ISLAMABAD - Toilets are still out of reach for more than one-third of the global population, with devastating consequences for health and development of children, says the United Nations Children's Fund (Unicef) on World Toilet Day being observed worldwide today (Tuesday).
In Pakistan, more than 43 million people defecate in the open. Every 24 hours, 320 children die of diarrhoea - the result of a deadly combination of unsafe water and poor sanitation conditions. Water and sanitation related diseases are responsible for some 60 per cent of the total number of deaths of children under five years of age.
"Access to toilets remains the unmentionable, often shameful secret in Pakistan," said Miriam de Figueroa, UNICEF Deputy Representative in Pakistan. "But it's invisibility doesn't make it less harmless; in fact it is quite the reverse especially as poor sanitation conditions contribute to malnutrition and the high level of stunting in Pakistan and provide a fertile ground for spreading the Polio virus. Lack of access to safe sanitation is literally killing Pakistani children - day after day after day."
"Every action which spurs people to change their way of dealing with defecation brings us closer towards the goal of sanitation for all. It is not easy, but it is certainly doable, and moreover, it is absolutely indispensable."
Diarrhoea contributes to and aggravates malnutrition, which is an underlying cause of more than half of all the deaths of children under five. Poor sanitation also has a serious impact on children's right to education when children miss school due to water and sanitation related diseases.
In addition, girls tend to drop out of school and female teachers may not work where there are no gender-segregated toilets. Women, as the primary caregivers of sick children, have less time to care for other children and to do other work, when they have to care for the ill.
Water, sanitation and hygiene related diseases cost Pakistan's economy an estimated 112 billion rupees each year. This economic loss is due to labour hours lost or reduced productivity, and household and public resources are diverted to curative services 
Although the world has met the global UN Millennium Development Goal (MDG) of halving the proportion of people without access to improved water sources, progress towards sanitation access remains the most off-track of all the sanitation related MDG targets in Pakistan.
The Government of Pakistan is pushing to bridge the gap. The National, as well as the provincial Sanitation Policies envision the creation of an open defecation free environment with safe disposal of liquid and solid waste and the promotion of health and hygiene practices in the country.
Further to this policy, a holistic vision of sanitation has been developed through an integrated Total Sanitation model resulting in the formulation of a Pakistan Approach to Total Sanitation (PATS) as a comprehensive strategy for promoting improved sanitation and hygiene outcomes in informal and rural areas that focuses social change.
Since 2010, UNICEF and the Government of Pakistan jointly with its implementing partners Plan International and Water Aid as well as several local NGOs initiated a rural sanitation programme reaching out to more than 7.4 million people by the end of 2012. Programs are being implemented to reach out an additional 1.3 million men, women and children in each province.
More needs to be done by the Government of Pakistan, communities and individuals to bring forth the taboo subject of toilets and open defecation for discussion and explore ways and means to tackle the problem.