By: S.K. Sami
Khyber Pakhtunkhwa stands today at a critical crossroads where a largely silent but deeply damaging public-health emergency demands urgent attention. The province, home to over 40 million people scattered across 35 districts and thousands of mouzas, continues to struggle with one of the most fundamental components of modern living, safe sanitation. While development debates often center on infrastructure, roads and technology, the reality on the ground shows that the most immediate threat to public well-being comes from the mismanagement of human waste and the absence of safely managed sanitation systems across both urban and rural KP. Recent assessments paint a worrying picture of the region. The vast majorities of households rely on on-site sanitation systems such as septic tanks and pit latrines, but these systems are often poorly designed, lack proper soak pits and drain fields, and overflow into open drains that snake through residential neighborhoods. Fecal sludge management, which lies at the heart of any safe sanitation system is almost nonexistent. Even when sludge is collected, it is dumped into open land, fields, or rivers, contaminating water sources and exposing entire communities to avoidable diseases. The province’s sanitation systems even in developed housing societies do not meet the global criteria of safe management from containment to disposal.
The consequences of this silent neglect are evident in the disease burden the people of Khyber Pakhtunkhwa endure year after year. Contamination levels of drinking water are extremely high, with up to 94 percent of household-level water samples testing positive for E. coli. This translates into persistently high rates of diarrheal diseases, especially among children, who remain the most vulnerable to unsafe water and poor sanitation. Seasonal outbreaks of hepatitis A and E are now almost expected in areas where sewage frequently leaks into drinking water lines. Typhoid fever continues to grip communities with alarming regularity, particularly in districts where sanitation coverage is the weakest. Parasitic infections thrive in environments where open defecation persists and excreta are not disposed of safely. These infections contribute to malnutrition, anemia and developmental challenges in children, issues that not only harm individual families but weigh down the social and economic progress of the entire province.
Water contamination is not limited to bacteria alone. Chemical pollutants such as nitrate, iron and fluoride, reported in several districts, point to sewage infiltration and deteriorating water quality. This complex mix of microbial and chemical pollution forms a dangerous health cocktail that the population is exposed to daily, often without knowing it. The sanitation crisis in Khyber Pakhtunkhwa is not merely a technical shortfall; it is a governance failure that stems from fragmented responsibilities and a lack of unified oversight. Sanitation is currently divided among multiple institutions, TMAs, WSSCs, PHED, district authorities, and development projects, resulting in duplication, confusion and incomplete management of the sanitation chain. Budget allocations remain insufficient and inconsistent, with sanitation receiving only a small share compared to the scale of the problem. Policies exist on paper as the KP Sanitation Policy, the KP Water Act, the Drinking Water Policy etc but implementation remains sporadic, uncoordinated and largely unregulated.
Experts around the world agree that the only sustainable solution lies in a public-service approach to sanitation, such as the City-Wide Inclusive Sanitation (CWIS) model that focuses on universal access, equitable services, safe handling of waste across the entire sanitation value chain, and long-term city-level planning. The province urgently needs to embrace this approach. It must establish a provincial-level sanitation authority mandated to plan, regulate and oversee all sanitation systems, whether sewered or on-site. The development of fecal sludge treatment plants across the province must become an immediate priority. Household sanitation practices require standardization, with mandatory guidelines for septic tank construction, desludging schedules and safe disposal. Urban centers require expanded and rehabilitated sewerage systems, while rural areas need affordable and locally appropriate sanitation solutions. Drinking water sources must be protected through comprehensive Water Safety Plans, ensuring safety from the catchment to the consumer.
In addition to infrastructure, community engagement remains vital. KP has seen positive behavioral shifts during past sanitation drives, but these efforts must be revived through modern communication strategies, school-based programs and partnerships with civil society. Sanitation should not be treated as an afterthought or a separate line item in development budgets. It is, in fact, the foundation of public health, economic productivity and human dignity. The prosperity of future generations depends on the decisions taken today.
Khyber Pakhtunkhwa must recognize that sanitation is not a luxury to be pursued after bigger challenges are resolved but it is the cornerstone upon which healthy, resilient and thriving societies are built. For too long, the province has allowed human waste to contaminate its water, its environment and its children’s futures. The time has come for decisive action. Safe sanitation must be treated as a core public service, planned strategically, funded generously and delivered equitably. Only then can the authorities protect its people from preventable disease and build a healthier, stronger tomorrow.
The writer is Resident Editor of Country News, can be reached to on: sami.kpk@gmail.com