Contaminated water results in diarrhea, typhoid fevers, ante gastro
enteritis, cholera, dysenteries, viral hepatitis, polio, ascending
spinal paralysis & parasitic disorders
Lt. Gen. Mahmud Ahmed Akhtar Former Surgeon General Pakistan Army
Public Health
Adequate sanitation is an important factor for the health and progress of any nation. Our religion says that half of faith is good sanitation. Good personal sanitation leads to good national economic health. Inadequate sanitation leads to poor national health and poor natural economic health. Inadequate sanitation facilities have significant economic impacts on countries like Pakistan, Bangladesh, India etc. resulting in substantial GDP losses. In Pakistan poor sanitation costs approximately 3.96% of its GDP equating to approximately US$ 5.7 billion annually.
Lt. Gen. Mahmud Ahmed Akhtar
These figures underscore the pressing economic burden of inadequate sanitation in Pakistan and urgent need for improved infrastructure and hygiene practices. As of 2020, only 68% of the population had access to basic sanitation services, leaving around 32% without access to decent toilets. This represents almost 1/3rd of Pakistan’s population highlighting the onward going on challenge of achieving universal sanitation coverage.
Poor sanitation has severe health consequences. Contaminated water supplies lead to diseases such as diarrhea (bacterial), typhoid / paratyphoid, fevers, ante gastro enteritis, cholera, dysenteries (bacillary / amoebic), viral hepatitis, polio, ascending spinal paralysis, parasitic disorders etc. Diarrhea alone is a leading cause of child morbidity and mortality in the region.
Recurrent infections of G.I tract leads to malabsorption of nutrients causing malnutrition leading to wasting, marasmus, rickets and osteomalacia etc. Additionally, poor hygiene and lack of sanitation facilities lead to worm infestations causing anemia, weakness and reduced productivity conditions. Unsanitary birthing conditions increase the risk of sepsis, neonatal and maternal deaths. Pakistan is having the highest maternal, neonatal and infant mortality in the world even more than Afghanistan. Lack of menstrual hygiene facilities adversely affect women’s health and dignity. Open defecation and poor waste water management further exacerbate the spread of anti-microbial resistance due to un regulated antibiotics in waste.
In Sindh province in cities like Karachi etc. there occur cases of multiple drug-resistant typhoid fever infections needing highly extensive third or fourth generation antibiotics beyond the reach of most of the population. Many patients suffering from multi-resistant typhoid infection were reported in the UK, European countries, who travelled from Pakistan, spreading multi-resistant salmonella infection. In Pakistan, even antibiotics are sold without prescription, one of the rare countries to do it inspite of the World Health Organization repeated warning of its danger not only to the Pakistani public but also to other countries due to travelers.
Unfortunately, public health is given the least priority in Pakistan particularly in the prevention of disease, promotion of health, early diagnosis and early treatment, resulting in poor public health outcomes due to the lack of interest of rulers in general public. Their interest lies in posh localities, building expensive underpasses / flyovers, motorways, highways, avenues etc. serving less than 20% of the population, ignoring the working blatantly against the vision envisaged by the Quaid e Azam, the founder of Pakistan due to these anti people policies. Pakistan is placed in a disastrous position in the comity of nations. The rulers are the richest people while majority of people are the poorest of the world even Bangladesh has surpassed far ahead of Pakistan.
Likewise, the education of the common people is badly neglected. More than 26.2 million children are out of schools suffering in the streets of shanty areas. Education is the basis of nations progress, which is badly neglected. The recent pay increases of rulers (members of Senate, National and Provincial Assemblies) show how the money is mis-appropriated by the rulers. According to the Islamic principle, the Khalifa Omar said “if dog goes without food, I will face terrible consequences”. But who cares?
Quaid-e-Azam took only one rupee as a token salary and distributed his whole savings to the educational institutions. He even banned serving of tea in the official meetings. Our rulers spend enormous amount on luxurious dinners, travels, cars and to office buildings. Unfortunately, there is complete elite capture in Pakistan.
The economic cost of inadequate sanitation particularly in terms of health expenditures are substantial. A 2012 World Bank report estimated that poor sanitation costs Pakistan around 3.9% of its GDP or US$ 5.7 billion annually at that time. A 2021 analysis calculated the cumulative economic impact including health, water, welfare, tourism and drainage costs at Rs 910.4 billion (approximately US$ 4.96 billion) representing 1.091% of Pakistan’s GDP.
Poor sanitation reduces workforce productivity as illness caused by inadequate facilities lead to absenteeism affecting economic output. A significant portion of health care expenses in Pakistan is spent by individuals pushing many families into poverty. Government meanwhile spends substantial resources treating preventable diseases, diverting funds from other critical areas.
In India, inadequate sanitation facilities result in economic losses, about 5.4% of GDP amounting to approximately US$ 53.8 billion annually. Around 11% of the Indian population, approximately 150 million population still practice open defecation. Healthcare costs related to inadequate sanitation are estimated to US$ 38 billion each year.
Bangladesh has seen significant improvements, with open defecation rates dropping across all income levels. Use of improved sanitation facilities has more than tripled among the poorest segments and more than doubled over all. However, health costs related to poor sanitation still account for 2.4% of GDP, with preventable disease leading to annual treatment costs of 84 billion.
Elsewhere in South Asia and South East Asia, Vietnam reports that 4.0% of the population approximately 3.7 million people lack adequate sanitation. In Indonesia, about 9.0% of population or 25 million people lack proper sanitation services.
Globally, as of 2022, approximately 3.5 billion people lacked access to safely managed sanitation services. This includes 1.5 billion individuals without even basic sanitation facilities, with 419 million practicing open defecation.
Investing in improved sanitation system can significantly reduce the disease burden, lowering the healthcare costs and enhance overall economic productivity. Effective policies, public awareness campaigns and infrastructure development are critical to addressing the crisis.
In all divine religions of the universe, an emphasis has been laid on cleanliness, hygiene and sanitation. It is our moral, religious and healthcare responsibility to ensure personal and community hygiene.
