Rural areas in Pakistan remain much poorer than urban areas and are far more disadvantaged in all aspects of service delivery, with the conditions showing the decline in poverty has not reduced the urban-rural gap by much. The World Bank recently published a report titled ‘When Water Becomes a Hazard’, on the state of water supply, sanitation, and poverty in the Pakistan clearly show this.
It stated that four out of five poor Pakistanis still live in rural areas, and there are large differences in the level and rate of progress on poverty reduction across districts. The report, however, said that incidence of poverty declined significantly in Pakistan over the past decade and a half, falling from 64 percent in 2001 to about 30 percent in 2014. The incidence of poverty declined significantly in Pakistan over the past decade and a half, falling from 64 percent in 2001 to about 30 percent in 2014. The reduction was coupled with an increase in asset ownership and dietary diversity, with substantial gains in both in the bottom quintile. Khyber Pakhtunkhwa (KP) saw the largest decline in poverty, followed by Punjab and Sindh. Balochistan remained the poorest province in the country, with a headcount poverty rate of almost 57 percent in 2014. Regional differences in living standards remain large, both within and across provinces. Rural areas continue to lag behind their urban counterparts in terms of both poverty and access to basic services like health and education and the gaps persist across all quintiles of the income distribution.
North South divide
District-level poverty is equalizing over time, but there is a clear north-south divide. Both within and across provinces, the poorest districts registered the largest declines in poverty, but most of the poorest districts are in Balochistan, followed by Sindh and southern Punjab. A northsouth divide is also evident within the two most populous provinces of the country, with the bordering districts of southern Punjab and northern Sindh registering the highest poverty rates within the two provinces
Within districts, urbanization tends to be positively correlated with the pace of poverty reduction. The districts of Hyderabad in Sindh and Musakhel and Killa Abdullah in Balochistan increased their urban share by about 23 and 25 percentage points, respectively, for example, and saw the largest reductions in poverty. But, pockets of high poverty exist within better-off areas. Districts that host large cities like Lahore, Rawalpindi, and Faisalabad have much higher levels of within-district inequality than smaller districts. District-level policy targeting may lead the government to overlook poverty hotspots within otherwise wealthier districts. This underscores the need for more granular data, below the district level, on poverty and basic indicators of wellbeing. Large cities also host a larger number of poor people. Targeting only on the poverty rate may thus miss a significant proportion of the poor residing in larger cities.
Poverty reduction has been coupled with an increase in access to WASH infrastructure throughout Pakistan. Access to within-dwelling improved water increased substantially over the past decade and a half, largely through privately bored hand and mechanized pumps. The percentage of households with latrine facilities also rose significantly, again largely through self provision. As a result, the national rate of open defecation plummeted from 29 percent in 2004/05 to 13 percent in 2014/15.
Access to even basic levels of improved water and sanitation varies widely, however. Access is much higher in urban areas—the capitals and other major cities in each province. This is particularly evident in access to piped water supply and flush-to-sewer latrines, which are almost entirely concentrated in the larger available centers. Even among households connected to piped water, there are again large regional disparities in the functionality of piped water supply systems. While 58 percent of connected households have more than six hours of water a day in Punjab, the figure is just 7 percent in Sindh and 2 percent in Balochistan.
Access to toilets connected to sewers or even septic tanks decreases sharply with an increase in district poverty. Poorer districts have a higher rate of open defecation, and a much higher incidence of unimproved toilets, mainly soak pits and flush to open drain toilets. Access to piped water decreases sharply with an increase in district poverty. Poorer districts are more reliant on hand pumps than better-off districts. Contamination tends to be lower in water drawn with motorized pumps, because they are used more in contexts where deeper drilling is required. Higher depth to the water table implies less contamination through seepage of human excreta from nearby toilets and fecal waste dumping sites. The combination of hand pumps and pit latrines (the most common replacement for open defecation in poorer districts) substantially increases water contamination.
Pakistan continues to lag behind its neighbors and income peers in terms of child nutritional outcomes. Despite reductions in poverty and increases in WASH access, stunting rates remain high. Indeed, stunting rates were somewhat higher in 2011 (44 percent) than in 2001 (42 percent). At the provincial level, 38 percent of all children in Punjab, 47 percent in Sindh, 49 percent in KP, and 53 percent in Balochistan were stunted in 2011. Although the rate of stunting is lowest in Punjab, a majority of Pakistan’s stunted children live there, due to its large population share. More recent data for Punjab and Sindh from the Multiple Indicator Cluster Survey (MICS, 2014) shows no improvement in these rates. The incidence of diarrhea—a critical factor behind immediate weight loss, intestinal damage, and malabsorption of nutrients—also remained at 22 percent between 2006 and 2012 and again shows no improvement in the more recent MICS for Punjab and Sindh.