Pakistan’s Sanitation Situation: Need for an urgent action

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 Pakistan’s Sanitation Situation: 
Need for an urgent action

In Pakistan, more than 40% of hospital admissions and
deaths are due to contaminated water borne disease

Prof. Emeritus Lt. Gen. Mahmud Ahmad Akhtar
Former Surgeon General Pak Army/DGMS (IS)

Last year, Pakistan was placed at the tenth position from the bottom in the world sanitary index of nations. Indeed, it was pathetic condition. Poor sanitation is one of the major factor for the high incidence for communicable diseases particularly created by oral fecal contamination. Sadly now, Pakistan has been ranked the seventh worst country - sinking down three places from the last year. Pakistan is at the bottom of the pile when it comes to the gamut of community health issues. Despite discomfiture, the authorities concerned both at the federal and provincial levels have done nothing to stop the slide- our priorities are lopsided. We ignore prevention of diseases which should be the top priority. We think that Pakistan consists of posh localities hardly forming 10% of Pakistan and totally ignore the 90% of Pakistan consisting of the common people (AWAM). Even within Islamabad one can see posh gated localities and adjoining terribly neglected slums and shanty towns. Although Quaid- e- Azam founded Pakistan to uplift these down trodden people but the dream has gone sour due to the policies of dictators and their created political parties/leaders.


Lt. Gen. (R) Mahmud Ahmad Akhtar

The population remains without access to basic sanitation. “Sanitation Charity Water-Aid” estimates that 79 million people lack access to a proper toilet while 37 % have no system for waste water disposal at all.

Last year there was a lot of empty rhetoric to rectify the embarrassing situation but it has worsened further. Even most of the sub- Saharan countries have better health indicators including sanitary index.

Lack of proper sanitation exposes large segments of population to highly contagious diseases and undermines public health. In Pakistan, more than 40% of hospital admissions and deaths are due to contaminated water borne disease. Enormous sufferings and loss of scarce money occurs in the treatment of these patients- also creating problems of antibacterial resistance. Prevention is cost effective in fact the only cure and the real cure. It is high time that the authorities in the federal level, in all four provinces and other regions woke up from the slumber and divert whole lot of attention to the issue. The severity of the crisis demands an immediate shift of focus.

The governments should take ownership of the sanitation problems and maximize their efforts to address these as a priority. The key is to tackle sanitation and waste-water problems. We have already missed millennial development goals and should not miss sustainable development goals at least for sanitation and waste water management.

The objective of these goals is to ensure that most individuals and households have access to a safely managed, household toilet year and the human waste contained, transported, treated and disposed of in a safe and sustainable way. It is absolutely possible. At the moment, waste is seen often openly burnt, further polluting the atmosphere- causing respiratory and other disorders increasing the burden of diseases.

Good hygienic measures are a vital part of our religion, said to be half of our faith as Pakistan's name signifies land of purity-of course the land is pure, but its inhabitants had made it impure. Let us take turn around and make it pure as envisaged by the founder of the state.


All segments of the population the media, prayer leaders, NGOs/INGOs academia and more actively medical community, institutions, associations, professional bodies should be part of the active and persistent campaign. The campaign should start from households to streets to communities. Personal hygiene/sanitation particularly proper hand washing should be given utmost importance. It would prevent massive morbidities and mortalities due to gastro-intestinal infections. Sanitation should be included in the text syllabi at all levels of education. During the British era, early in mornings, water was sprinkled on the streets and roads, sanitary staff used to sweep streets and roads and clean the drains. The sanitary inspectors and the health officers were present on the spot supervising the proceedings. Deputy Commissioner or his wife used to frequently visit sites. In the cantonment area, there was a station health organization headed by a senior health officer. The cantonments were kept thoroughly clean.

Insecticides were sprinkled regularly at all places including residences. The station commander or his wife used to pay visit to the sites. There used to be a dry day in a week to prevent breeding of mosquitoes, potable water was properly chlorinated and regularly tested.

Awareness campaigns were carried out by the municipal authorities and the Cantt station. Has Food outlets were regularly and strictly checked. There were municipal services like reading rooms provided with newspaper, journals, magazines, health education literature in the localities and well stocked central libraries in the towns and Cantts. There were also dispensaries in the localities visited by doctors, providing first aid and treatments for common ailments. Alas, these services are no more. These should be restored. In the UK sanitary worker is paid ten pounds per hour for the services. Pakistani sanitary workers should also be paid better wages, their status enhanced and their services better appreciated.

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