Pakistan: Sanitation for Millions

Promoting Gender Equality in Sanitation for Millions Program, Pakistan.

  1. Contextual Background and General situation Analysis

Balochistan, being the largest province, spreads over an area of 347,190 Sq, KMs and forms 43.6 per cent of the total area of Pakistan. In terms of population, it constitutes only around 6 per cent of the total population. The Province is the least developed province of the country which is evident from the fact that it falls at the bottom of almost all globally and nationally accepted indicators. According to Pakistan Human Development Index Report, 2017, Balochistan lagged behind all provinces with score of .421. The province is the worst in terms of Mean Years of Schooling (2.6) and Expected Years of Schooling (7.6). According to the Economic Survey of Pakistan 2018-19, the province has the lowest literacy rate in the country which is 55.5% (Male, 73 %, female, only 33.3%). According to the Report of  Higher Education Commission, the survey of 194 public and private sector Higher Education Institutes reveals total enrolment of 1.576 million whereas in Balochistan it was only 31,925( male, 22,357, female, only 9568). The budget allocation in Education and Health sectors in Balochistan is the lowest as compared with the other provinces. The province normally ranges in Low to very Health Index (.3 to .5) with worst scenario for female. According to Pakistan Health Demographic Survey (PHDS), Balochistan stood at the top of all provinces in term of Maternal Mortality Rate (MMR). Balochistan experiences the greatest deprivation in terms of the standard of Living Index but it is mostly female who bear the brunt.

Tribal conventions are very strong in Balochistan and generally do not allow property ownership for women and work on the principle of exclusion and subjugation. Entitlements to common property resources are also regulated and measured with reference to male family members. Single women and widows remain economically dependent on extended male family members. Parallel judicial system often puts women in disadvantage. Furthermore, religious inclination towards traditional norms and values and tribal mindset act as stumbling block to Gender equality and mainstreaming. Even education and awareness campaigns are considered as intrusion in personal/domestic domain resulting in altercation, rivalries and even death.

Precisely, all indicators in Balochistan depict the worst picture with regards to women gender because they are the most vulnerable to adversities and are deprived of access to basic facilities such as education and health. The level of awareness towards self hygiene is severely low lowest enrolments, highest dropout rates, poor infrastructure and quality educational standards, highest Maternal Mortality Rate, long distances, poor communication system serve as compounding effect to the problems of women.

  1. Specific Context

Generally, the level of awareness with regards to health and general hygiene is very low in Balochistan which is why many diseases are spread unnoticed and this is true for both men and women. Educational and health centers are considered to be the most relevant places to impart such education, awareness and facilities; however, it is very unsatisfactory. Nevertheless, the exclusion of female gender with regards of educational awareness and health hygiene is tantamount to pushing more than the half population in abysmal darkness. This scenario has drastic implications towards society when the future generations (children) do not have any awareness about their health and hygiene just because their parents (mothers) do not know it themselves.

  1. Initiative to achieve Objectives and Targets

The target area for the application of initiative was Baleli Union Council of Quetta in Balochistan Province. The target population was 26000 in the first phase that rose to 203076 in second phase when nine Basic Health Units were included in the fold of the initiative.

The purpose behind the initiative: Sanitation for Millions was provision of sanitation facilities at Educational and health centers in the target area on sustainable basis. The initiative specifically focused to bring women at par with men by inculcating the sense of equality, ownership, decision making, mainstreaming, assessment of gender specific needs, etc. through awareness, behavioral change Management and pertinent projects.

  1. Approaches, accomplishments and impacts of the Initiative

Sanitation for Millions implemented the project in a very different way. One of the main objectives of the program was ensure the sustainability of the sanitation facilities provided at schools and health centers and therefore, female were given special consideration. Initial assessment (Knowledge, Attitude and current practices) of the situation was done when 45% female were interviewed in the target area in schools, community, health centers, etc. Next step was to design the whole program to meet the specific needs of women by inculcating the sense of inclusiveness and ownership. The approaches included the activities like, Revitalization of Parents Teachers Committee, formation of Water and Sanitation clubs, Awareness sessions to community, Operation and Maintenance of sanitation facilities, Celebration of International Days and awareness regarding Menstrual Health Management. The initiative always focused and prioritized females in all programs.


All these approaches resulted by changing the attitudes and softly challenging the traditional mindset and enhancing the confidence level of female and bringing them at lead roles from no roles and  decision making. The inclusion and positive interaction of students, teachers and parents and their participation greatly helped to understand the often neglected area of health hygiene and cleanliness. Awareness, construction of specially designed toilets for female, training of Female Master Trainers on MHM and distribution of MHM kits resulted in boosting the confidence and morale of parents, students and teachers.


Now female are more in design of programs as per their needs and Department of Education and Health also encourage the participation of females in all sort of programs. The immediate impact is that WASH working group and MHM working group have been notified at Provincial Level with 50% female participation.  Additionally, all technical working groups in education department give equal opportunity to male and female workers. Thus, GIZ created a friendly environment for female in very tribal environment of Balochistan. The total beneficiaries in Sanitation for Millions program is 203,076/- 40% females have benefitted from it. The long term impacts are that Provincial Departments is very satisfied with our performance and agreed to keep female in priority area while designing any project. Thus, this will result in sustainability and ownership of our initiative and projects. The biggest unseen factor or long term impact is transmission of knowledge from educated and aware mothers to their daughters regarding MHM and general hygiene orientation. This factor is indeed FUTURE BUILDING FACTOR of coming generations


“ Now we are more aware on Menstrual Health Management, WASH and above all we feel like it is our problem and we have to find out the solutions for it. We are more confident in identifying our day to day problems and we feel confident now to discuss it with teachers and parents” a female student of Balochistan during her interview to DW channel on MHM Day.


Awareness and breaking the inertia will give a greater boost and change the attitudes in short, medium and long term. The awareness and realization of taboo topic in tribal background in itself, is a greatness achievement and accomplishment.






Gender as a quality feature of our work


Acknowledgment and acceptance of our Initiative

In the tribal area with conventional mindset, there is generally little or no acceptance of foreign players with reform agenda especially that touches the sensitive or so called TABOO areas. However, our initiative: Sanitation for Millions did wonders by not only getting it accepted but also acknowledged by all stakeholders. This is evident from the fact that during the project, not a single altercation or untoward incident happened. The best thing in our approach was that the target was achieved by slowly and sensitively creating the environment for absorption of our approach. Moreover, the confidence building process of parents and community members who were the main stakeholders (with opposite opinion) was done systematically but involving government agencies. The government of Balochistan not only accepted our work but also extended cooperation in execution of the targets like directing Lady Health Visitors to make frequent visits of schools and guide and educate girls on the importance of hygiene and MHM.  The acceptance of the work at the level of school can be gauged from the fact that the specifically designed toilets for girls at school are being looked after by the school management committee members. 


Gender and result-based monitoring


Monitoring and Cooperation


Without cooperation of stakeholders, no program or project in the world can achieve the targets. In our case, Policy, Planning and Implementation Unit (PPIU) of Education Department identified an area for our work; consequently by remaining in close liaison with them as well as other stakeholders, the Initiative was launched, executed and successfully handed over to it along with completion and progress report. During the project, all kind of support and cooperation was extended by it by continuously monitoring our project based upon our regular correspondence and feedback. The final handover was accomplished through progress report.


It is also worth mentioning that the community has always been taken on board throughout the program. Sanitation for Millions (S4M) works in close collaboration with Department of Education and Health on Sanitation.  S4M made sure that enabling environment is created where no one is left behind. In schools different toilets have been constructed for both genders as per their needs. Same is implemented in Health Centers not only this but S4M has also given special consideration for inclusive WASH and special toilets have been designed for special children at schools and patients in health centers. Ramps, hand rails and wider spaces as per the international standards have been applied to leave no one behind as per the SDGs.


Though S4M only representative in Balochistan was male colleague and it was never easy to speak for female inclusions in the programs. Especially the topics like MHM were extremely challenging to be taken up at department level and then at community level. S4M implemented the project through its local partner BRSP, which had a very good linkages with all stakeholders, community and having field staff in the schools made a very good environment for GIZ. S4M has been able to mobilize the Education Department to notify MHM and WASH working groups and S4M also conducted a National MHM workshop in which all Federal and Provincial Stakeholders were invited to share their issues, ideas, challenges and way forward.


Throughout the program, GIZ enjoyed the overwhelming cooperation of target community members, local partners, government agencies, and other stakeholders. The process went very smooth. With regards to monitoring, the evaluation and assessment have been made in documented form both by the GIZ as well as Government agency. The parameters defined in our work have been confirmed by the government and local partners and documented. Moreover, field visits of the local partners and specially government authorities and on field assessments has raised our confidence in the shape of appreciation and praise.



Challenges and Success factors

The biggest challenge was the fear of touching the taboo area and that too in the tribal background with unstable law and order situation. However, remaining within the boundary of local traditions and respecting tribal setup, parallel system was not created rather, our reform agenda was infused in them through creating conducive environment to absorb change slowly. In this regard, we made best use of our local partners like BRSP who had developed good rapport with community and stakeholders and utilized government resources and networking. The change of mindset on MHM was a single biggest success. Breaking the barrier of no communication on Menstrual cycle and them inculcating the idea of modern and yet safe approaches to avoid psychological and physical trauma, was great achievement. Parents, teachers and students interaction on the topic and training and guidance by lady health visitors made the day for the affected female students. The target community has been strengthened to an extent that they will implement and carry forward our concept and model without need for donation. They have capability and are willing to provide local solutions if there is any prospective problem. This movement from donation to local solution bears the testimony of carry forward the idea of sustainability.