LAHORE: Punjab leads Pakistan in water, sanitation and hygiene (WASH) coverage but still loses tens of thousands of children each year to diseases that clean hands, safe water, and proper toilets could prevent. The numbers show that progress is real — but far from enough.
For Punjab to rise above its sanitation and hygiene challenges, investments must move beyond pipes and pumps to people, behaviour, and long-term maintenance. Clean hands, after all, remain the simplest and cheapest prescription for a healthier future.
According to UNICEF and the World Health Organisation (WHO), unsafe hand hygiene is responsible for 394,000 deaths from diarrhoea and 356,000 deaths from acute respiratory infections annually. Yet in Pakistan’s largest province, Punjab, tens of thousands of children continue to die each year from preventable waterborne diseases.
Globally, 1.4 million people, including 400,000 children under five, die every year due to inadequate water, sanitation and hygiene. Around 1.7 billion people still lack access to basic hygiene facilities, and 611 million have no handwashing stations at all. While 83 percent of the world’s population now has access to some form of sanitation, Pakistan continues to lag behind this global average, and Punjab — though performing slightly above the national mean — still faces a serious hygiene crisis.
Punjab, home to around 100 million people, represents nearly half of Pakistan’s population and thus holds the key to achieving national WASH goals. According to UNICEF and WaterAid estimates, 94 percent of Punjab’s households have access to an improved source of drinking water, which is somewhat better than the national average of 92 percent but access does not mean safety. Only about 55 percent of Punjab’s residents receive safely managed drinking water — meaning water that is treated, stored safely, and free of contamination. Across Pakistan, this figure falls below 40 percent.
The situation with sanitation is similar. Roughly 75 percent of Punjab’s population use improved sanitation facilities — toilets that hygienically separate human waste from contact — compared to a national average of 68 percent.
Despite this progress, more than 13 percent of people in Punjab still practice open defecation, especially in southern rural districts. The unsafe disposal of human waste contaminates water resources and spreads diseases such as diarrhoea, typhoid, and cholera.
Handwashing practices also present a worrying gap. Around 78 percent of Punjab’s households have both water and soap available for handwashing — better than the 71 percent national figure, but still leaving 22 percent of households without even the most basic hand washing facility.
The cost of poor hygiene and unsafe water is counted in human lives. In Punjab alone, nearly 27,000 children under the age of five die annually from diarrhoea — one of the most preventable causes of death. Nationwide, the number rises to about 53,000. UNICEF notes that 80 percent of all diseases in Pakistan are linked to contaminated water, and that up to 33 percent of deaths are associated with waterborne illnesses.
While the province has made major strides in expanding infrastructure, quality remains the missing link. Studies by the Pakistan Council of Research in Water Resources (PCRWR) found that up to 60 percent of drinking water samples from Punjab’s cities contained unsafe levels of bacteria.
Experts cite several reasons for Punjab’s uneven performance. First, urban-rural disparity: large cities like Lahore and Faisalabad have relatively better coverage, while remote rural areas lag far behind. Second, infrastructure decay: thousands of rural water schemes built over the years have fallen into disrepair due to lack of maintenance.
Against the global 83 percent benchmark for safely managed sanitation, Punjab’s 75 percent remains low, and the figure for safely managed water — just over 50 percent — highlights the huge safety gap. Punjab’s situation offers both hope and warning. The province needs to invest more in safe water infrastructure, ensure continuous testing and treatment, and expand sewage and waste management systems, especially in rural areas.
Punjab also needs to prioritise maintenance of existing water schemes, many of which fail within years of installation due to negligence. Empowering local communities to monitor and maintain these systems could bridge the gap between access and safety.