Run-of-the-mill and piecemeal solutions have failed Pakistan in addressing its economic, social and health challenges – persistent diarrhoea is a case in point. Perhaps it is time to look at holistic solutions combined with non-conventional remedies. Often, these unconventional solutions are the ones that are not that difficult to implement, have far-reaching results and usually cost little. However, therein lies the problem. If the solution is not money-intensive, then how do the powers-that-be make money?
Pakistan’s development discourse has become crowded with money-intensive plans – building filtration plants and high-tech infrastructure through the procurement of billions of dollars in foreign loans. Necessary at times perhaps, but far too often, they overlook the most powerful tools of public health: behaviour change and basic hygiene. This is not hyperbole; it is backed by evidence and would save lives, improve productivity, and save billions annually. Let us look at the prevalence of diarrhoea and stunting in Pakistan.
Let’s begin with some hard facts many policymakers overlook – diarrhoea remains a killer of children. According to a report by UNICEF, roughly 36,000 children under the age of five die each year in Pakistan from diarrheal diseases linked to poor water, sanitation and hygiene (WASH), while unsafe drinking water is widespread – about 70% of households in Pakistan still consume bacterially contaminated water.
To put the child death numbers in perspective, every day, an average of more than 100 children in Pakistan lose their lives due to diseases associated with unsafe water and poor sanitation. These deaths are not just statistics – they are families destroyed, futures stolen, human potential wasted.
Furthermore, for the children who survive the episodes of diarrhoea in their early life, stunting becomes a persistent crisis. Nearly four in ten children under five in Pakistan are stunted, which is directly linked to diarrhoea, among other causes of malnutrition.
Pakistan is a country struggling with low growth, rising debt and an underperforming workforce. What makes this worse is ignoring what we already know. Waterborne diseases and poor sanitation place a massive economic burden on families and the nation. Since around 44 per cent of children are stunted, stunting decreases the productivity of the population by 7 to 10 per cent throughout their lives. Nutrition International estimates that stunting alone costs Pakistan around USD 16 billion per year in productivity loss. That is huge for a country that begs, borrows and pleads for loans and FDI, which collectively average USD 10 billion per year!
Pakistan cannot afford to waste another generation to preventable diseases when the solutions are literally within the reach of every household.
The direct economic toll associated with waterborne diseases is staggering as well. The estimates vary depending on the source, but the average family spends in the range of Rs. 25,000 – 40,000 (estimates from various sources) on treating illnesses related to contaminated water or poor hygiene practices. This equates to USD 3.5 – 5.7 billion yearly spent on diarrhoea – multiply yearly family spending of Rs. 25 – 40,000 by 40 million families of Pakistan. That is around USD 4.5 billion (median) down the toilet, literally!
So diarrhoea is not simply a health issue; it is an economic travesty costing the country around USD 20 billion per year, and it is preventable.
First, proper handwashing practices with soap at critical times: after using the toilet, before preparing food, and before feeding young children, is one of the most effective public health measures ever discovered. It can reduce diarrheal incidence by 40% or more. However, Pakistan has not been able to create a hygiene-conscious nation, simply convincing the population to wash their hands properly. So, it isn’t a question of technology – it’s a question of behavioural change, communication and habit formation.
Second, Solar Water Disinfection (SODIS) and other simple water purification techniques work. Solar Water Disinfection, or SODIS, is a low-cost method that involves filling clear plastic bottles with water and exposing them to sunlight for several hours. The UV rays of the Sun deactivate most harmful pathogens. SODIS has been shown in multiple contexts to reduce diarrheal diseases when implemented correctly. Importantly, SODIS costs almost nothing apart from education and bottles – no fancy machinery, no foreign consultants, no big budgets.
Pakistan has spent enormous sums on water infrastructure – filtration plants, pipelines, treatment systems. These are valuable investments, but they are ineffective if water is contaminated after it reaches the home through poor storage, dirty containers, or handling with unwashed hands.
Infrastructure without behaviour change communication (BCC) is like building a state-of-the-art kitchen and never teaching anyone to cook.
This is where successive governments and development agencies have faltered. They invest in hardware, not habits. They hire multinational consultants, not community mobilizers. The result? Billions spent with too little impact. At the risk of sounding redundant, the uncomfortable truth is, simple solutions are unattractive to powerful interests. There is no mega-contract for teaching handwashing. There is no commission for distributing plastic bottles. There is no lucrative consulting retainer for explaining what UNICEF and WHO have known for decades.
But that’s exactly why Pakistan needs to champion these solutions – because they help people, not profit centres.
Pakistan stands at a crossroads. We can continue to fund infrastructure without accompanying behavior change, or we can adopt a comprehensive strategy that includes: nationwide, sustained handwashing campaigns using mass media, schools, mosques, community health workers and local leaders; promotion of safe household water treatment, including SODIS, boiling, and chlorination where appropriate; integration of hygiene education into school curricula and maternal health programs; investment in sanitation to reduce open defecation and environmental contamination. None of this requires rocket science – just political will.
Simple conclusion – health is wealth! Eliminating malnutrition and curing stunting in Pakistan is not just a moral imperative – it’s an economic one. What’s missing is not knowledge; it’s commitment. Pakistan cannot afford to waste another generation to preventable diseases when the solutions are literally within the reach of every household. Let’s teach people to wash hands, treat water with sunlight, and value the health of our children as the foundation of the nation’s future and save USD 20 billion in the process.
The writer is a former Senior Advisor to the Government and a sector development specialist. He is a member of the APP Think Tank and Pakistan’s Buddhist Heritage Promotion Ambassador for Green Tourism, a company under SIFC.
The writer is a freelance columnist.