The World Bank Group's Board of Executive Directors approved US$300 million in financing on November 13, 2026, for selected rural areas of Pakistan's Sindh province; it also covers hygiene services. The funds will go to the Sindh Transformational Accelerated Rural Water Supply, Sanitation, and Hygiene Services Phase 1 project, known as STAR WASH-1.
Stunting as the starting point
More than half of children under five in rural Sindh are stunted, the World Bank said in explaining the rationale for the project. According to the World Bank, unsafe water and poor sanitation cause repeated bouts of diarrhea in young children, impair nutrient absorption and limit physical and cognitive development. At a meeting in October 2025 between Sindh Chief Minister Syed Murad Ali Shah and a World Bank delegation led by Country Director Bolormaa Amgaabazar, it was noted that more than 90 percent of rural households in the province supply their own drinking water, often from contaminated groundwater, according to the Pakistani newspaper Dawn. Previous water, sanitation and hygiene initiatives had built infrastructure, Dawn further reported, but had been hampered by inadequate operation and maintenance after being handed over to local administrations or communities.
What the financing provides for
STAR WASH-1 is intended to finance climate-resilient infrastructure, including solar-powered water supply systems and improved sanitation facilities. According to the World Bank, it also includes an integrated social and behavioral change program intended to improve personal and environmental hygiene and support the transition from a focus on infrastructure development to safe, sustainable water, sanitation and hygiene services. The World Bank lists targets of halving water contamination at the point of use and connecting 80 percent of the targeted rural communities to a professional water and sanitation service provider. Amgaabazar said childhood stunting was among Pakistan's most severe and persistent human capital challenges, with unsafe water and inadequate sanitation and hygiene being a major underlying factor. The World Bank's lead water resources management specialist, Bekele Debele Negewo, said investments in safe water, sanitation and hygiene were more than building infrastructure, they were an investment in human capital, according to the news portal Nukta. The project is also intended to support the formalization of Sindh People's Housing for Flood Affectees as a rural water, sanitation and hygiene utility and is estimated to generate more than 14,000 new jobs. STAR WASH-1 totals US$540 million. Of that, US$150 million comes from the Asian Development Bank and a further US$90 million in counterpart funding from the Sindh government.
Service coverage, previous projects, study findings and risks
At the time of the project proposal in September 2026, only 29 percent of Sindh's rural population had access to safely managed water, according to the World Bank. That was significantly below the 48 percent in Punjab but above the 13 percent in Khyber Pakhtunkhwa, Business Recorder reported. According to the World Bank's project appraisal, STAR WASH-1 is the first phase of a four-phase Pakistani program intended to run from FY27 to FY35 and cover, in addition to Sindh, Khyber Pakhtunkhwa, Punjab and, depending on demand and available funding, Balochistan. A report published by ProPakistani in April 2026, citing a World Bank document from that time, had still anticipated around 2.5 million beneficiaries in 16 of 23 rural districts, while the first phase approved in November covers 1.5 million people.
The World Bank's Independent Evaluation Group subsequently rated an earlier project with a similar objective in the province, Sindh-MSAN, as moderately unsatisfactory. At project completion, Sindh-MSAN had reached 23 percent of the total rural population in the target districts with certification as free of open defecation, against a target of 50 percent. A cross-sectional study published in April 2026 in BMC Public Health analyzed data on 4,371 Pakistani children under five from the Pakistan Demographic and Health Survey 2017-18. It found a significant association between inadequate household access to water, sanitation and hygiene services and higher odds of underweight and stunting, but not wasting. According to the study, regions with low coverage of basic household hygiene and sanitation facilities, such as Sindh, Balochistan and FATA, were particularly affected. The authors write that targeted WASH interventions could help reduce chronic undernutrition, particularly in underserved regions. The World Bank's environmental and social review of STAR WASH-1 classified the project's risks as “Substantial” at the time of the review and cited, for example, groundwater contamination from improperly constructed latrines and a possible lowering of the groundwater table through solar-powered pumping. Which specific locations within Sindh's rural districts would benefit from the measures had not yet been determined at the time of the review.
The planned transformation of SPHF
Part of the proposed institutional reform is the planned transformation of Sindh People's Housing for Flood Affectees, so far primarily an implementing organization for construction, into a rural utility for water, sanitation and hygiene services. According to Dawn's report, earlier water projects in the province had been hampered at precisely this transition from completed infrastructure to ongoing operation.