SCALING UP RURAL SANITATION IN PAKISTAN Jawed Ali Khan DG (Environment), MOE, Pakistan

1. Ministry of Environment Government of PakistanMinistry of Environment SCALING UP RURAL SANITATION IN PAKISTAN Jawed Ali KhanDG (Environment), MOE, Pakistan

2. Poor Sanitation – A Significant Health Hazard • 884 million people around the world still lack access to improved water supply (JMP 2010) • 2.6 billion people lack access to improved sanitation (JMP 2010) • 88% of this diarrhoeal disease is attributable to unsafe water and sanitation and is mostly concentrated on children in developing countries • Nearly one in five child deaths – about 1.5 million each year – is due to diarrhea (UNICEF/WHO, 2009) • Diarrhoea kills more young children than AIDS, malaria and measles combined (UNICEF/WHO, 2009) • In Pakistan, diarrhoea is the leading cause of mortality for children under 5 (PDHS 2006-7) • Approximately 117,000 children under the age of 5 in Pakistan die each year of diarrhoea (PDHS 2008) i.e 13 children/ hour • Diarrheal child morbidity – 24. 477 million cases (PSLM 2006-07 MINISTRY OF ENVIRONMENT

3. Total Sanitation Trends(JPM 2010) MINISTRY OF ENVIRONMENT

4. Vision under the National Sanitation Policy The National Sanitation Policy envisions creation of an open defecation free environment with safe disposal of liquid and solid waste and the promotion of health and hygiene practices in the country MINISTRY OF ENVIRONMENT

5. Holding of PACOSAN • Pakistan Conference on Sanitation (PACOSAN) was held on May 28th and 29th 2009 in Islamabad • PACOSAN provided a country level link, to the South Asian Conference on Sanitation (SACOSAN), a high level ministerial conference held every two years to address the regions critical sanitation issues • PACOSAN was organized by the Ministry of Environment, in collaboration with the Rural Support Programme Network (RSPN), the Water and Sanitation Program-South Asia (WSP-SA), UNICEF, USAID, UN Habitat, WaterAid and Plan Pakistan • A comprehensive roll out plan was prepared and presented in order to translate the National Sanitation Policy into action MINISTRY OF ENVIRONMENT

6. Pakistan Approach to Total Sanitation • Under the National Sanitation Policy of 2006, it is mentioned that the Total Sanitation model for the provision of sanitation will be formalized • Accordingly a Pakistan Approach to Total Sanitation has been devised and presented in a National Workshop on June 4, 2010 • The Approach uses principles as the basis of sanitation programming approaches enabling the federal and provincial governments greater programming flexibility in adapting context specific solutions as well as the opportunity to engage in meaningful discourse and exchange of experience across provinces • Presents community approaches to attain Integrated Total Sanitation MINISTRY OF ENVIRONMENT

7. FLOODS 2010 • 20.25 million people have been affected due to floods • 10.4 million of them are severely affected • 82 districts and over 230 tehsils experienced flood damage to water supply and sanitation (WATSAN) infrastructure. • No. of toilets lost in Pacca houses: 1,550 • No. of toilets lost in Kacha houses: 77,420 • Direct damages to public assets estimated at PKR 3,359 million (US$40 million) • Direct damage private assets estimated at PKR 4,532 million (US$53 million) • Indirect losses estimated at PKR 5,130 million (US$60 million) over a six-month early recovery period MINISTRY OF ENVIRONMENT

8. Challenges, Gaps & Capacity Issues • Sanitation and Hygiene promotion • When to do what (i.e. water vs sanitation and relief vs ER) • Understanding of what sanitation and hygiene promotion entails • keeping track of who-does-what-where is a major challenge • capacity for hygiene promotion at national and sub-national levels • Strategic priorities and timelines, as well as type of approach, will vary between and within provinces • Acute diarrhoea, acute respiratory infections, skin diseases and suspected malaria remain the leading causes of seeking health care in the flood affected districts • Total cases of reported acute diarrhoeal cases are more than 700,000 MINISTRY OF ENVIRONMENT

9. Early Recovery Sanitation Program in Flood affected Districts of Pakistan • Phase I of Sanitation Programme: • The primary objective of the proposed program is to reach out 0.700 million people (350,000 children, 154,000 women and 196,000 men) in four flood affected districts of Pakistan to safeguard and protect their health from water, sanitation and hygiene related diseases by means of undertaking a series of measures aiming at: • Ensuring 100 % safe management of excreta, attaining and sustaining the open defecation free status, and the use of secondary barriers • Promoting the use of safe, hygiene latrines and other sanitation facilities for men, women and children living in flood-affected areas • Persuading improved hygiene behaviors (The mass awareness campaigns will benefit the whole population of the Districts in general) MINISTRY OF ENVIRONMENT

10. Early Recovery Sanitation Program in Flood affected Districts of Pakistan • Phase I of Sanitation Programme: • The primary objective of the proposed program is to reach out 0.700 million people (350,000 children, 154,000 women and 196,000 men) in four flood affected districts of Pakistan to safeguard and protect their health from water, sanitation and hygiene related diseases by means of undertaking a series of measures aiming at: • Ensuring 100 % safe management of excreta, attaining and sustaining the open defecation free status, and the use of secondary barriers • Promoting the use of safe, hygiene latrines and other sanitation facilities for men, women and children living in flood-affected areas • Persuading improved hygiene behaviors (The mass awareness campaigns will benefit the whole population of the Districts in general) MINISTRY OF ENVIRONMENT

11. Early Recovery Sanitation Program in Flood affected Districts of Pakistan • Component 1: Institutional linkages & Capacity Building: • Advocacy with Provincial govts /District Governments • Conducting rapid capacity assessment to serve as the foundation for designing comprehensive training and capacity building solution • Preparation of district action plan with the involvement of district focal points • ToTs of govt. officials • Linkages will be developed with the private sector institutions, MFIs and soap manufacturing companies etc MINISTRY OF ENVIRONMENT

12. Early Recovery Sanitation Program in Flood affected Districts of Pakistan • Component 2: Attaining Total Sanitation • Collecting base line data • Participatory sanitation approaches and PRA triggering options • Finalization of PRA tools for mobilizing communities with respect, dignity and pride • Triggering with CLTS and SLTS with positive motives for community • Holding training for trainers (TOT) for Social Organizers/ Master Trainers • Advocacy for constructing and consistently using safe sanitation facilities at the household level • Construction of demo latrines • Training of masons • Piloting establishment of one sanitation mart in each Tehsil • Developing and promoting technical innovations • Imparting trainings to entrepreneurs in sanitation related business skills • Provision of Incentives • Piloting 100 % Drainage & wastewater treatment MINISTRY OF ENVIRONMENT

13. Early Recovery Sanitation Program in Flood affected Districts of Pakistan • Cascading Model: • IPs hire social organizers who would be trained as Master Trainers • Social organizers train community resource persons/ community activators to trigger communities to attain ODF status and hygiene promotion • 40 social organizers will be hired who will be trained as Master Trainers • One social organizer will work for 2500 households/ 25 communities • total of 200 CRPs will be identified in consultation with Village Sanitation Committees (VSCs) • The formation of Village Sanitation Committees shall be facilitated by the IP’s. MINISTRY OF ENVIRONMENT

14. Early Recovery Sanitation Program in Flood affected Districts of Pakistan • Component 3: Campaigning for Improved Hygiene Behaviour: • Conducting Knowledge Attitude and Practices (KAP) and formative research on behaviours • Conducting IEC campaign • Holding events through inter personnel channels in schools/ communities for hygiene promotion to reach out primary school-aged children and their primary caretakers • Conducting Mass Media campaign in rest of the districts through different approaches and channels including • Radio jingles • TV Promos • Newspaper promos • Talkshows on radios • Events on engaging with celebrities as hand-washing champion • Popular theatres (drama, puppets) • SMS Campaigns MINISTRY OF ENVIRONMENT

15. Early Recovery Sanitation Program in Flood affected Districts of Pakistan • Component 4: Monitoring, Evaluation and Learning • Development of M&E framework • Evaluation and certification criteria of ODF Villages • Establishing Post KAP baseline/ end line survey through PRA exercise • Mid-term peer review and dissemination workshop • Documentation of best practices & successful case studies • Outcome evaluation through end of project PRA exercises MINISTRY OF ENVIRONMENT

16. Early Recovery Sanitation Program in Flood affected Districts of Pakistan

17. Opportunity of Replication and Scaling up • Model can be adapted for scaling up Rural Sanitation in all flood affected districts of Pakistan by the Federal/ Provincial Governments • Institutional Arrangements and the Roles and Responsibilities of the different tiers of the government will be specified • There has been few consultations with the sector partners • The proposal was also discussed during the meeting of the National Sanitation and Drinking Water Implementation Committee in October, 2010 • MOE willing to take the leadership role and decide the final modalities of the sector program based on the views of the provincial governments and the sector partners MINISTRY OF ENVIRONMENT

18. THANK YOU MINISTRY OF ENVIRONMENT