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Health, Safety and Dignity of Sanitation Workers An Initial Assessment Health, Safety and Dignity of Sanitation Workers An Initial Assessment © 2019 International Bank for Reconstruction and Development / The World Bank 1818 H Street NW, Washington, DC 20433 Telephone: 202-473-1000; Internet: www.worldbank.org The findings, interpretations, and conclusions expressed in this work do not necessarily reflect the views of The World Bank, its Board of Executive Directors, or the governments they represent, or those of ILO, WaterAid, or WHO. The World Bank, ILO, WaterAid and WHO do not guarantee the accuracy of the data included in this work. The boundaries, colors, denominations, and other information shown on any map in this work do not imply any judgment on the part of The World Bank, ILO, WaterAid and/or WHO concerning the legal status of any territory or the endorsement or acceptance of such boundaries. Rights and Permissions The material in this work is subject to copyright. Because The World Bank encourages dissemination of its knowledge, this work may be reproduced, in whole or in part, for noncommercial purposes as long as full attribution to this work is given. Please cite the work as follows: World Bank, ILO, WaterAid, and WHO. 2019.“Health, Safety and Dignity of Sanitation Workers: An Initial Assessment.” World Bank, Washington, DC. Any queries on rights and licenses, including subsidiary rights, should be addressed to World Bank Publications, The World Bank Group, 1818 H Street NW, Washington, DC 20433, USA; fax: 202-522-2625; e-mail: pubrights @ worldbank.org. Cover design: Bill Pragluski, Critical Stages, LLC. Cover photo: © CS Sharada Prasad / WaterAid / Safai Karmachari Kavalu Samiti. Used with permission. Permission required for reuse. Other photos: Page x (left to right), © WaterAid / James Kiyimba; WaterAid / Basile Ouedraogo; CS Sharada Prasad / WaterAid / Safai Karmachari Kavalu Samiti; WaterAid / Nyani Quarmyne. Used with permission. Permission required for reuse. Page xi (left to right), © ILO; CS Sharada Prasad / WaterAid / Safai Karmachari Kavalu Samiti; ILO; World Bank. Used with permission. Permission required for reuse. Contents Foreword v Acknowledgments vi Abbreviations vii Executive Summary ix Chapter 1 Introduction 1 Context and Rationale 1 Objectives and Scope 3 Notes 4 Chapter 2 Main Findings 7 Key Challenges and Risks 7 Good Practices 10 Gaps in Knowledge 14 Note 15 Chapter 3 Areas for Action 17 Reform Policy, Legislation and Regulation 17 Develop and Adopt Operational Guidelines 19 Advocate for Sanitation Workers and Promote their Empowerment 19 Build the Evidence Base 19 Notes 20 Chapter 4 Next Steps 23 Note 24 Bibliography 25 Appendix A Sanitation Worker Case Studies 29 Appendix B Areas for Future Study 45 Health, Safety and Dignity of Sanitation Workers iii Boxes 1.1. Sanitation Workers and the 2030 Development Agenda 2 2.1. Regulations That Protect Workers 9 2.2. Occupational Safety and Health Guidelines for Fecal Sludge Management for Bangladesh 13 2.3. The Memphis Sanitation Workers’ Strike 14 Figures ES.1. Key Challenges, Identified Good Practices, and Areas for Action ix 1.1. Types of Sanitation Work 3 Tables 2.1. Comparative Table of Sanitation Worker Conditions 11 A.1. Bangladesh 30 A.2. Bolivia 32 A.3. Burkina Faso 33 A.4. Haiti 34 A.5. India 35 A.6. Kenya 37 A.7. Senegal 38 A.8. South Africa 40 A.9. Uganda 42 iv Health, Safety and Dignity of Sanitation Workers Foreword Sanitation workers provide an invaluable service organize as a labor force; and their working condi- that many of us notice only when confronted with tions need to be improved and progressively formal- locked, blocked, or filthy toilets; overflowing septic ized to safeguard health and labor rights to ensure tanks; or beaches contaminated with sewage. These decent working conditions, as called for by SDG 8. workers are vital to the proper functioning of the The World Bank, World Health Organization sanitation systems that underpin daily life, and we (WHO), International Labour Organization (ILO), and need many more of them to achieve the ambitious WaterAid have joined forces in the year of “no one agenda of Sustainable Development Goal (SDG) 6. left behind” to shed light on this neglected issue. In Yet sanitation workers are often invisible and too this report, the most extensive global exploration of often subject to conditions that expose them to the the topic to date, we analyze the problems, explore worst consequences of poor sanitation: debilitating good practices, and challenge ourselves, countries, infections, injuries, social stigma, and even death and development partners to act so that we can in their daily work. Workers’ rights need to be rec- improve the health, safety and dignity of sanitation ognized; workers need freedom and support to workers. Jennifer Sara Maria Neira Alette van Leur Tim Wainwright Global Director of the Water Director of Public Health, Director of the Sectoral Policies Chief Executive Officer Global Practice of the World Environment, and Social Department of the International of WaterAid Bank Determinants of the World Labour Organization (ILO) Health Organization (WHO) Health, Safety and Dignity of Sanitation Workers v Acknowledgments The report was prepared by Ndeye Awa Diagne Alvéstegui (World Bank), and Srinivasa Rao (World Bank) with the support and guidance of a Podipireddy (World Bank). working group from WaterAid, the World Health The team is also grateful to the numerous Organization (WHO), the International Labour colleagues and peer reviewers from the four Organization (ILO), and the World Bank, which partnering organizations for their valuable comments included Andrés Hueso (WaterAid), Kate Medlicott and support during the preparation of this report: (WHO), Carlos Carrion-Crespo (ILO), Martin Gambrill Halshka Graczyk (ILO consultant), Avinash Kumar (World Bank), Seema Thomas (World Bank), and (WaterAid), Rémi Kaupp (WaterAid), Henry Ruth Kennedy-Walker (World Bank). The report was Northover (WaterAid), Sophie Boisson (WHO), Bruce finalized with the support of Pippa Scott (independent Allan (WHO), Maria Angelica Sotomayor (World consultant). Bank), Richard Damania (World Bank), Luis Andres The preparation of the case studies would not have (World Bank), Gustavo Saltiel (World Bank), Soma been possible without the following people who took Ghosh (World Bank), Dan Owen (World Bank), Odete the time to speak with the team: Antoinette Kome Duarte Muximpua (World Bank), Silpa Kaza (World (SNV), Neil Macleod (independent consultant), Bank), Kamila Galeza (World Bank), Ayumi Koyama Sharada Prasad (Azim Premji University), Jennifer (World Bank), and Nandita Kotwal (World Bank). Barr (Emory University), Sally Cawood (University of Leeds), Maryam Zaqout (University of Leeds), Kathy Disclaimer Eales (iafrica), Rachel Sklar (University of California, The report is a first attempt by the four global Berkeley), Ibra Sow (VICAS SARL/Association des development partners to together understand the Acteurs de l’Assainissement du Sénégal [AAAS]/ challenges faced by sanitation workers. It does not Association Panafricaine des Acteurs de seek to make specific conclusions or detailed l’Assainissement Autonome [APAA]), Yaye Sophiétou recommendations on how to improve the working Diop (Speak Up Africa), Raj Bhushan Roy (WaterAid), conditions of sanitation workers. Moreover, unless Suman Kanti Nath (WaterAid), Léocadie Bouda stated otherwise, claims from the case studies stem (WaterAid), Kuilga Marc Yameogo (WaterAid), Alfonso from key informant interviews. vi Health, Safety and Dignity of Sanitation Workers Abbreviations ABASE Association of Manual Emptiers of Burkina Faso BMC Brihanmumbai Municipal Corporation ESF Environmental and Social Framework ESS Environmental and Social Standards FDIS Final Draft International Standard FSM fecal sludge management ISO International Standards Organization ILO International Labour Organization KCCA Kampala Capital City Authority LGD Local Government Division NGO nongovernmental organization OHS occupational health and safety ONAS National Sanitation Office of Senegal ONEA National Office of Water and Sanitation OSHE Bangladesh Occupational Safety, Health and Environment Foundation PPE personal protective equipment SDG Sustainable Development Goal SSP Sanitation Safety Plan SuSanA Sustainable Sanitation Alliance UBSUP Up-scaling Basic Sanitation for the Urban Poor UDDT urine-diverting dry toilet UN United Nations WHO World Health Organization WSP water service providers WSUP Water & Sanitation for the Urban Poor Health, Safety and Dignity of Sanitation Workers vii Executive Summary The global sanitation workforce bridges the gap focusing on emptying pits and tanks, providing between sanitation infrastructure and the provision transportation of fecal sludge, and performing of sanitation services. Sanitation workers provide an sewer maintenance. It is an initial analysis into a essential public service but often at the cost of their growing body of work on sanitation workers, but dignity, safety, health, and living conditions. They already the findings highlight several action areas are some of the most vulnerable workers. They are to ensure that efforts in reaching Sustainable far too often invisible, unquantified, and ostracized, Development Goals (SDG) 6.2 and 6.3 do not com- and many of the challenges they face stem from this promise the dignity, health, and rights of the work- fundamental lack of acknowledgment. Sanitation force. Collecting data from literature
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