Sustainable services for the underserved: Using transformative WASH to tackle child stunting

Results Highlights

• As of mid-2025, 218,000 beneficiaries in 180 villages have safe water, with 99 percent of connected households receiving WHO-standard supply. Eighty villages now have wastewater treatment, and 15,000 households use metered connections, with volumetric tariffs planned to encourage conservation. A centralized Management Information System (MIS) tracks construction, safeguards, complaints, and behavior change, with over 90 percent of grievances resolved within two days.

• Capacity building has trained 150 local mobilizers (70 percent women), reached 46,700 women with Water, Sanitation, and Hygiene (WASH) messages, and formed 200 village organizations. The project has created over 600 jobs for semi-skilled and skilled workers in the village and at the Punjab Rural Municipal Services Company (PRMSC) offices. Reflecting its credibility, the Government of Punjab (GoPb) has requested PRMSC to replicate the PRMSC model of service delivery in an additional 400 villages, financed by GoPb's own funds.

• By 2028, the Project aims to provide safe water to 6 million people, establish wastewater treatment in 2,000 villages, increase the rate of households with WHO-quality water from 35 to 75 percent, cover 75 percent of Operation and maintenance (O&M) through tariffs, and ultimately reduce child stunting from 37 to 22 percent.

Challenge

Poor management of fecal waste and drinking water quality are among the main drivers of child stunting in Pakistan, which affects 2 out of 5 children under 5 years of age, hindering nutrient absorption and cognitive development causing lifelong impacts on health, immunity, productivity, and learning outcomes. Fecal burden on water sources and increases in waterborne diseases contribute to 20-40 percent of hospital admissions in Pakistan. Past public investments in rural water and sanitation focused disproportionately on water supply, which were handed over to communities with no technical or financial support for operations and maintenance, resulting in infrastructure dysfunction, affecting about a third of all public schemes. Rural sanitation and treatment and safe disposal of wastewater have historically received limited budgetary and investment support.

Approach

The project tackles rural stunting by combining infrastructure investments, behavior change communication (BCC) campaigns, and improved service delivery. With the World Bank support, the Government of Punjab established the Punjab Rural Municipal Services Company (PRMSC), a first-of-its-kind rural utility responsible for design, construction, and ongoing operations. Operation and maintenance (O&M) is financed through user tariffs, and has already achieved a 70 percent recovery rate, aided by the rollout of mobile payments.

PRMSC employs a geo-referenced Management Information System (MIS) with timestamped evidence to monitor construction, ensure compliance, and authorize payments, creating transparency and continuous feedback loops. Based on pilot lessons, PRMSC redesigned schemes to reduce costs by 10-30 percent and expand technology options. A solarization program is shifting long-term energy costs into upfront investments, mitigating service risks from unreliable electricity supply.

For services, behavior change campaigns are led by regional BCC officers and female Ambassadors of Change, while independent third-party testing ensures all water supply and wastewater treatment meets national standards.

World Bank Group Contribution

Skills and "better jobs": PRMSC has provided structured induction and on-the-job training, including clear roles, basic Personal Protective Equipment and safety protocols; reliable remuneration backed by tariff revenues; and progression pathways from village posts to regional operations teams.

Women's economic participation: 150 local social mobilizers have been trained (~70% women) supporting behavior change and customer engagement; 46,700 women have been reached with hygiene/WASH behavior training-expanding the pipeline for paid community-facing roles and enabling time-savings that can translate into labor-force participation.

At full scale (2,000 villages) in 2028: ≥8,000 sustained local O&M jobs will be filled by residents of beneficiary villages (tariff-financed posts for network operation, customer service, minor maintenance, and village cleanliness/solid-waste tasks).

Looking Ahead

By Project closing in 2028, it is expected that all infrastructure O&M costs, including regional office overheads will be covered by PRMSC tariff revenues. PRMSC Head Office would be supported by the World Bank (and potentially other donors) to expand its infrastructure and service delivery model to new areas and continue providing technical support to its regional offices. A second Phase of this project is under discussion and will likely be developed as part of the Pakistan Rural WASH Multiphase Programmatic Approach (MPA) under preparation. Phase one of the proposed MPA focuses on Sindh, for which the project design has benefited from the PRMSC experience , including through a field visit by Government of Sindh to Project locations in Punjab, and a workshop delivered by PRMSC to technical staff of Government of Sindh.