Sanitation rarely makes headlines in Pakistan. It does not carry the political visibility of roads, electricity or even water supply. Yet, its impact on public health, economic productivity and human dignity is profound. The real challenge is not merely the absence of infrastructure—it is weak governance, fragmented institutional responsibility, and the lack of political ownership that have kept sanitation at the margins of development priorities.
At the heart of the problem lies a fundamental misunderstanding. Sanitation is still widely perceived as the construction of toilets or drainage systems. In reality, it is a complete service chain that includes containment, collection, transportation, treatment, and safe disposal or reuse. Ignoring any part of this chain undermines the entire system. This narrow approach has led to piecemeal interventions that fail to deliver sustainable results.
Institutional fragmentation further compounds the issue. In Pakistan, sanitation responsibilities are divided between Public Health Engineering Departments for rural areas and Local Governments for urban areas. This split has created overlapping mandates, weak coordination and inconsistent service delivery. The result is inefficiency at scale—projects are implemented, but services remain unreliable.
The experience of regional countries shows that this trajectory can be reversed. made remarkable progress by aligning institutions and empowering communities to take ownership of sanitation. elevated sanitation to a national priority through the Swachh Bharat Mission, backed by strong political commitment and dedicated financing. adopted a unified “One WASH Plan,” ensuring coherence across all levels of government. These examples underline a simple but powerful lesson: sanitation improves when governance improves.
The economic case for sanitation is equally compelling. Poor sanitation fuels the spread of waterborne diseases such as diarrhoea, cholera and typhoid. For millions of households, this translates into lost working days, reduced productivity and diminished earning potential. Children miss school, adults miss work, and the cycle of poverty deepens.
Improved sanitation governance breaks this cycle. When services are reliable, disease incidence declines, labour productivity rises, and human capital improves. In effect, sanitation becomes a driver of higher per capita income. At the household level, the benefits are immediate. Families spend less on medical treatment, reducing out-of-pocket health expenditures that often push the poor into deeper financial distress. The savings can instead be invested in education, nutrition or small businesses—fueling long-term economic mobility.
Cities, too, benefit. Clean and well-managed urban environments attract investment, boost property values and create jobs across the sanitation value chain—from waste collection to treatment and recycling. In this sense, sanitation is not a cost; it is an investment with measurable economic returns.
Despite this, sanitation remains chronically underfunded. A key reason is that sanitation budgets are typically merged with water supply allocations. Water projects, being more visible and politically rewarding, consume the larger share of resources. As a result, sanitation continues to lag behind.
Regional platforms such as the have repeatedly called for separate budget allocations for sanitation and hygiene. Countries that have adopted ring-fenced funding mechanisms have seen tangible improvements. However, increasing allocations alone will not suffice. Without strong governance, funds are often absorbed into block allocations with limited impact. What is needed is performance-based financing—where resources are linked to service delivery outcomes.
Pakistan now stands at a crossroads. Incremental improvements will not be enough. Structural reforms are required to unlock the full potential of the sanitation sector. This begins with adopting a clear, service-oriented definition of sanitation aligned with global approaches such as Citywide Inclusive Sanitation. It requires institutional reform, including the creation of a dedicated entity responsible for both urban and rural sanitation. Most importantly, it demands political will to introduce separate budget codes and ensure accountability in spending.
Sanitation must be repositioned—not as a peripheral service, but as a cornerstone of economic development and public health. The evidence is clear: countries that invest in sanitation governance reap dividends in productivity, reduced healthcare costs and improved quality of life.
Pakistan can no longer afford to treat sanitation as an afterthought. The cost of inaction is too high—not just in terms of disease, but in lost economic potential. If governance is fixed, sanitation can become one of the country’s most effective tools for inclusive growth.
Syed Shah Nasir
Safely managed sanitation KP
