Situational Assessment for Fecal Sludge Management (FSM) in Pakistan

doi:10.21203/rs.3.rs-1583178/v1

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Situational Assessment for Fecal Sludge Management (FSM) in Pakistan

https://doi.org/10.21203/rs.3.rs-1583178/v1

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With enhanced focus on global sanitation, access to toilets at the household level is increasing in developing countries although the provision of sewer networks is not expanding at the same pace. This is resulting in the adaptation of On-Site Sanitation (OSS) facilities. The fecal sludge generated by the OSS facilities requires emptying, treatment, and safe disposal. In this study, the sanitation situation and need for Fecal Sludge Management (FSM) was evaluated in major cities of Pakistan including Karachi (provincial capital), Lahore (provincial capital), and Islamabad (national capital). Primary and secondary data were collected from key informant interviews (KII) of the stakeholders, national and international reports, research, and review articles. Infographics on wastewater and fecal sludge from origin to disposal were developed using a Shit flow diagram (SFD) tool and enabling environment was evaluated with a modified Service Delivery Assessment (SDA) tool. The results indicate that adequate sewerage network cover exists in Karachi (60%), Lahore (63%), and Islamabad (50%). The sewerage network in major cities is leaking and a limited amount reaches the treatment plants. Total wastewater treatment in Karachi, Lahore, and Islamabad is 10%, 0%, and 9% respectively. The safe sanitation in Lahore (8%) and Islamabad (25%) is coming from OSS with fecal sludge buried safely onsite. The inclusion of FSM related framework, guidelines, and policies can help achieve the goal of safe sanitation for all.

On-Site Sanitation (OSS)

Fecal Sludge Management (FSM)

Shit flow Diagram (SFD)

Service Delivery Assessment (SDA)

Access to safe water and sanitation is a basic human right. Sanitation refers to having access to a proper sanitary sewerage system through a house connection, as well as a proper stormwater drainage system and safe excreta and wastewater disposal (ISO 2018). United Nations put the first global level commitment toward safe water; sanitation and hygiene (WASH) in Millennium Development Goals (MDGs) (von Schirnding 2002). Target 7C of MDG has planned to reduce the number of people without access to sanitation by half (Bartram, Lewis et al. 2005, Editorial 2008). The goal was partially achieved as 1.9 billion people gained access to improved sanitation between 1990 and 2015, equivalent to more than 200,000 people every day (Mara and Evans 2018). Following MDG, the second and more comprehensive global effort to tackle the sanitation issue is the Sustainable Development Goals (SDGs) (UNICEF 2017).

Goal#6 of SDG is the provision of safe drinking water and sanitation for everyone. The rapid decrease in ending open defecation and providing basic sanitation was achieved through a massive increase in onsite sanitation (OSS) technologies especially in low and middle-income countries (Water 2021). OSS includes flush/non-flush toilets connected to a septic tank, aqua privy, composting toilets, single or double pit latrine, etc. (Franceys, Pickford et al. 1992). Lack of sanitation contributes to 10% of the global disease burden, mainly causing diarrheal diseases. To achieve equitable sanitation, quadrupled-paced improvement is required as one-third of the world’s population still needs basic toilet facilities (WHO 2020). The current COVID-19 pandemic has highlighted the need for access to safely managed sanitation as fecal excreta contains COVID-19 RNA that can be transferred to others if it is not properly managed (Sangsanont, Rattanakul et al. 2022, Wang, Liu et al. 2022).

Huge economic implications exist for countries that fail to address safe sanitation. According to the World Bank, 165 million children globally under the age of five are trapped in poverty and living under substandard sanitary conditions. Children living in places near open defecation are 11% more likely to have stunted growth (Mansuri, Sami et al. 2018). The importance of sanitation can be assessed that for every dollar spent in sanitation, there is a return of US $5.50 in lower health costs (Nishat 2013). The stark inequalities between different regions and classes further complicate the issue. The differences exist between the global south and global north and between the rural and urban areas. About 75% of the rural population lack improved sanitation (WHO/UNICEF 2021).

About 52% of households in rural areas of Pakistan do not have any sanitation system as compared to only 8% of households in urban areas (Khan, Fatima et al. 2021). Since 2000, Pakistan is among the 16 countries that have reduced open defecation by more than 20% yet 16 million people still practice open defecation (Ababa 2016). The impact of the unavailability of safe sanitary facilities is directly affecting the lives of people, especially in slums and informal settlements in Pakistan. Every year 94,000 people including 53,000 children under five die from diarrhea due to poor quality of water and sanitation (WHO/UNICEF 2021, Ali, Abbas et al. 2022).

According to a recent survey by the Pakistan Bureau of Statistics (PBS) on Pakistan Social and Living Standards Measurement (PSLM) 2019-20, toilets are divided into three main categories, Flush, Non-Flush, and No Toilet. Flush toilets (an improved form of a toilet) connect to either a sewerage system, septic tank, pit, or an open drain. Around 83% of households all over Pakistan have Flush toilet facilities out of which 27% are connected with sewerage, 21% have septic tanks, 17% have pit latrines, and 18% have open drains (PBS 2021). Currently, non-networked on-site sanitation systems are the predominant form of sanitation systems in the country. In Pakistan, 43 million people living in urban areas have access to sewer networks, and only 7 million in rural areas. A complete shift can be seen in the use of OSS as 52 million people in the rural areas use a septic tank and only 13 million people in urban areas (WHO/UNICEF 2021). The fate of fecal sludge generated by the OSS is unknown as no policy or guidelines regarding fecal sludge management exists in Pakistan. During PSLM 2019-20 survey, it was revealed that 62% of the OSS are never emptied and 13% of users do not even know about emptying. Only 4% have emptied within the last 5 years and 16% replace the OSS when it becomes full (PBS 2021).

OSS is considered a relatively inexpensive system for the treatment of excreta and wastewater generated in the household for the public sector but puts more responsibility on the user and service providers (Dodane, Mbéguéré et al. 2012, Beard, Satterthwaite et al. 2022). OSS require a proper management scheme termed as Fecal Sludge Management (FSM). The FSM service chain includes the containment, collection, transportation, treatment, and disposal of fecal sludge from the on-site sanitation systems. The sludge that accumulates in the OSS needs to be regularly removed and treated before safe disposal (Strande, Englund et al. 2021). The collection, emptying, and treatment of on-site sanitation is undeveloped in Pakistan and the collected fecal sludge is disposed of untreated in the environment. In Pakistan, a major focus has only been on containment, and the service chain of collection, treatment, and safe disposal is completely missing (Sarbagya Shrestha 2019). The concentrations, quantities, and consistency of fecal sludge are highly variable (Strande, Ronteltap et al. 2014). The quantities and qualities of fecal sludge accumulated in the OSS depend upon many demographic, technical and technical parameters. These include water availability for cleaning, dietary habits of the individuals, sludge storage space availability, type of infrastructure built for storage and storage time in the OSS, and type of water entering in the OSS (Blackwater only and/or mixed with greywater (Strande, Schoebitz et al. 2018). Thus, a local scenario investigation is always required the identify the stakeholder, local practices followed, the weak links of safe sanitation, and how they can be addressed.

FSM in Pakistan needs implementation after planning and coordination between the different stakeholders involved, i.e., households, desludging service providers, the city administration, Non-Governmental Organizations (NGOs), Environmental Protection Agency (EPA), Water and Sanitation Authorities (WASA), Public Health Engineering Department (PHED), etc. In Pakistan, the institutional framework is present but particular attention is given to sewerage networks and FSM does not get due attention. The infrastructure for the service chain is missing even though the majority of the population uses OSS (CDA 2008). In Pakistan the information available on wastewater and treatment is scarce. Data related to sanitation and especially OSS is completely missing. Thus, the performance of the currently available OSS cannot be gauged.

The objective of this work is to get a first-hand view of the situation of fecal sludge management in Pakistan. Primary data was collected from KII with officials who overlook the sanitation situation in different cities of Pakistan. Data from primary and secondary sources were used to assess the sanitation situation in three major cities of Pakistan i.e. Karachi, Lahore, and Islamabad. The cities were selected to represent the major provinces of Pakistan and their demographic profiles. Shit flow diagrams (SFD) were developed and Modified Service Delivery Assessment (SDA) was assessed on information gathered from primary and secondary sources. This helps in understanding the gravity of the sanitation situation in major cities of Pakistan and advocating for the redressal of the issue. The weakness in the existing legislation and infrastructure are also highlighted.

2.1. Study Area

Three major cities of Pakistan were selected for situational assessment, Karachi, Lahore, and Islamabad. Karachi, the capital of Sindh, is the largest city of Pakistan with more than 16 million people (Khan and Qureshi 2018). Located on the coast of the Arabian sea, Karachi has an arid climate. The city's proximity to the sea keeps humidity levels at a near-constant high, and cool sea breezes relieve the heat of the summer months (Arshad, Ashraf et al. 2020). This city alone contributes 15% to the national GDP. Karachi Water and Sanitation Board (KWSB) is the department responsible for the provision of water and sanitation facilities for the city. A large number of refugees have settled in informal settlements covering approximately half of Karachi's population (Khakpour, Iqbal et al. 2019). Major surface water in Karachi comes from Indus and Hub Rivers. Groundwater resources are limited. There are small streams draining water from the coastal basins of Lyari, Malir, and Budnai serving 80% of the surface runoff generated from the city. The untreated wastewater heavily pollutes these streams and carries the same toward the Arabian Sea (Amin, Zaidi et al. 2019, Fatima, Urooj et al. 2021).

Lahore is the second-largest city of Pakistan and the capital of the Punjab province with a population of approximately 11.1 million. Lahore has a semi-arid climate; with May the hottest month and October being covered with smog (Shahzad, Tahir et al. 2021). Water and Sanitation Agency (WASA) Lahore is responsible for services provided related to water and sanitation. The surface and groundwater resources have been under a lot of pressure lately, due to various factors, among which high population growth, increasing urbanization, inefficient irrigation practices, unsustainable water use, and fragmented management are the most prominent. The water demand of the increasing population of Lahore depends entirely on groundwater, but with increasing urbanization and industrialization, the amount of domestic sewage being produced in the city is spiking with each passing day (Hasan, Akram et al. 2021). Lahore disposes of its wastewater directly into River Ravi through 14 main drains without any treatment (Haider and Ali 2012).

Islamabad is the capital city of Pakistan and the Federal Government of Pakistan administers it. Islamabad has a humid subtropical climate and experiences heavy rainfall during monsoon. It has a population of 2 million which is almost equally divided between the rural and urban parts of the city (PBS 2017). The major source of water in the city is Simli and Khanpur dams (Shabbir and Ahmad 2016). The Deputy Commissioner is responsible for the administration and the Mayor for political governance. Capital Development Authority (CDA) is responsible for water and Municipal Corporation Islamabad (MCI) for sanitation facilities in the city. For administrative purposes, the city is divided into 5 zones (Adeel 2010). Zone I and Zone II are urban areas connected with a sewerage network and a centralized sewerage treatment plant. In complete contrast to the urban areas, the city's rural and peri-urban settlements constitute Zones III, IV, and V do not have access to any sewer networks. Different types of fecal sludge containment (septic tanks and pit latrines), and transport systems (manual and mechanical) are used but no treatment facility exists (Sarbagya Shrestha 2019).

2.2. Primary and Secondary Data

KIIs were conducted to get an insight from the personnel administrating the water and sanitation. It helped validate the data collected from secondary sources. In Islamabad, KII was conducted with senior officials at the CDA, MCI, WASA, and KWSB. Questions were asked from representatives of these organizations on the current sanitation situation in these cities. The existing sewerage coverage, shortfalls in the systems, planning, budgeting, and areas that need improvement were discussed. The officials were supportive of the necessity of an alternative centralized sewerage network including decentralized and OSS technologies.

Secondary data was collected from national and international publically available reports and published research articles. Under the 18th amendment of the national constitution in 2010, provinces were delegated to make and implement policies to meet their specific requirements. National and provincial policies along with national water and sanitation plans were analyzed. Publically available data was taken from the Pakistan Bureau of Statistics (PBS) (www.pbs.gov.pk), Pakistan social and living standard monitory survey (PSLM) conducted by PBS, Multiple Indicator Cluster Survey (MICS) (mics.unicef.org) by the United Nations International Children's Emergency Fund (UNICEF) and Joint Monitoring Program (JMP) (washdata.org) of the World Health Organization (WHO) and UNICEF.

2.3. Shit Flow Diagram (SFD) and Modified Service Delivery Assessment (SDA)

Shit Flow Diagram (SFD) is a universally accepted visual tool for focusing the attention of involved stakeholders and politicians on critical areas in sanitation that require utmost attention. The infographics are quite understandable and show how excreta flows through a city or town (Panesar, Walther et al. 2018). It reveals information on the movement of excreta from point of generation to its disposal (whether safe or unsafe). It clearly shows which components of the FSM need attention for the safe disposal of waste. SFDs are made with a graphic generator on the SuSanA website (https://sfd.susana.org). Data is entered depending upon the sanitation services available. The groundwater pollution aspect is also considered based on contamination by excreta and the population`s dependency on groundwater consumption. Numerical data is entered based on the percentage population to get an infographic.

The service delivery assessment is a tool used that analyses the quality of the ecosystem including planning, policies, financial health, regulatory and institutional arrangement. The infographic presents a vivid picture of the strong and weak areas of each city. A comparison can be developed with other countries around the world having a similar socioeconomic conditions (Scott, Ross et al. 2019). It is an analytical framework with three building blocks used to measure 1. the quality of the enabling environment, 2. the level of service development, and 3. the level of commitment to maintain the WASH services sustainability. A composite SDA ‘score’ is calculated for each building block at each step along the value chain. The scores are representative of each area of evidence and are averaged on a scale between 0 (worst case) to 3 (best case) (Peal, Evans et al. 2014). These tools are presently used by the World Bank’s Water and Sanitation Program (WSP) to compare management in cities across developing countries (Baltazar, Harada et al. 2021). The SDA and SFD Graphic provide an overview of the sanitation situation without detailing recourses to field studies (Peal, Evans et al. 2020). These tools are used in this study to assess the situation in the three cities of Pakistan, namely, Islamabad, Lahore, and Karachi using the mentioned data sources.

3.1. FSM scenario in Karachi

Out of 16 million people residing in Karachi, only 9.6 million (60% population) have access to sewerage. Out of the remaining 40%, 3% use OSS technologies, and, 1% population practices open defecation. The SFD for Karachi (Fig. 1a) gives a pictorial representation of the waste flow from the entire city along the FSM service chain. Though a centralized sewerage network contains 60% population’s wastewater yet, only 29% reaches the existing treatment plants. The reduced capacity of the system to deliver wastewater to the treatment sites is due to the dismal condition of the laid sewerage network. These treatment plants are partly functional and ultimately only 10% of the wastewater is treated. The remaining wastewater is discharged untreated to the nearby water streams of the Lyari and Malir rivers ultimately falling into the Arabian sea (Sánchez-Triana, Enriquez et al. 2015). The existing treatment plants were built in the 1960s and the population has increased significantly in that time, yet treatment capacity has been nearly stagnant. The sewer lines were also laid down at the same time and deteriorated to the extent of being dysfunctional (Beard, Satterthwaite et al. 2022).

About 36% of the population has no access to sewerage so the wastewater does not even get contained. The portion of the contained wastewater (31%) not delivered to a treatment plant together with without access (36%) makes 67%. Fecal sludge generated by OSS (3%) population is also disposed of openly and 1% population practices open defecation. There are three primary treatment plants of 151 Million Gallons per Day (MGD), out of three, one treatment plant is nonfunctional and other two are operating at limited capacity of 55 MGD. (Source: KII KWSB) All the remaining excreta and wastewater eventually contaminates majorly pollutes the waterways leading to the Arabian Sea. Discharge of wastewater and fecal sludge in open environments and rivers is common in developing countries like Bangladesh, India, and Sub-Saharan Africa (Semiyaga, Okure et al. 2015, Singh, Mohan et al. 2017, Singh, Hariteja et al. 2020, Foster, Falletta et al. 2021, Chandana and Rao 2022). Global implementation of SFDs in 39 cities identified that dumping of excreta is widespread and discharge to open drains is common in some Asian cities (Peal, Evans et al. 2020).

The composite SDA scorecard for Karachi is shown in Fig. 1b. The policy framework related to wastewater is largely in place but does not mention FSM at all. Containment and transport are having the highest scores illustrating that a centralized sewerage network is considered only. The planning and finances are also allocated for the development of sewer-based infrastructure. Although, the National Sanitation Policy (NSP) 2006 mentions “safe disposal of excreta by using sanitary latrines, creating an open defecation free environment” (GoP 2006). This does not imply on centralized sewerage network but on alternate options including OSS too. Alongside the NSP, the provincial Sindh Sanitation Policy (SSP) 2016 is trying to align itself with goal 6.2 of SDG. The intention is to completely cover the densely populated areas with sewer networks and peri-urban areas with septic tanks. Oxidation ponds based wastewater treatment units are considered and public private partnership is encouraged. NGOs and development partners often coordinate directly with the municipalities and Community Based Organizations (CBOs) and private sector operators play a role in supporting safe sanitation (GoS 2014). Orangi Pilot Project (OPP) is an example of a successful initiative of a community-led sanitation program. Under this project, the informal settlement of Orangi town was connected by a self-provisioned decentralized sewer network (Hasan 2006).

3.2. FSM scenario in Lahore

In Lahore, 63% of the population is connected to the sewerage network, 34% is relying on OSS and 2% performing open defecation (Fig. 1c). Despite having higher access to the sewerage network, none of the wastewater gets treated (Source: KII WASA). Non functional treatment plant in the city is one of the major reason of having very low scores in safely managed sanitation (Murtaza and Zia 2012, Ashfaq, Li et al. 2019). There are leakages in the distribution network and 70% water connections are un-metered resulting in 30–40% wastage (Haider and Ali 2012). The generated wastewater is directly disposed off in river ravi resulting in human waste back to drinking water sources.

The informal settlement have limited access to sanitation facilities as lower income and population density. There are no safely managed public toilets resulting in open defecation (2%). Only 8% of the fecal sludge contained onsite is buried safely. Septic tanks are the major type of OSS available but they are not properly operated. The tanks are connected to unlined leaching pits and/or unlined single-chambered tanks from the bottoms. However, the sludge is not emptied on regular basis, thus making the operation of the septic tank incapacitated. Lahore lies in a flat terrain and the groundwater level is below 60ft (Muhammad, Zhonghua et al. 2016). The groundwater is contaminated by industrial and residential sources largely (Khan, Toqeer et al. 2021). Lahore is also facing the issue of water levels lowering down due to excessive pumping compared to recharge. 80% of the domestic water usage including drinking is met from groundwater sources (Mahmood, Rana et al. 2011, Khan, Toqeer et al. 2021). Lahore is the country`s second-largest city without any wastewater treatment plant. There has been an increase in consideration of policy components for containment of wastewater, however, there is also no systematic approach for overall FSM in Lahore (Fig. 1d). The major issue is the lack of implementing policy and city-wise funding for FSM in the province of Punjab. Moreover, it was observed during KII, that there is less knowledge and awareness regarding fecal sludge management.

3.3. FSM scenario in Islamabad

In Islamabad 50% of wastewater is contained by a centralized sewerage network, 28% is delivered to treatment and only 10% percent is treated. About 49% is contained onsite, and 1% population defecates openly (Source: KII MCI). The SFD for Islamabad (Fig. 1e) paints a picture of the contrasting fortunes of the urban and peri-urban populations. The centralized sewerage network mostly contains the wastewater generated by urban sectors. Total wastewater of 60 million gallons is generated per day. There is only one treatment plant located in the I9 sector in Islamabad. The treatment capacity of the plant is 17 MGD but the actual treated is 6 MGD. The remaining 13 MGD is discharged untreated into the Lai stream (Source: KII CDA).

SDA scroes for Islamabad are represented in Fig. 1f. As Islamabad was a properly planned city and the sewerage network condition in the urban region is relatively better, thus the score in policy planning and budgeting is better (Adeel 2010). But due to the unavailability of a fecal sludge management service chain, the score in developing and sustaining services building blocks falls in the unsafe category. The peri urban and rural areas have septic tanks and pit latrines that are emptied manually/ mechanically on need basis. Sludge emptying is mostly performed by private companies and due to a lack of legal dumping sites and treatment plant for fecal sludge, the sludge is discharged into the environment (Zahid 2018, Khan, Fatima et al. 2021). The overall scores for emptying, treatment, and disposal are all in the lowest range (0–1) and unsafe category.

Pakistan made significant progress in reducing open defecation and providing basic sanitation during the MDG era (Ababa 2016). This is attributed to the provision of toilet facilities at the domestic level individually (Ali, Abbas et al. 2022). Sewers and OSS including pit latrines and septic tanks provide the separation of excreta from the human. A large portion of the population is connected to sewerage system 60% in Karachi, 50% in Islamabad, and 63% in Lahore yet the safely managed portion is 10%, 34%, and 8% respectively. The safe sanitation in Karachi is 10% and is generated by the primary wastewater treatment plants. In Islamabad, the major portion of safe sanitation (25%) is coming from the peri-urban areas where fecal sludge is disposed of onsite. Lahore is only generating the safe sanitation score (8%) from OSS disposing of fecal sludge insitu.

The main reason for low safe sanitation scores in the major cities of Pakistan is that the sewerage network is considered as a permanent solution and OSS is regarded as temporary. Among other South Asian countries, Pakistan has the highest coverage provided by sewers (27%) followed by Bangladesh (18%) and India (13%) as depicted in Fig. 2a (JMP, 2022). It is worth noting that the sewerage network in the major cities was laid decades ago and requires huge investment on repair and maintenance. Annually US $12.3 billion are required for safe water and sanitation provision in Pakistan including US $7 billion on capital and US $5.3 billion on operation and maintenance (Richard Watts 2020) while US $860 million was total budget allocated for WASH in 2019-20 (UNICEF 2020). However, the entire service chain of emptying, transport, treatment and safe disposal is missing. The fate of excreta when the OSS becomes full is a big question that needs addressing.

The sanitation situation in Pakistan is not much different in comparison to other South Asian countries including Afghanistan, Bhutan, Bangladesh, India, Nepal, and Sri Lanka. More than 50% of the population is relying on septic tanks and pit latrines in all the countries. However, the approach taken to resolve the sanitation issues are playing a major role in shaping the outcomes. The strong political will and strong partnership with donor agencies like WHO, UNICEF, World Bank, national and local level NGOs have made Bangladesh, Bhutan, and Sri Lanka open defecation free (Giribabu, Bharadwaj et al. 2019, Lindamood, Armitage et al. 2021, Haque, Moe et al. 2022). The safely managed sanitation in Bhutan, India, Bangladesh, and Nepal is 65%, 46%, 39, and 29% respectively while Afghanistan, Pakistan and Sri Lanka have no safely managed sanitation available to date (WHO/UNICEF 2021). The safely managed criteria is divided into two categories i.e. disposed of insitu, fecal sludge treated and sewerage treated. The major portion of safely managed sanitation in these countries is coming from disposed insitu (Fig. 2b) and is a common practice in rural areas (WHO/UNICEF 2021).

In Pakistan, the major reason for no safely managed sanitation is due to unavailability of government capacity to regulate and enforce sanitation standards for safe public health and the environment. To meet the targets of safe sanitation in Pakistan, it is important to look beyond the containment and improvise the policies related to collection, transport, treatment, and safe disposal. Currently, there is no policy on fecal sludge management and the focus is primarily given to sewer based networks only. In India and Bangladesh, the holistic approach of offsite and onsite is taken side by side (Narayan, Maurer et al. 2021). Citywide inclusive sanitation (CWIS) targets safe sanitation provision for everyone either connected by a centralized/decentralized sewerage system or utilizing OSS (Narayan, Marks et al. 2021). The current policies in Pakistan are completely ignoring this component. To meet SDG goal 6.2, complete recognition of the importance of OSS technologies and the service chain required for FSM is mandatory. The policies, plans, and guidelines need to be revised in light of the prevailing sanitation options.

Karachi (60%), Lahore (63%), and Islamabad (50%) are majorly covered with sewer based networks still the safely managed sanitation score is very low i.e. 10%, 8%, and 34% respectively. Wastewater treatment plants are not available in all the cities. In cities where they are available, their performance is far below the designed capacity. In Karachi, three treatment plants of 151MGD are available but only treat 33% of the wastewater. In Islamabad, the total capacity is 17MGD but 6MGD receives treatment and wastewater from Lahore does not receive any treatment at all. The major safe sanitation score from Lahore (8%) and Islamabad (25%) is coming from fecal sludge buried onsite safely. Policies related to planning, budget, allocation, infrastructure development, operation, and maintenance for sanitation are concerned to sewer based networks majorly. However, in all the cities OSS including septic tanks is a prevalent alternative sanitation option. Yet, there is no service chain available for fecal sludge accumulated within these OSS. There are no guidelines at the national, provincial, or local level for the handling of fecal sludge. FSM can be included in already existing water and sanitation policies with a due highlighted share on the complete service chain. Less capital investment is required from the public sector for OSS and puts more responsibility on households and private service providers. The government needs to develop a greater capacity in the CWIS context to enforce and regulate the sanitation standards and leave no one behind to meet SDG goal 6.2.

Ethical Approval

Not applicable

Consent to Participate

All authors participated and contributed to the research

Consent to Publish

All authors have approved the final version of the manuscript for submission to the journal

Authors Contribution

Nida Maqbool: Designed the study, data collection, manuscript drafting

Muhammad Arslan Shahid: Data collection and compilation, editing manuscript

Sher Jamal Khan: Supervising research, editing manuscript

Funding

The authors declare that no funds, grants were received during the preperation of this manuscript

Availability of data and materials

The data used in the study can be obtained from the corresponding author on request.

Competing Interests

The authors have no competing interests on the work reported in this paper.

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Editorial decision: Major Revision
14 Jun, 2022
Reviewers agreed at journal
18 May, 2022
Reviewers invited by journal
17 May, 2022
Editor assigned by journal
04 May, 2022
First submitted to journal
21 Apr, 2022

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Situational Assessment for Fecal Sludge Management (FSM) in Pakistan

Status:

Version 1

Abstract

Figures

1. Introduction

2. Methodology

2.1. Study Area

2.2. Primary and Secondary Data

2.3. Shit Flow Diagram (SFD) and Modified Service Delivery Assessment (SDA)

3. Results

3.1. FSM scenario in Karachi

3.2. FSM scenario in Lahore

3.3. FSM scenario in Islamabad

4. Discussion

5. Conclusion

Declarations

References

Status:

Version 1