sustainability

Article
Assessing Health Damages from Improper Disposal of Solid
Waste in Metropolitan Islamabad–Rawalpindi, Pakistan
Tanzila Akmal * and Faisal Jamil

School of Social Sciences and Humanities, National University of Sciences and Technology (NUST),
Islamabad 44000, Pakistan; [email protected]
* Correspondence: [email protected] or [email protected]

Abstract: Rapid urbanization in developing countries leads to a dramatic increase in solid waste
production, with serious socio-economic and ecological impacts. In order to avoid the associated
hazards, particularly those related to human health and the environment, solid waste management
is indispensable. Disposal of municipal waste that predominantly comprises household and com-
mercial refuse has become a daunting task for local governments and municipalities of Pakistan.
Issues related to both inadequacy of service delivery and inappropriate disposal signify that waste
management should be high on the local environment policy agenda. In particular, the external cost
of waste management is high, and cost recovery of refuse collection may cause the exclusion of many
households and additional costs on the households that avail themselves of the service. In this study,
we carried out an evaluation of the health damage caused by improper waste disposal in a sample of
heterogeneous households. The study shows a framework for evaluating the damages caused by
inadequate waste management practices. The results indicate that irregular disposal in the vicinity of
residents causes illness: respondents living within 100 m are more vulnerable to malaria, dengue, and



asthma than those living more than 500 m away. Moreover, the findings highlight that households

 lack knowledge of waste hazards and 75.9% of waste is not segregated. We suggest a subsidized
Citation: Akmal, T.; Jamil, F. waste collection and disposal service provided either by the local government or by outsourcing.
Assessing Health Damages from
Improper Disposal of Solid Waste in Keywords: solid waste management; health hazards; environmental awareness
Metropolitan Islamabad–Rawalpindi,
Pakistan. Sustainability 2021, 13, 2717.
https://doi.org/10.3390/su13052717

1. Introduction
Academic Editor: Antoni Sánchez
Rapid urbanization in developing countries leads to a dramatic increase in solid waste
production, with serious socio-economic and ecological impacts [1–3]. Poor infrastructure
Received: 6 January 2021
Accepted: 22 February 2021
and land use regulations have resulted in inadequate cover of waste collection services
Published: 3 March 2021
and inappropriate disposal. Moreover, poorly managed municipal waste creates many
environmental and health-related issues, especially in the neighborhoods of dump sites.
Publisher’s Note: MDPI stays neutral
Poor urban slum dwellers are particularly vulnerable and are acutely affected by waste
with regard to jurisdictional claims in
dumping [4]. Waste collection is an essential first part of the process of waste management.
published maps and institutional affil- Ever-growing volumes of solid waste create serious issues in handling and disposing it of
iations. aptly in the face of resource constraints in less-developed countries [5]. A weak institutional
setup and difficulties in recovering the cost of the service make it difficult for municipal
authorities in these countries to collect and segregate the waste from all potential waste
producers [6–8].
Copyright: © 2021 by the authors.
In most developed countries, a door-to-door collection system is commonly used, but
Licensee MDPI, Basel, Switzerland.
municipalities in developing countries can provide this service to only a limited proportion
This article is an open access article
of the population due to financial and administrative incapacity [9]. As a result, waste
distributed under the terms and is thrown into open landfill sites and dumpsites, which evolve into sources of health
conditions of the Creative Commons and environmental threats for people living in the neighborhood [10]. Because of poorly
Attribution (CC BY) license (https:// designed municipal waste management systems, many urban areas in developing countries
creativecommons.org/licenses/by/ experience significant environmental deterioration and health threats [11]. Various studies
4.0/). have investigated the health and environmental impacts of waste dumping and have shown

Sustainability 2021, 13, 2717. https://doi.org/10.3390/su13052717 https://www.mdpi.com/journal/sustainability

Sustainability 2021, 13, 2717 2 of 18

that waste and health variables are closely linked [12–19]. The conclusion of these studies has
led researchers to become deeply involved in the study of environmental pollution and its
effects on microorganisms [20]. However, very few studies have explored the environmental
and health effects of solid waste for people living near waste dumpsites [21–23].
The increasing rates of the consumption and production of goods result in the gen-
eration of a tremendous amount of waste that needs to be absorbed by the environment,
posing a serious risk to human health [24]. In many developing countries, waste disposal
sites are located in the vicinity of urban areas, and these mini-dumpsites are a source of
infection for children due to the incubation and reproduction of mosquitoes, flies, and
rodents [25]. They, in turn, produce gastrointestinal, dermatological, respiratory, genetic,
and several other types of contagious infections [24,26,27]. Moreover, residents living near
dumpsites present increasing rates of stomach and cervical/uterine cancers in women and,
likewise, stomach, liver, lung, and prostate cancers in men [28].
Improper disposal of waste also includes that of sharp objects (such as syringes, razors,
and blades) that directly pose serious health hazards to waste pickers and disposal workers.
Data revealed that more than 250 million people are infected with the Hepatitis B virus,
70 million with Hepatitis C, and 38 million with immune deficiency infections worldwide,
primarily due to exposure to infected syringes and blades [29,30].
Accordingly, Pakistan is facing serious solid waste management (SWM) problems that
have received a lot of attention due to an increase in environmental vulnerability [31]. Recent
assessments in major cities of Pakistan showed that the average waste generation rate from
all types of municipal controlled areas varies from 0.283 kg to 0.613 kg per person each day,
and waste production is growing annually at a rate of 3.67% to 7.42% [32–34]. In addition,
Pakistan ranks highest for poorly handled plastic in South Asia. In Pakistan, 30 million tons of
solid waste are produced annually, out of which 9% are plastics, contributing approximately
0.2 million tons of plastic waste along the Indus river to the Arabian Sea. Almost 55 billion
plastic bags are produced in a year and make their way into water streams and landfills,
making sewerage systems even harder to manage. Several countries—including Bangladesh,
France, and Rwanda—have banned the use of plastic bags. In Pakistan, the Environment
Protection Agency (EPA) has also released a Statutory Regulatory Order to ban plastic bags in
the Federal Capital, Islamabad, and in other cities, like Lahore and Hunza. Currently, there is
no constitutional mandate at the federal and provincial levels that addresses the implications
of single-use plastics and plastic waste management in a wider area [35].
Municipal corporations in Pakistan generally provide bins at a community level, which
are evacuated after being filled. Waste containers are provided at designated convenient
points within a community to enable households to put out their trash. Waste pick-up
vehicles are supposed to empty these containers as soon as they are full. However, waste
is often overflowing, and land dumping takes place near the bins and on illegal sites [36].
In addition, the paucity of bins increases the time, effort, and cost of waste disposal, and
households may, in turn, choose inappropriate dumping on unauthorized sites. Illegal
dumping on unauthorized land, in canals and streams, and on roadsides all contaminates
canal and ground water supplies [37–39]. Moreover, improperly handled waste blocks
sewage, which creates a conducive environment for the breeding of mosquitos that spread
malaria, dengue, and other infections [23,40].
The Millennium Development Goals (MDGs) and Sustainable Development Goals
(SDGs) have made environmental sustainability and the security of human health a greater
focus. As a result of initiatives taken to meet the MDGs, 2.1 billion people now have
access to improved sanitation systems in developing countries. The SDG policy encourages
waste minimization through extensive waste reuse and recycling activities. For example,
SDG-3 is about the well-being and health of people, SDG-6 aims to improve water and
sanitation systems, and SDG-11 is directly related to solid waste collection and management.
Sewerage is a primary source of water contamination in Pakistan. In certain cases, lax
environmental regulations have resulted in the dumping of hazardous and toxic industrial
waste in water bodies [41,42].
Sustainability 2021, 13, 2717 3 of 18

In this context, the inadequacy of infrastructure and the inappropriate handling of mu-
nicipal waste is a matter of great importance. This study aims to outline a comprehensive
and feasible policy to address these challenges which would subsequently improve health
indicators for urban households. In this study, we carry out an objective assessment of the
health damages incurred in twin cities. (Twin cities are a special case of two cities or urban
centers which are situated in near geographical proximity, and Islamabad–Rawalpindi are
known as twin cities because they are adjacent.) The results derived on the cost of illness
will contribute to policy implications for the waste management sector.
The rest of the paper is as follows. Section 2 highlights the waste management practices
in the twin cities. Section 3 outlines the literature review used to assess the role of health
damages from solid waste. Section 4 outlines the sampling process and survey design and
provides an analysis of relevant variables. Section 5 presents and discusses the proposed
model. Finally, Section 6 concludes the study.

2. Household Solid Waste Management Issues in Islamabad–Rawalpindi

The capital of Pakistan, Islamabad, is the tenth largest city in Pakistan, and the
neighboring city of Rawalpindi is the fourth largest. These two cities have populations
of 1.019 million and 2.09 million inhabitants, respectively [43]. The terrain is of higher
altitude (1043 m above sea level) in the northwestern part, while the southeastern area is of
lower altitude (660 m above sea level) [44]. The climate of Islamabad–Rawalpindi is humid
subtropical, since both are located at the foot of the mountains.
The twin cities are well-planned and are thus distinct from other cities in the country
that have historically evolved downtown areas, old cities, and urban slums. Despite
being well-planned cities, they lack a proper waste disposal system even 50 years after
establishment. Only 60% of the waste generated in the cities is collected by the Capital
Development Authority (CDA) and Rawalpindi Waste Management Company [45,46]. The
waste disposal method in the twin cities is open dumping without any gas collection or
leachate management system for the safety of ground and surface water resources [47].
An existing dumping site, I-12, is located in a residential area next to a major government
hospital, which is not ideal for waste disposal.
A huge amount of waste is dumped on the bed of the Soan river. Nullah Lai flows
west of the city, entering from the southwest and joining the Soan River on the southern
side. The Soan is the main stream draining Islamabad and the surrounding areas, which
particularly affects the Dhok Chapper, Dhoke Ratta, Gulraiz Charistain Colony, Dhoke Hassu,
and Nullah Lai. The Nullah Lai is a watercourse that transports a high amount of untreated
community sewage and municipal solid waste along its path [48]. In addition, the main
source of piped water is three dams, namely, the Khanpur dam, the Simly dam, and the Rawal
dam. All except for Rawal dam are quite distant from the urban area of the twin cities and
are less exposed to manmade contamination. However, the Rawal Dam is likely to be
polluted with municipal waste.
Solid waste management is unsustainable in Islamabad–Rawalpindi as the local
authorities fail to handle waste properly. The spreading of uncollected heaps of waste is
visible almost everywhere, posing a major threat to public health and the quality of the local
environment. There is a fundamental difference between the processes of waste collection
and disposal adopted by most of the public and private agencies in the twin cities and the
operationally available best practices accounting for sustainability and circular economy.
It is alarming that waste is typically discarded in an unauthorized way and that many
residents of the metropolis do not dump their waste at the designated sites. Even the
planned urban areas lack appropriate waste collection. Private service providers in the
waste management sector operate either on a commercial basis where services are provided
to those who demand it or as private operators who serve all residents of a locality and
receive a subsidy from local municipal governments. In addition, source-segregation of
waste materials among households prior to collection is unusual in the sample compared
to in advanced countries, where waste is typically segregated and collected separately. In
Sustainability 2021, 13, 2717 4 of 18

the twin cities, waste segregation at the source among households is lacking, and generated
waste is jumbled in a single container.
In the twin cities, NOx and PM10 concentrations were found to be higher than the
WHO guidelines. In Islamabad, the highest level of CO per hour was reported to be
3.3 ppm. These pollutants create a layer of smog that reduces the visibility of Margalla
Hills (a suburb of Islamabad), showing the intensity of the city’s pollution [49]. The Pb
and Zn concentrations in waste were also found to be relatively higher than those of other
components. The average concentrations of Pb were 3.9, 3.2, and 4.6 µg/g and the average
concentrations of Zn were 6.6, 5.3, and 6.7 µg/g in Islamabad–Rawalpindi [50].
In addition, monsoons play a decisive role in evaluating the air quality in Islamabad
due to weather conditions. The production and composition of leachate become worse
during the monsoon season. Open dumping during the monsoon season triggers the
highest output of leachate. Evidence shows that the post-monsoon period is more polluted
than the pre-monsoon period, posing a threat to the local population. Similarly, compared
to the pre-monsoon period, a higher level of PM10 was found to result in 43% more infant
deaths and 41% more all-cause-mortality deaths in the post-monsoon period [51].

3. Literature Review
The existing SWM systems in developing countries have resulted in the mushrooming
of unplanned dumpsites. Environmental governance of SWM is becoming the central com-
ponent of a sound waste management policy that dominates the development discourse.
Studies in the literature have focused primarily on the planning part, and very few studies
have investigated the social and health costs of waste production and its disposal activities.
The externality aspect of waste management makes it essentially a normative policy issue.
The utility provider may recover the financial cost of the service from waste producers;
however, it would be difficult to analysis this without calculating the cost of externalities.
The disposal of waste at landfill sites has an effect on people living in the site neigh-
borhoods [52]. A study showed that 78% of participants living near a landfill site reported
significant air pollution due to bad odors, and 56% of those living near the landfill site
expressed concerns for their health in the future. The prevalence of diarrhea in households
was found to be 14.4% in a cross-sectional epidemiological analysis [19].
One of the most serious health consequences of dumping waste in inhabited areas is
the risk of infectious diseases through water. Endemic zoonotic diseases, which are highly
correlated with fecal material at waste disposal sites, are usually flushed away by rain
into the surface or ground water, thus polluting the water source. Contaminated water
contains fecal coliform counts of up to 15.25 MPN/100 mL of water, as compared to the
recommended level of 0 MPN/100 mL, which makes it extremely unhealthy for drinking
purposes [28]; the health effects of hea MPN y metals in waste can also be life threatening
and may range across headache, irritability, memory deterioration, diminished intellectual
capacity, kidney damage disease, and liver and bioaccumulation leading to cancer [53,54].
Substantial efforts have been made and many waste management programs have been
introduced in order to mitigate the harmful effects of solid waste in developing countries
over the past two decades [55]. Aside from national waste management plans, household
SWM practices are becoming increasingly important as external costs of waste management
grow [56].
Household participation can help in resource conservation and providing economic
value through appropriate waste handling, which reduces environmental pollution and
minimizes the financial costs of waste disposal. However, the participation rates of the
community in waste management remain low in developing countries, perhaps due to a
lack of understanding of segregation, individual behavior, or issues regarding awareness
of the perceived benefit.
Source segregation is a key determinant of effective sustainable waste management [57].
The SW-Corp Strategic Plan 2014–2020 was introduced in Malaysia to implement the
mandatory segregation of household waste, and it was found that segregation and re-
Sustainability 2021, 13, 2717 5 of 18

duction of waste generation are efficient ways to minimize the harmful effects of waste
disposal [58]. Household response to waste management can be two-pronged: mitigation
and adaptation by taking protective measures. For mitigation purposes, the municipal
agency can create enabling circumstances to reduce waste production and improve segre-
gation and appropriate disposal. Households can take protective measures (safe drinking
water, use of masks, etc.) to avoid the consequences of hazardous waste [59,60]. There-
fore, direct and indirect effects on air, water quality, and health can also be mitigated by
adopting an appropriate waste management system that essentially requires institutional
commitment and a legal framework [61]. Table 1 summarizes the literature related to solid
waste and its health impacts.

Table 1. Summary of literature related to the health impacts of solid waste.

Authors Objective of Study Results

78% of participants living closer
Disposal of waste in landfill
to the landfill site indicated
[52] has an impact on residents
serious contamination of
living closer to it
air quality
Results revealed that
Cross-sectional households suffer from
[19]
epidemiological study diarrheic disease because of
poor sanitation
Poor waste management and Poor waste management has
[28]
water contamination adverse effects on human health
Causes kidney damage disease
Cadmium exposure and
[53] and liver and bioaccumulation
liver disease
that leads to cancer
Cause headache, irritability,
Effects of toxic metals
[54] memory deterioration, and
on health
diminished intellectual capacity

• Respondents living within

Assessment of the health 100 m are more vulnerable
damages incurred in to malaria, dengue, and
This study heterogeneous households asthma
due to poor waste • Proposed decentralized
management model for sustainable
waste management

4. Study Design and Sample Size

In this study, we employed a cross-sectional quantitative dataset obtained from the
residents of the selected localities of the twin cities of Rawalpindi and Islamabad through a
structured questionnaire. The questionnaire was self-administered and paraphrased in the
Urdu language as most of the respondents would not be able to answer in English. The
questionnaire was based on a literature review and in consultation with sectoral experts
before and after pretesting.
The study presumed that waste is dumped at a site in each locality. Households
were assumed to be heterogeneous in their choice of residence and were divided into two
groups—those living near the dumpsite (within a range of 100 m to 500 m radius) and
those living away from the dumpsite (more than 500 m away). Urban poor in the twin cities
face many barriers to accessing solid waste management services and live in an unhealthy
environment compared to the residents of wealthy communities. The predominant practice
of poor communities is open dumping in empty plots and beside water streams (nullahs).
Sustainability 2021, 13, 2717 6 of 18

Nullahs originate from the river. A huge water stream flows near the residential area; it is
not only natural—it is also used for sewage purposes in the twin cities.
Solid waste services in poor communities are not considered to be the main service
delivery component. Both types of households are distinct in their degree of exposure to
pollution and may be at varying risk of diseases. The survey included questions about eight
reported toxic exposure symptom variables across households: (1) diarrhea, (2) malaria,
(3) dengue, (4) asthma, (5) skin problems/irritation, (6) cholera, (7) typhoid, and (8) fatigue.
Multistage random sampling was employed for data collection. In the first stage, we
randomly selected certain residential areas. In the second stage, houses within a street
were randomly chosen in a particular sector. In the third stage, the sample was divided
into 35 sectors and towns, and 24 households from each sector were selected for interviews.
Selected sites were further divided into 17 locations close to dumpsites and 18 residential
locations away from dumpsites. In the final stage of the analysis, 850 households were
interviewed. The data were input into SPSS to generate descriptive statistics, and then
frequency and correlation tests were conducted.
It was hypothesized that both the waste collection services and waste-related envi-
ronmental health awareness vary in different localities. Generally, each locality consists of
households with similar income, which can be an important factor revealing the capacity
of households to successfully implement solid waste management strategies to support
municipal corporations. This leads to disparities in the attitude of householders to han-
dling and segregating waste, as well as their participation in waste reduction programs,
participation in recycling, and demand for collection services. Figure 1 gives a glimpse of
the survey site and properly numbered sampling basis.

Figure 1. Cont.
Sustainability 2021, 13, 2717 7 of 18

Figure 1. (a) Map of the twin cities and (b) locus of sampling clusters.

4.1. Statistical Analysis

The demographic statements included in the survey were gender, age, education, and
income. The majority (64.8%) of the respondents in the sample were women, as shown in
Table 2. The education levels of households were erratic, as we found a dip in the case of
secondary education vis-à-vis the lower and higher education levels. A similar data trend
was exhibited for monthly family income, where the lowest and the highest income groups
had the highest frequencies in relation to other inhabitants of the selected sample, as can
be seen in Table 2. Correlations between all items are presented in the Appendix A.

Table 2. Social–economic information on the respondents.

Age
Gender
15–20 21–30 31–40 41–50 >51
Female 153 221 119 47 11
Male 92 94 109 3 1
Income
Education <30 k 31 k–50 k 51 k–70 k 51 k–70 k 71 k–1-lac
Illiterate 92 57 21 7 26
Primary 30 10 9 3 5
Secondary 70 41 38 13 46
Higher 29 38 46 19 56
Professional 27 32 28 24 73
Source: Author’s calculation.

4.2. Waste Generation and Composition

In the present study (Table 3), biodegradable waste (mainly kitchen waste) was found
to contribute most (45.5%) to the generation of household solid waste (HSW). These
results are consistent with findings from several other developing countries, including
Nigeria [55]. Kitchen waste typically becomes moldy and produces strong odors. Proper
Sustainability 2021, 13, 2717 8 of 18

treatment of waste materials is therefore essential for the maintenance of a healthy and
balanced environment.

Table 3. Waste composition.

Index Item Sample Percentage Kg/Person/Day

Plastic 342 kg 18.46 0.40 kg/day
Organic 842 kg 45.46 0.99 kg/day
Waste Glass 279 kg 15.06 0.32 kg/day
composition
Paper 172 kg 9.28 0.20 kg/day
Other 217 kg 11.71 0.25 kg/day
Total 1852 kg 100 2.17 kg/day
Source: Author’s calculation.

The survey results revealed that each person produces 2.17 kg of waste per day in the
study area of twin cities in Pakistan, out of which 0.40 kg/day is plastic, 0.99 kg/day is
organic components, and 0.32 and 0.20 kg/day are glass and paper, respectively. This result
is similar to the findings of previous studies in Beijing, China (0.8 kg/cap/day); Ambon,
Indonesia (0.9 kg/cap/day); and Lahore, Pakistan (0.84 kg/cap/day) [39]. Various factors
can affect household waste generation, such as family size, education level, and monthly
income [62].
Only 51.4% of households in the study area have access to waste collection services.
In addition, the solid waste disposal methods used by households in the survey area
are quite unsatisfactory. The most common means of waste disposal were a street-side
container and door-to-door collection, and 29.3% of households dumped their waste into
containers. Respondents stated that containers overflow and create a breeding ground for
mosquitoes and rodents. Another 22.2% used a door-to-door collection service, while 17.6%
of households dumped their waste directly into empty plots, and 21.8% of households
dumped their waste into water bodies such as sewage streams (nullahs). Burning of waste
was reported by 9.1% of households. Households do not recycle waste in the twin cities of
Pakistan—the results showed that collected waste is mostly not segregated (75.9%).

4.3. Awareness of Solid Waste Management

The results demonstrate that 58 percent (n = 492) of the survey participants were not
aware of the hazardous effects of solid waste, compared to 42 percent (n = 359) who were
aware of them (Figure 2).

Figure 2. Household awareness of solid waste management (SWM) practices.

Sustainability 2021, 13, 2717 9 of 18

4.4. Interconnection between Solid Waste and Diseases in Islamabad–Rawalpindi

In the present study, 21% of households reported that no member of the household
had suffered from the mentioned diseases or disorders during the past 12 months as a
result of their exposure to hazardous waste. According to the responses, 31% of households
had a member who suffered from diarrhea, 13% from dengue, 20% from malaria, 13%
from cholera, 6% from skin infections, 9% from asthma, 6% from typhoid, and 2% from
fatigue (Figure 3), all of which can be linked to various environmental and hygiene factors,
including poor sanitation. In low-income, high-density areas, the number of different
types of diseases per household has increased in the last year. Therefore, household risk
perception needs to be addressed. It is suggested that awareness of a health hazard leads to
a household’s willingness to clean exposure-relevant contaminated sites, thereby leading
to a reduction in health hazards [63].

Figure 3. Household disease burden declared by respondents.

4.5. Interconnection between Distance from Dumpsite and Diseases

The households analyzed in this study can be divided into clusters based on their
geographical distance from a dumpsite. Based on our survey results (see Figure 4), people
living close to dumpsites are more likely to be exposed to pollution such as air pollution,
toxic gases from rotten trash, contaminated tap water, and Cu, Mg, and Sb contamination.
These hazards can cause a variety of diseases, as shown in Figure 2. Respondents living
within 100 m are more vulnerable to malaria, dengue fever, and asthma, and 31% of
respondents suffering from different waste-related diseases lived within 100 m, compared
to 16% living ≥500 m away. Moreover, 29% of those living in the 101–200 m range and 17%
living in the 201–300 m range reported facing illnesses.

Figure 4. Interrelation between diseases and distance from a dumpsite.

Sustainability 2021, 13, 2717 10 of 18

4.6. Government Policy Instruments

Households can be induced to segregate waste by monetary rewards, coercion, and
penalties levied by the government. As shown in Figure 5, our results revealed that a
subsidized waste management service is an optimal solution to be provided either by
local government or by outsourcing. Based on our survey data, 32.7% of households
were strongly in favor of incentive-based waste management policies. As a result, the
Government will be able to allocate its resources in an appropriate manner to boost societal
standards and benefits, as well as carry out targeted interventions to encourage households
to segregate their garbage.

Figure 5. Government policy instruments for SWM.

5. A Proposed Plan for an Improved Waste Management System

Sustainable waste management (SWM) is a key concept of circular economy that
opens up a multitude of opportunities. Environmentally friendly waste management starts
right from its generation. In exacting frameworks, waste management is a “value chain”
that involves the treatment, reuse, and disposal and recycling of various waste streams
that provide economic incentives; however, current frameworks lack descriptions of the
external costs and the related economic players, as well as why economic agents should
cooperate to achieve an optimal solution.
For sustainable waste management, it is necessary to know where we are before
we can plan the route to where we wish to be. Figure 6 highlights and compares the
adopted model vis-à-vis the desired process. Figure 6 demonstrates a comprehensive
SWM strategy with clearly established goals and priorities that transforms the current
infrastructure to a decentralized model for sustainable waste management. The proposed
model shows that an optimal model for SWM includes devolving collection, which would
integrate households into the waste management process, and delegating treatment, which
incentivizes municipality authorities to install appropriate technology, thus controlling the
external costs and the number of landfill sites built and promoting monitoring. A coherent
national legislative framework is designed and enforced in addition to comprehensible
monitoring at every step.
Sustainability 2021, 13, 2717 11 of 18

Figure 6. The architectural View of Economic Planning for an Integrated MSW system.

In the given scenario, three types of economic agents work together, namely, house-
holds, waste collection companies, and the government. The choice of a household between
external costs and abatement activities depends on the price ratio and the marginal utility
they gain. The proposed plan offers a normative model of individual behavior towards
waste disposal that can reduce the associated externalities of waste in the form of health
damages and can recover resources.
In additional, the framework provides useful insights for municipal authorities,
enabling local administrations to share the responsibilities associated with solid waste
management practices, reducing local administrations’ vulnerability and diminishing re-
gional economic disparities. Integrating local populations, community-based organizations
(CBOs), and non-governmental organizations (NGOs) into the operational scheme would
enable the sharing of financial burdens and more appropriate waste management.
In addition, the approach proposed herein offers numerous policy options for inte-
grating authorities and shows how these policies assist in achieving desired outcomes
for sustainable waste management. Each operation is connected to the defined goals and
policy recommendations, and it helps in achieving the desired solution for sustainability.

6. Conclusions and Policy Implications

This study identified the health impacts of waste disposal sites. According to our
study results, the health status of residents in Islamabad–Rawalpindi varies depending on
their proximity to a dumpsite. Households living closer to a dumpsite are more vulnerable
to various risk factors, such as air pollution, water contamination, and mosquitoes and
Sustainability 2021, 13, 2717 12 of 18

rodents, all of which can result in a number of hazards and should be taken seriously by
the local authorities.
This empirical study offers policy guidance to policy-makers in order to make their
intervention plans more cost-effective in reducing the negative externalities of waste.
Improvements in waste collection services can set forth a huge chain of beneficial outcomes.
Improvements in human health are, of course, the most widely predicted result of waste
management interventions. Increased availability of waste collection services reduces the
incidence of waste-related diseases, while improvements in the quality of water lower the
incidence of waterborne diseases.
The analysis of waste-related illness in the present study repeatedly demonstrated the
importance of safe and adequate waste collection and disposal services in improving the
status of households in Pakistan who are vulnerable to the occurrence of such illnesses. The
results highlight the significance of overall infrastructure variables such as garbage removal
facilities, water sources, and the usage of contaminated water, which are not always within
the control of the specific household. As a consequence, community and government
participation is needed. In addition, the results also indicate extreme demand for waste
management services as only 51.4% of residents in the study area availed themselves of
waste collection services. The results provide food for thought to local bodies in terms of
meeting the unsustainable demand for waste collection services.

Author Contributions: T.A.—conceptualization, methodology, formal analysis, original draft prepa-

ration, study design, methodology, review and editing, supervision, project administration, method-
ology, data curation, validation, and formal analysis. F.J.—supervision, review and editing. All
authors have read and agreed to the published version of the manuscript.
Funding: This research was funded by the National University of Sciences and Technology (NUST),
Pakistan (Grant 633 USD).
Institutional Review Board Statement: So far, Pakistan does not have an institutional review board
or national ethical guidelines for Economics studies. The study therefore adhered to existing research
ethics principles such as obtaining verbal consent to participate in research, retaining personal
informal privacy, and allowing participants to withdraw their consent if they so wished at any
point. In addition, no personal information was used in this analysis. Participants, who provided
information related to solid waste generation and related information, were used in this research.
Informed Consent Statement: Informed consent was obtained from all subjects involved in the study.
Data Availability Statement: Data published in this study are available on request from the corre-
sponding author. The data are not publicly available due to the policy of the research project.
Conflicts of Interest: The authors declare no conflict of interest.

Appendix A
Appendix A.1. QUESTIONNAIRE
We are here to conduct a study on solid-waste-management-related issues. You
are invited to take part in this research project. Please note that your participation is
entirely voluntary, and deciding not to participate will not affect your relationship with the
researchers or associated organizations. If you agree to participate, you will be interviewed
using a questionnaire. You may choose not to answer some of the questions or all if you feel
so inclined, but your response will be a very important source of information on sustainably
managing waste and the drinking water supply in your area. It will take approximately
30 min, and you may of course decide to stop the interview at any point. You have been
selected as a resident of Islamabad–Rawalpindi Metro. The purpose of this research is
to collect information on various aspects of solid waste management. This research aims
to raise awareness about the issues associated with solid waste and to provide valuable
information to the municipality and relevant policy-makers to manage solid waste in a
sustainable way. The questionnaire contains alternative policy options related to municipal
solid waste management and household information. There are no right or wrong answers,
Sustainability 2021, 13, 2717 13 of 18

and the choices you are going to make are useful for future planning and making relevant
policies for the effective management of solid waste. We are interested in your opinion and
we will take handwritten notes on your responses on a questionnaire sheet.
We would like to assure you that your response will be completely anonymous, and
only aggregated results of the questionnaires will be used for disseminating and publishing
research outcomes.
Thank you very much.
Would you like to participate in the survey? [ ] Yes = 1 No = 0 (find next household).

Appendix A.2. INSTRUCTIONS FOR ENUMERATORS

√
• Multiple ticks ( ) are allowed; always ask if the respondent wants to tick more than
one option.
• Please fill the blank with an appropriate entry and do not leave it empty.
• When consecutive numeric entries show inconsistency and do not make sense, please
confirm the answers or explain the questions again, if the respondent is not clear.

Appendix A.3. PERSONAL INFORMATION OF THE RESPONDENT

Respondent Name
P11 Area Name P12
(optional)
Respondent Cell Household head
P21 P22
No. (optional) or not?

Appendix A.3.1. A. Household Basic Information

Household Size: ___________ Household Head_____________

Relationship Years of
Sr. # Gender Age Occupation 2 *
with HH 1 * Schooling
a11 1 a12 a13 a14 a15 a16
a21 2 a22 a23 a24 a25 a26
a31 3 a32 a33 a34 a35 a36
a41 4 a42 a43 a44 a45 a46
a51 5 a52 a53 a54 a55 a56
a61 6 a62 a63 a64 a65 a66
a71 7 a72 a73 a74 a75 a76
a81 8 a82 a83 a84 a85 a86
a91 9 a92 a93 a94 a95 a96
a101 10 a102 a103 a104 a105 a106
a111 11 a112 a113 a114 a115 a116
a121 12 a122 a123 a124 a125 a126
a131 13 a132 a133 a134 a135 a136
a141 14 a142 a143 a144 a145 a146
a151 15 a152 a153 a154 a155 a156
1*Household head = 1, Spouse = 2, Son/Daughter = 3, Grandchild = 5, Brother/Sister = 6,
Head parent = 7, Other relative = 8. 2* Housewife = 1, Unemployed = 2, Employed in
Government = 3, Employed in private sector = 4, Business = 5, Employed in formal
sector (contractual) = 6, Employed in informal sector = 7, Retired = 8, Earnings from
abroad = 9, Student = 10, Technician = 11, Daily wages = 12, Other (specify) = 13.
Sustainability 2021, 13, 2717 14 of 18

Appendix A.3.2. B. Waste Disposal

b1 How many bins/bags do you have in your home?

No. of bins/bags Size (2, 5, 10 kg) Total
b11 b12 2 kg
b21 b22 5 kg
b31 b32 10 kg
b41 b42 15 kg
What different types of waste are produced in your house? Quantity (kg)
b.2
1. Plastic (bottles, toys, disposable plates/cups, polythene shopper)
2. Organic
3. Glass
4. Paper
5. Other

b.3 Household waste generation rate per day (bags/kg)?

Do you have complete knowledge about
b.4 Yes No
integrated solid waste management initiatives?
b.5 Do you partly segregate the waste? Yes No
b.6 Do you have access to waste collection services? Yes No
Street-side container
Door-to-door collection
b.7 Which of the following facilities do you use? Open-space dumping
Dumping into the nullah
Burning
Less than 100 m
101–200 m
What is distance of your residence from a solid
b.8 201–300 m
waste bin/container?
301–400 m
Greater than 500 m
Strongly oppose
Do you support the government implementing a Oppose
b.9 monetary incentive for segregation activities in Uncertain
order to increase segregation at the source? Support
Strongly support
Strongly oppose
Do you support the government implementing Oppose
b.10 penalties towards residents who fail to carry out Uncertain
waste separation? Support
Strongly support
Strongly oppose
Do you support the government developing a
Oppose
combination of penalties and incentive-based
b.11 Uncertain
laws and regulations regarding
Support
waste separation?
Strongly support

Appendix A.3.3. C. Health Status and Waste Disposal

Once a month
How frequently do you or your Once twice months
c.1 family members fall sick due to Once in three months
environmental issues? Once in months
greater than six months
Sustainability 2021, 13, 2717 15 of 18

c.2: Has anyone in your household suffered from any of these listed diseases during
the last six weeks, which can be attributed to dumpsites/non-dumpsites?

No. of Days No. of Expenses for

Waste-/Water-Borne HH, s No. of Days
S. No Unable to o to Hospital Treatment
Diseases Code Sick
Work/School Visits (RS)
c.21 Diarrhea

c.22 Dengue

c.23 Malaria

c.24 Typhoid

c.25 Cholera

c.26 Asthma

c.27 Skin disease

c.28 Fatigue

Not caught any

c.29
disease
Note: In case of an employed person falling sick, link with family table.
Sustainability 2021, 13, 2717 16 of 18

Appendix A.3.4. Correlations of the Constructs

Methods Incentives Fine Combo Diseases Distance Access Segregation Awareness Total
Methods 1
0.138 **
Incentives 1
(0.000)
−0.142 ** 0.382 **
Fine 1
(0.000) (0.000)
0.025 0.542 ** 0.509 **
Combo 1
(0.472) (0.76) (0.000)
−0.226 ** −0.075 * −0.033 −0.033
Diseases 1
(0.000) (0.029) (0.331) (0.343)
−0.321 ** −0.102 ** 0.165 ** −0.019 0.587 **
Distance 1
(0.000) (0.003) (0.000) (0.586) (0.000)
0.754 ** 0.179 ** −0.036 0.032 −0.257 ** −0.367 **
Access 1
(0.000) (0.000) (0.298) (0.347) (0.000) (0.000)
0.196 ** 0.043 −0.001 −0.066 −0.052 −0.46 0.245 **
Segregation 1
(0.000) (0.214) (0.981) (0.056) (0.130) (0.181) (0.000)
−0.068 * 0.002 0.056 −0.005 0.031 0.055 −0.057 −0.026
Awareness 1
(0.047) (0.963) (0.101) (0.876) (0.362) (0.108) (0.097) (0.450)
0.332 ** 0.622 ** 0.627 ** 0.655 ** 0.072 ** 0.030 0.322 ** 0.155 ** 0.148 *
Total 1
(0.000) (0.000) (0.000) (0.000) (0.035) (0.380) (0.000) (0.000) (0.000)
Note: ** and * indicate significance at 1% and 5%, respectively, and squared correlations are in parentheses.

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