2013 2013-2014 2014-2014 Total

Population (million)

Total 23.77 24.26 24.74 25.24

Urban 7.6 7.76 7.91 8.07

Rural 16.16 16.49 16.82 17.16

Per Capita 4000

67% Sanitation Coverage Target (percentage)

Urban 63 64.3 65.6 66.9

Rural 56 59.67 63.34 67.01

Investment Required (Rs. billion)

Urban

0.41 0.42 0.43 1.26

Rural

2.42 2.47 2.52 7.41

Total

2.83 2.89 2.95 8.67

80% Sanitation Coverage Target (percentage)

Urban 63.00 69.00 75.00 80.00

92

Rural 56.00 64.00 72.00 80.00

Investment Required (Rs. billion)

Urban

1.86 1.90 1.94 5.70

Rural

5.28 5.38 5.49 16.15

Total

7.14 7.28 7.43 21.85

100% Sanitation Coverage Target (percentage)

Urban 63.00 75.00 87.00 100.00

Rural 56.00 71.00 86.00 100.00

Investment Required (Rs. billion)

Urban

3.72 3.80 3.87 11.40

Rural

9.89 10.09 9.61 29.60

Total

13.62 13.89 13.48 40.99

Source: PSLM 2010-11 data and provincial PHED average costs)

93

Table 20: Sanitation Costing Punjab

Sanitation Sector Investment Requirements For Punjab Province

Punjab 2011-2012 2012-2013 2013-2014 2014-2015 Total

Population (million)

Total 97.87 99.88 101.92 104.01

Urban 31.31 31.95 32.61 33.28

Rural 66.56 67.92 69.32 70.74

Per Capita 4000

67% Sanitation Coverage Target (percentage)

Urban Achieved 0 0 0

Rural 61 63 65 67

Investment Required (Rs. billion)

Urban

0 0 0 0.00

Rural

5.43 5.55 5.66 16.64

Total

5.43 5.55 5.66 16.64

80% Sanitation Coverage Target (percentage)

Urban Achieved - - -

94

Rural 61.00 67.33 73.67 80.00

Investment Required (Rs. billion)

Urban

0.00 0.00 0.00 0.00

Rural

17.20 17.55 17.91 52.66

Total

17.20 17.55 17.91 52.66

100% Sanitation Coverage Target (percentage)

Urban 97.00 98.00 99.00 100.00

Rural 61.00 74.00 87.00 100.00

Investment Required (Rs. billion)

Urban

1.28 1.30 1.33 3.91

Rural

35.32 36.04 36.78 108.15

Total

36.60 37.35 38.11 112.06

Source: PSLM 2010-11 data and provincial PHED average costs)

95

Table 21: Sanitation Costing Sindh

Sanitation Sector Investment Requirements For Sindh Province

Sindh 2011-2012 2012-2013 2013-2014 2014-2015 Total

Population (million)

Total 42.20 43.07 43.95 44.85

Urban 13.50 13.78 14.06 14.35

Rural 28.69 29.28 29.88 30.49

Per Capita 4000

67% Sanitation Coverage Target (percentage)

Urban Achieved 0 0 0

Rural 26 39.66 53.32 67

Investment Required (Rs. billion)

Urban

0 0 0 0

Rural

16.00 16.33 16.66 49.0

Total

16.00 16.33 16.66 49.0

80% Sanitation Coverage Target (percentage)

Urban Achieved - - -

96

Rural 26 44 62 80

Investment Required (Rs. billion)

Urban

0 0 0 0

Rural

21.08 21.51 21.95 64.5

Total

21.08 21.51 21.95 64.5

100% Sanitation Coverage Target (percentage)

Urban 95 96.75 98.5 100

Rural 26 50.65 75.35 100

Investment Required (Rs. billion)

Urban

0.96 0.98 0.86 2.81

Rural

28.99 29.58 30.19 88.75

Total

29.95 30.56 31.05 91.56

Source: PSLM 2010-11 data and provincial PHED average costs)

97

Table 22: Sanitation Costing Summary

INVESTMENT FOR SANITATION

POPULATION 2012-2013 2013-2014 2014-2015 Total - PKRs

Total 172.90 176.44 180.03

Urban 55.30 56.44 57.59

Rural 117.57 119.97 122.42

INVESTMENT IN PKRS BILLION

Urban

67% 0.41 0.42 0.43 1.26

80% 1.86 1.90 1.94 5.70

100% 6.56 6.69 6.80 20.05

Rural

0.00

67% 28.12 28.69 29.29 86.10

80% 48.83 49.82 51.11 149.76

100% 81.23 82.88 83.90 248.02

Total

67% 28.54 29.11 29.71 87.36

80% 50.69 51.72 53.05 155.46

100% 87.79 89.57 90.71 268.07

This does not include population or cost estimates for AJK, FATA and Gilgit Baltistan as PSLM data

was not available for these.

98

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Pakistan Country Office/WASH

90 Margala Road, F-8/2

Tel: 051-209-7848

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