After announcing the ambitious housing plan, PM Khan now plans to introduce a mega poverty alleviation program, and for good reason. Overall poverty levels have declined to 30 percent in 2014 (1999: 58%), and even multidimensional poverty (measures health, education and living standard) has declined to 39 percent, from 55 percent in 2005.

But, inequality has grown, not only between urban and rural divides, but across cities, districts and within districts. The reason is water and sanitation.

A World Bank report argues that rate of progress in poverty alleviation in the rural areas and across many districts has been slower because of inaccessibility of clean drinking water, poor sanitation and hygiene, water pollution and ineffective disposal and waste management systems in these areas. While open defecation (OD) was reduced, since there was no investment in fecal and water waste management, a large concentration of untreated water ends up near human settlements defeating the purpose of eliminating OD. The waste also seeps into the groundwater or drains contaminating surface water as well as the soil.

“This is shockingly evident in the level of bacterial (E. coli) contamination observed in surface and ground water. Studies also suggest, high levels of bacterial contamination of the soil, multiplying the channels through which the oral transmission of fecal bacteria can occur—food, flies, fingers, fields, and fluids”, the report maintains.The untreated waste water is ultimately also used in crop irrigation that contaminates the entire food chain.

According to the report, virtually no piped water or sanitation is provided by the public sector in rural areas.

There is a clear correlation between poverty and the access and quality of water and sanitation infrastructure. This is also why despite overall improvement in poverty levels; all other measures of human development have remained stagnant, or even deteriorated. Diarrhea in children has worsened which is a major cause for malabsorption of nutrients in children, malnourishment across the population has remained the same at 22 percent since 1999, infant mortality remains high, stunting in children has worsened from 40 percent to 45 percent between 2006 and 2016, and neonatal mortality is even worse—Pakistan is the worst country in the world for new born babies.

The subject of water, sanitation and hygiene (WASH) is devolved to provincial and local governments but faces immense governance challenges.

There is no federal role in setting agenda to improve water and sanitation metrics, while multiple institutions in provinces are working with overlapping functions. Local governments lack technical capacity.

There is gaping inequality in these services between rural and urban centers, across districts and even within high income districts. But most importantly, there is an underlying inequality in how public finances are distributed and utilized which tend to be heavily concentrated toward provincial capitals, and high income districts.

Allocation per capita in Lahore is 18 times higher than average of all other districts in Punjab. This gap is less for KP and Baluchistan but a whopping 100 times in Karachi against other districts in Sindh.

Similar is the case for allocations between poor and rich districts. Ironically, the poor districts with lower access to water and sanitation received lower per capita for water and sanitation in the budget allocations. In fact, the level of access to WASH and decentralization has had no impact on WASH budget allocations.

Any new plan’s primary focus should be better allocation of funds, with an aim to curb the inequality that seems to be rising. Equally important is, overhaul of provincial and local level technical capacity, creation of ownership in governance at district level and eliminating the confusion and overlap between institutions that result in poor execution of well-meaning projects.