https://orcid.org/0000-0001-7576-3756
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Abstract
In Bangladesh, cities produce huge volumes of solid waste, sewage, and greywater with limited resources to manage it. Waste and sanitation workers, key players in managing waste, are continuously exposed to different health hazards in their work due to lack of occupational safety and basic protections. This vulnerability has been exacerbated by the COVID-19 Pandemic. Focusing on workers’ experiences and everyday working realities, this study sought to assess the organizational capacity, gaps, and challenges of local waste management authorities during COVID-19. It also sought to deepen understanding of job arrangements, occupational safety, hygiene knowledge, and practices of these waste workers at their workplace. A qualitative study was conducted consisting of 61 key informant interviews with seven categories of local officials and 50 in-depth interviews with five categories of waste and sanitation workers in 10 cities of Bangladesh. An inductive content analysis approach was adopted. The results showed that COVID-19 had aggravated the existing waste management challenges and imposed severe health risks on waste workers. Respective conservancy departments lagged behind due to lack of safe cleaning methods and equipment, and limited funds for waste worker training, which ultimately led to poor occupational safety for workers. This vulnerable worker group lacked basic job facilities, received poor payment and insufficient protective equipment, and rarely had any health support from their employers. Also, they were not provided with an adequate understanding of occupational safety and health hygiene; and no appropriate handwashing facilities at their workplace to tackle infectious diseases like COVID-19. The study investigated this countercomplaint and discussed the current arrangements from the prespective of both city authorities and waste workers. The study recommended more automated waste collectors and compositors for the conservancy departments, increased active monitoring, work benefits, safety equipment for waste workers, and tailored training to eradicate work-related health hazards and injuries.
Citation: Sharior F, Alam M-U, Zaqout M, Cawood S, Ferdous S, Shoaib DM, et al. (2023) Occupational health and safety status of waste and sanitation workers: A qualitative exploration during the COVID-19 pandemic across Bangladesh. PLOS Water 2(1): e0000041. https://doi.org/10.1371/journal.pwat.0000041
Editor: Eugene Appiah-Effah, Kwame Nkrumah University of Science and Technology, GHANA
Received: June 1, 2022; Accepted: November 30, 2022; Published: January 26, 2023
Copyright: © 2023 Sharior et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: Our manuscript and the anonymized data within the Supporting Information files contain the minimal data set, which is used to reach the conclusions drawn in the manuscript. Authors used only qualitative data for this study. All analyzed data was in the form of transcripts from semi-structured interviews. Authors provided quotes from the interview transcripts within the manuscript, and summaries of the data's contents relevant to the study are provided in supporting information tables. Following the approval from the Research Committee of International Training Network - Bangladesh University of Engineering and Technology (ITN-BUET) and to minimize risks to the participants, raw data from this study in the form of interview transcripts may not be publicly available for any purpose. Additionally, the research team informed the participants that raw data would not be made publicly available as part of the approved written consent process. Furthermore, to ensure privacy and confidentiality, no individuals who were part of this study may be enabled to access information regarding the other participants or the data they provided. Thus, all data provided in supporting information tables is completely de-identified, summarized, and grouped only according to position classifications of "officials from Local Government Institutes, government agencies, and relevant NGOs" or "sanitation and other waste workers," as defined in the "Materials and methods" section of the manuscript.
Funding: The study was funded by the Bill and Melinda Gates Foundation (Award No. INV-007345 to TA) and administered by the International Training Network of Bangladesh University of Engineering and Technology (ITN-BUET) - Centre for Water Supply and Waste Management. The funder had no general role in the study design, data collection and analysis, decision to publish, review and approve the manuscript before submission.
Competing interests: The authors have declared that no competing interests exist.
Introduction
Municipal wastes, including human waste, have become a serious environmental and public health hazard and often a social problem in Bangladesh, as there is a lack of appropriate waste management planning, infrastructure, prolonged governmental and managerial procedures. Different cities in Bangladesh produce huge volumes of solid and human waste [1], whilst the city conservancy departments cannot dispose of more than half of the produced waste [2] due to the lack of financial resources. Operational problems and lack of good governance are also noticeable in conservancy service delivery [3]. Waste workers working for these city conservancy departments are deprived of occupational safety [1]. Though the Bangladesh Labor Act (2006) and further amendments (e.g., 2013) included a significant focus on workers’ health and hygiene (from sections 51 – 60), and occupational safety (from sections 61 – 78) [4], most of these provisions are not being practiced in the case of waste workers. Whilst some countries (like South Africa) provide health benefits, pensions, and legal protections to their waste and sanitation workers, in most South-Asian countries, these worker groups are neglected, poor, and maltreated members of society who accept a low salary and perform dangerous work [5, 6]. Though there is emerging evidence of good practices and a growing body of actors working to improve waste workers’ working conditions and rights, these efforts are ad hoc and fragmented [5]. We need to find effective ways to systematically address waste and sanitation workers’ occupational health and safety hazards.
Reality of waste and sanitation workers in Bangladesh: Occupational injury and health risk
Waste workers are commonly engaged in waste collection from different places by picking and removing solid waste, cleaning city drains, and sweeping streets, whereas sanitation workers are cleaning pit latrines and emptying septic tanks or sewers. However, these worker groups often overlap and do more than one job to earn extra money, as they are low-wage earners [7]. They are often economically and socially deprived with limited access to several basic services [7, 8]. Furthermore, they are exposed to various occupational hazards with an alarming risk of diseases, injury, and death [9, 10]. Some studies in Bangladesh found that most of the sanitation workers perform their duty without taking any protective measures and clean the septic tanks and pits manually [11, 12], which is also true in the case of other waste workers types, such as street sweepers or drain cleaners [13]. Manual emptying of a septic tank or a pit latrine increases the risk of vision and hearing impairment due to sensory loss, other physical injuries, and exposure to toxic fumes, leading to death [8]. In 2015, within ten months, 31 pit emptiers died due to work-related accidents in Southern Bangladesh, along with more unreported cases [12]. Waste workers are often exposed to various risks such as extreme noise, toxic substances, sharp objects of metal, wood, glass, and dust particles which increases the risk of causing infections [14], injuries at their workplace [13, 15], and respiratory disease [16].
These waste workers are also at high risk of underlying chronic diseases like hypertension, heart disease, diabetes, respiratory diseases, asthma, kidney disease, and liver problems [17]. In addition to health risks, waste workers face severe social discrimination and financial insecurity. Many workers come from socially marginalized, low-income, and low-caste communities with socially neglected occupations [18]. In most cases, waste workers, including pit-emptiers, do not have any health insurance so that they can get recompensated for the days lost due to illness or occupational injuries [5].
Hygiene practice of the waste workers and exposure: COVID-19 context in Bangladesh
The COVID-19 Pandemic has increased health risks for waste and sanitation workers. The pandemic also reduced work opportunities due to movement restrictions, which led to a risk of losing livelihoods [17, 19]. Since the beginning of the COVID-19 Pandemic, local waste workers and their family members commonly experienced COVID-19 symptoms [20]. As the workers have to collect wastes from different public places, roads, hospitals, and other institutions, they are extremely vulnerable to infection and disease transmission [8]. However, measures to tackle the spread of COVID-19 among them are still inadequate. A study that scrutinized the immediate impact of Corona Virus showed that nearly half of the waste and sanitation workers in Bangladesh do not have access to handwashing facilities at their workplace, and over two-thirds were not provided with handwashing materials [17]. In many cases, waste workers as low incomes earners, considered buying handwashing materials an unaffordable luxury. In addition, the supply of cleansing materials from the city authorities is insufficient [8].
Another vulnerable group is the medical waste pickers, who are also highly exposed to infectious diseases [21, 22]. Their health risk has been worsened by the larger amount of infectious waste generated from healthcare facilities during the COVID-19 Pandemic [23]. Medical waste is often dumped openly at solid waste dumping sites, eventually exposing all the workers [24]. Also, waste and sanitation workers are not provided with sufficient knowledge of maintaining personal hygiene and do not practice it during work [25]. Psychosocial impact of COVID-19 were revealed in clinical reviews, yet these worker groups, even in a similar setting as Bangladesh, were identified as having inadequate personal protective equipment (PPE) to use during waste collection and disposal [26, 27]. However, women workers face more challenges as PPE is commonly designed according to a male’s body size [28]. Furthermore, some waste workers do not want to wear the PPEs because of the low-quality fabric and the hot and humid weather [8, 25]. However, most workers did not receive any training on occupational health and safety issues [29], and also, they are largely unaware of the use and need to wear PPE during their work [8].
Research on waste and sanitation worker’s safety and wellbeing
In the last five years, development agencies and researchers have shown growing concerns about the welfare and livelihoods of waste and sanitation workers. In São Paulo, researchers recently proved that waste workers could be at high occupational risk [30]. Other critical observations from Nigeria even show a lack of recognition [31, 32], policy gaps [33], and an absence of government support [32] for some waste worker groups during the Pandemic. However, in the Bangladesh context, little work has examined the safety aspects, health risks, knowledge, practice, and demands directly from those working to handle wastes during the COVID-19 pandemic. It is essential to understand the exposure to infectious diseases, work-related injuries, and the vulnerability of waste workers, especially in light of the pandemic and its long-term impacts.
This study deepens our understanding by highlighting the organizational capacity and current limitations in ensuring the occupational safety of waste and sanitation workers during and beyond COVID-19. The research analyzes waste workers’ working conditions by investigating the current waste management and monitoring procedures in different local government institutions in Bangladesh. It explains waste workers’ job realities in conjunction with their knowledge and practice regarding occupational safety, infectious disease prevention, hygiene practice and demonstrates a pathway to ensure an occupationally safe workplace within the waste management sector.
Materials and methods
Study design and setting
Qualitative research techniques were implemented for this study, as there has been limited research on the perceptions and experiences of waste and sanitation workers and local officials, in relation to occupational health and safety, especially in the context of COVID-19. Qualitative research provides deeper insight into a particular problem, and the findings can help to develop solutions based on common emerging themes [34]. The study employed Key Informant Interviews (KII) and In-depth Interviews (IDI) for data collection. KIIs were conducted to capture the administrative activities of the city authorities, who were directly monitoring waste and sanitation workers. The IDIs were used to gather waste workers’ perspectives on everyday working realities. Both data collection tools allowed us to identify underlying factors such as daily work tasks, occupational safety status, and barriers to ensuring proper hygiene facilities for the respondents.
We conducted this study in 10 cities in Bangladesh considering two different types of local government institutes: City Corporations and Municipalities. Among 10 study areas, there were three City Corporations and seven Municipalities (Fig 1: Study locations in Bangladesh; Base layer map source: https://yourfreetemplates.com). Municipalities in Bangladesh (locally known as “Paurashava”) are the local governing bodies that deal with the state government directly and often work through the‘Upazila Parishad,’ while the City Corporations deal with the state government through the district administration and often work with the relevant ministries.
Study participants
For this study, respondents were of two types: 1) the sanitation and other waste workers and 2) the officials from Local Government Institutes, government agencies, and relevant NGOs. The first group covered five categories of sanitation and waste workers (septic tank cleaner/pit-emptier, solid waste collectors [including waste pickers], drain cleaners, street sweepers, and medical waste handlers). The second group included seven categories of officials (conservancy/waste management officer, the mechanical engineer responsible for the garbage vehicle, conservancy inspector/supervisors, relevant officers related to the conservancy department, sanitary inspector/health section official, private entrepreneur and NGO representatives working on solid waste management /fecal sludge management/medical waste management, DPHE engineers and officers). We conducted IDIs with the first group and KIIs with the second group.
Sampling and data collection
We conducted the study from September to November 2020. For the KIIs, we aimed to illustrate (i) existing waste management activities, (ii) monitoring procedures, (iii) organizational capacity, gaps and challenges, and (iv) initiatives taken by the recruiting authorities to make their workers occupationally safe during COVID-19. Hence, we chose key personnel from the officials who directly monitor the waste workers or their supervisors, are involved with waste-related service delivery or are from a non-governmental organization concerned with waste management in any of the 10 study areas. For IDIs, we chose sanitation and waste workers from those listed by a local government institute or those who work individually in any of our study locations. We intended to focus on (i) waste worker’s job reality, (ii) health-hygiene practices and opportunities for hygiene practice, (iii) provision of PPE and safety measures, (iv) knowledge and practice to tackle COVID-19 and other similar infectious diseases.
We applied a purposive sampling approach to select our respondents. Before the field-level data collection, we informed the respective mayor of each study area about the study details via official letters and sought permission for data collection. Afterward, we collected a list of the sanitation and waste workers from the City Corporation/Municipality offices and communicated with them to choose study participants to collect primary data. We followed the list to get workers’ contact details. Via the listed workers, we also contacted those who were not on that list but working individually. We recruited only those workers who belonged to one of our targeted groups and were willing to participate in the study. We conducted 61 KIIs and 50 IDIs in total (Table 1).
Data analysis
We transcribed and translated the audio recordings of IDIs and KIIs and tabulated them. Data analysis followed the inductive content analysis approach [35]. During the first stage of coding, we used the outlined categories or supplemented their use with inductively determined codes. In the next round, we inspected all our transcripts, developed initial codes, and included or deleted them (based on relevancy). We created code groups during the next phase, where codes and sub-codes were accreted. In the last phase, we finalized the code groups. After these phases, 240 codes were defined (S1 Table). Assigned codes and themes were highlighted in italics throughout the text. Sometimes a response was labeled with two (or more) codes stated in both IDIs and KIIs. The inclusion criteria for the codes were as follows:
- Repetition of a particular code (e.g., “Lack of occupational training” and "Lack of safety gears" with “Organizational capacity and gaps”);
- Mentioned in at least two different interviews;
- Mentioned more than three times by a respondent category.
Ethical approval
The Research Committee of the International Training Network (ITN-BUET) gave the study ethics approval. Before data collection, enumerators read out an information sheet to the respondents in the local language, answered any questions/confusions raised, and obtained written consent from the respondents to recruit them in the study. Respondents received a copy of the information sheet with the contact details of the study team. Participation in this study was voluntary, and the respondents were given full rights to opt-out of the study at any stage. As primary data were collected during the COVID-19 Pandemic, enumerators followed an SOP developed by REACH Resource Centre to collect data safely [36]. As the SOP recommended, enumerators took the responsibility to maintain mandatory safety protocols, maintained social distancing, carried handwashing agents, wore facemasks and hand gloves, and cleaned recording devices.
Results
Based on our evaluation criteria, we identified nine themes that included 30 sub-themes and 74 categories (S1 Table). Two codes reached the highest score from both KIIs and IDIs. They were “Increased salary” and “Didn’t receive any occupational training.”
Local government officials, government agencies, and relevant NGOs (KIIs)
Waste management and monitoring procedure.
Under the respective mayor’s supervision, conservancy officers made different activity plans based on waste generation, like "Daily activity plan". Solid waste collection from households, offices, and commercial areas continues through three types of schedules: daily, weekly, and quarterly. Usually, the female sweepers sweep the road at dawn and store the waste on the roadside, which is later collected by the male sweepers and taken to a designated transfer station. Finally, waste is carried through a garbage truck to dispose at the waste dumping site. Planned activities for waste management were implemented in different ways. "Strategies to implement planned activities” included "Task distribution" and "Coordination among relevant departments" through regular “Official meetings". "Group leaders" and the "Supervisors" were identified as the key responsible people to monitor the implementation of planned activities.
In two municipalities, we found that workers’ daily work was registered, reported, and presented in a monthly meeting with the Ward Committee. Supervisors in a Ward were monitoring waste collection, and the conservancy officers were monitoring solid waste trucks in a dumping zone. While monitoring, the supervisors ensured that the solid waste is collected from door to door and waste workers wore an apron. Thirteen KII Respondents mentioned that they faced difficulties with managing waste if a few waste workers "Remain absent,” "Get injured,” or if the solid waste collection incurs "Vehicle malfunction." In nine KIIs, it was mentioned that occasionally it takes a long time to repair a garbage truck.
Organizational capacity: Gaps and challenges in waste management.
Codes like “Low salary" of the waste workers, "Lack of skilled worker”, "Lack of proper equipment”, "Lack of occupational training", and "Lack of safety gear” were repeated frequently under the "Organizational Capacity and Gaps" category.
In four KIIs, respondents stressed that waste workers left their jobs immediately after getting a relatively higher salaried job. In six locations, respondents confirmed that the waste workers were not well-equipped to complete their tasks on time and safely. Moreover, most of the workers did not get any occupational training. One of our key informants stated -
“Workers are uneducated and unskilled, so we have to do hard work to monitor them. We are also facing a lack of logistic support.” [KII, Male conservancy supervisor, Cox’s Bazar Paurashava]
Furthermore, workers’ "Discomfort feeling" while wearing PPEs was mentioned frequently by key personnel. Eleven key personnel described that despite getting instructions from the inspectors, waste workers were not wearing face masks, safety clothes, hand gloves, and gumboots during their work due to the sweltering weather.
Responses under "Challenges while implementing plans" category also include “Non-co-operative attitudes of the citizen,” “Unfriendly behavior”, “Lack of awareness among the citizens,” and "Social disgust" toward the workers. To exemplify such challenges, three key personnel from two different study areas also reported that the waste management authority received threatening phone calls while removing construction wastes in the past where a political person may be involved. In nine KIIs, respondents also mentioned that people often complain about the noise that cleaning machines generate at night for lifting drain wastes on roads to dry.
Newly formed City Corporations and Paurashavas had a lack of “Sufficient workforce” and “Insufficient logistic support”. For example, Laksham Paurashava owned only one solid waste truck to serve a large area of 135.61 km2. Another respondent from Bhola stated-
“Our Paurashava currently produces 22 tons of solid waste per day, but we have a workforce to manage only 12 tons of them. So, we don’t have enough workforce for proper waste management.” [KII, Male Health Assistant Officer, Bhola Paurashava]
In addition, codes like “Renting vehicle”, “Multiple work shifting”, “Hiring daily wagers”, “Clean based on complaints” were commonly mentioned under “Management procedure with limited equipment” category. City authorities had reduced their service-providing areas in two places (Mymensingh City Corporation and Sirajganj Pourashava) because of the limited workforce. They do not have enough funds to hire the required number of workers in both cases. In nine KIIs, Conservancy Inspector/Supervisors reported that waste collectors and sanitation workers face more difficulties in “The rainy season”, because of frequent drain blocks; and in “The summer season” due to increased fruit waste.
Interviews revealed mostly “No difference” in salary, job benefits, and responsibilities among the same type of workers. However, only a KII in Rangpur City Corporation indicated that the Muslim workers were getting 1000 BDT (approx. 12 USD) more as a festival bonus than the Horijons (a Hindu caste historically associated with waste activities) for the same waste-related jobs.
Initiatives to ensure safety at the workplace and to tackle COVID-19.
“PPEs provided” or “Have a budget to buy PPEs” for the waste workers were repeated 36 times, whereas ”Have no PPEs” or “No budget for buying PPEs” was repeated 10 times with the “Organizational initiatives required to ensure protective equipment” category. However, “Not maintaining social distance”, and “Lack of safety kits” were commonly mentioned under the “Difficulties faced to ensure occupational safety” category. Only in Rangpur City Corporation and Satkhira Paurashava different NGOs provided a few PPEs to the waste workers. However, in 19 KIIs, informants mentioned “No difficulties” in their area. Ten interviews revealed “Self-managed” PPEs (with workers buying their own). Regarding these difficulties, one stated-
“We work for a public organization. Therefore, we meet many people every day. It is tough to maintain hygiene during COVID. Moreover, our office does not ensure safety for us. We usually manage our safety equipment personally.” [KII, Male Sanitary Inspector, Moulovibazar Paurashava]
In 34 KIIs, respondents believed that the COVID-19 Pandemic impacted the services they were providing. Frequently mentioned impacts were “Increasing waste”, “Shrinking work opportunities” for the workers due to countrywide lockdown, “Decreasing service area”, “Decreasing workforce” and “Worker’s hesitation” while collecting wastes from places with COVID-19-positive patients. We found no evidence that waste workers had stopped providing their services in our study areas during the Pandemic. To tackle the spread of the infection, “Providing safety instructions” to the waste workers by their supervisors was mentioned in 17 KIIs. Six of our key informants believed that the workers were not so conscious of their occupational safety. Five recent injuries of sanitation workers were also reported during the study. Informants confirmed that there was no fund for the treatment of the waste workers. Lack of the worker’s “Willingness to follow hygiene rules” was commonly mentioned under “Challenges faced to ensure proper hygiene behavior” category. In 15 KIIs, respondents identified workers’ “Literacy level” as responsible for lack of health-hygiene knowledge.
“Measures taken to reduce COVID-19 at the workplace” category commonly included codes like “Face masks provided,” “Cleaning agents provided,” “Disinfectant activities,” and “Set-up handwashing stations.” Findings also shed light on the PPE collection and supply procedure. Distributed PPEs were received from “Multiple channels” (NGO’s contribution and other personal funds), “Organizational purchases,” or “Government provided.” The conservancy inspectors and ward coordinators were mainly responsible for distributing PPEs among the waste workers. One stated –
“We couldn’t provide the required number of PPEs to the workers. We just provided face masks twice.” [KII, Male Conservancy Inspector, Sirajgang Paurashava]
“No training on PPEs” was mentioned in 41 KIIs. Only eight key personnel mentioned providing “Informal training” (oral instructions). However, city authorities claimed they followed “Government provided guidelines” or “Organizational guidelines” for hygiene practices. Yet, “Following no safety guidelines” was mentioned in nine KIIs.
Initiatives suggested for better workplace.
From the KIIs, “Suggestion to ensure a safe workplace and smooth service” category includes frequent codes like “Increased salary,” continuous “Supply of PPEs,” “Occupational training” and “Improved equipment” needed. “Treatment facility,” “Awareness building programs,” and “Accommodation facility” were pointed out as other required components to increase workers’ job facilities. Fifteen key personnel also demanded “Coordination” between relevant departments of local government and NGOs. Other recommended components were “Vehicles for garbage transportation,” “Formation of monitoring committees,” and “Training on monitoring.”
Sanitation and other waste workers (IDIs)
Current scenario of the waste and sanitation worker’s job.
Through IDIs, we recorded different “Types of contract.” Thirty one of our IDI respondents were in a “Daily wager” contract, while 11 were in “Muster roll” (a contract type where the workers get listed by name under a project for a certain period), two were in a contract with “NGOs”, and only one was in the “Monthly” contract. Waste workers believed that working under a government contract provides more job security and facilities. Workers hired by NGOs were getting higher salaries than others with the same work responsibilities. We found that female workers only did road sweeping out of the categories of waste work listed.
Thirteen out of 50 workers mentioned “Had two festival bonuses.” Only three waste workers from Moulvibazar Paurashava mentioned receiving government-provided one-time aid such as groceries during COVID-19 Pandemic. One-fifth of the interviewed workers faced difficulties, such as late payments or reduced salaries during the Pandemic. Seven of these workers reported rickshaw pulling as an alternative way to earn during this period. Twenty-two workers were found living in government-provided accommodation; 19 either had rentals or their own houses; almost all of them were using “Shared water and sanitation facilities.”
“Did not receive any occupational training” was the highest mentioned code overall, whereas only eight workers mentioned “Received training” (at least one) under the “Training status of the waste workers” category. Most waste workers did not know about the proper sequence of wearing PPE. Frequently mentioned challenges included “Got injured previously,” “Lack of proper equipment,” “Lack of safety equipment,” and “Social stigma.” In four IDIs, sanitation workers mentioned facing social harassment by their neighbors.
Almost two-thirds of the respondents reported “Following no guidelines” during work. Almost all the pit/tank emptiers followed “Traditional techniques” for waste collection; only two were found using “Vacuum tank.” One solid waste collector also stated-
“We use a spade, crowbar, grubber, spike and basket for waste collection. We only have a trolley to transfer waste.” [IDI, Male Solid Waste Collector, Mymensingh City Corporation]
Current health-hygiene practices and safety measures of the waste workers.
Only 37 waste workers reported “Wear any PPE” including a face mask, whereas 10 reported “Take no safety measures” during work. Only 14 workers reported using gumboots; four were using hand gloves. Twenty one of 50 workers did not use PPEs before the COVID-19 Pandemic appeared in Bangladesh (8th March 2020). Quality of provided PPEs being “Not so good” was mentioned in 14 interviews. Significantly, female workers reported that the received PPEs did not fit them properly. “Discomfort feeling” including “Breathing problem”, “Sweltering problem” and “Lack of PPE supply” were the frequent reasons for not wearing PPEs. As one worker stated –
“I got a face mask and full-body apron from the Pourashava office. But it is made of polyester. So, I do not wear it.” [IDI, Male Drain Cleaner, Rangpur City Corporation]
Only 16 workers reported used PPEs were “Washed every day with soap.” Used PPEs were commonly disposed of “With other waste.” Suggestions to improve PPE quality include “Use cotton fabric” while making a full-body apron, considering exact size, color and long-lasting materials. However, in 23 IDIs, workers predicted a chance of being “Affected by a disease” or “Getting an injury” if they work “without taking any safety measures.” Regarding these consequences, one stated-
“Working without safety equipment is dangerous. There are pieces of glass in the waste. If one worker gets injured by cutting his leg with glass pieces, his whole family will suffer. Our office does not provide financial aid from their fund.” [IDI, Male Solid Waste Collector, Manikganj Paurashava]
The code “Not sufficient” was commonly mentioned under the “Sufficiency of the safety equipment/logistics received” category. Protective gears were rarely provided to the workers; thus, “PPEs needed” were mentioned in 38 interviews. One waste worker stated-
“I have enough equipment for my work but not enough protective gear for my health and safety. If we need any safety equipment in an emergency and ask any officer for that, they show us a long procedure. Instead, we buy them at our own cost.” [IDI, Male Medical Waste Collector, Cox’s Bazar Paurashava]
Worker’s knowledge about safety, COVID-19 and other diseases.
Out of the 50 interviewed workers, 46 strongly believed that there was a chance of getting affected by back pain, skin diseases, COVID-19, asthma and other respiratory problems due to the work they do. We checked workers’ COVID-19-related knowledge. Thirty-one workers mentioned sneezing, coughing, and social gathering and five identified air as the leading causes of COVID-19 transmission. Maintaining “three feet of distance” was mentioned 28 times under “Knowledge about social distancing.” If anyone suspected of having any COVID-19 symptoms, staying in a “Separate place for 14 days” was frequently mentioned under “Knowledge about quarantine.” In only seven IDIs, respondents reported the term ‘isolation.’ According to them, isolation meant total hospitalization of a severe COVID-19 infected patient. However, 15 workers did not know about social distancing, 33 did not know about quarantine, and 38 did not know about isolation.
For the workers, “Mass media” and “Peer groups” were the common “Source of COVID-related knowledge.” Medical waste collectors mainly received that information from the hospitals they worked for. Fourty-four workers knew that washing both hands for 20 seconds, using masks, and social distancing could prevent COVID-19 infection.
Worker’s suggestion to ensure better and safe working conditions.
Workers were apprehensive of increasing health risks as COVID-19 appeared. In 31 IDIs, they believed that a regular supply of necessary PPEs could ensure occupational safety. Workers also demanded training like “Training on PPEs,” “Training on advanced cleaning technology,” and “Training on COVID.” Most frequently mentioned recommendations were “Increased salary,” “Treatment facilities,” “Stable job contract,” “Improved working equipment,” and “Stable accommodation.”
Discussion
This study had two primary aims. First, we scrutinized administrative capabilities, perceptions and monitoring mechanisms of different Municipalities to examine existing health and work safety issues in the context of COVID-19. Secondly, based on the workers’ perspectives, we wanted to suggest effective measures to address the current challenges that waste and sanitation workers face. Eventually, the study identified several novel issues related to waste and sanitation workers’ occupational safety: lack of equipment, lack of scope to scale-up professional skills, low payment and poor job security, lack of PPEs, unsuitability of the PPEs, and lack of training. Any tailored initiatives based on this assessment will positively impact the waste workers’ occupational health.
Not all Municipalities and City Corporations were equally equipped with waste management equipment. Newer municipalities lacked essential logistical and financial support to manage waste produced in their area. The conservancy departments often performed with limited functionality due to a lack of required workforce and modern cleaning equipment. Coordination between the conservancy and other relevant departments and monitoring systems could be more extensive in local administrative areas. Previous studies in Bangladesh also reached a similar conclusion by showing that the lack of good governance in properly managing public resources, corruption, and the inability to guarantee decent workplace and worker rights has a negative effect on the performance of conservancy departments, even in the larger City Corporations [22, 37–39]. As a result, the department delivers inadequate waste-related services. A shift towards a more automated cleaning system is needed (i.e., machines need to be properly designed for the type of work, relevant, and appropriate for the working area, and also provide stable job opporutnities for waste and sanitation workers).
We found that waste workers are exposed to various risks. In Bangladesh, solid and medical waste are dumped on the ground directly, often shoveling it by hand or left in an open area or basket to be picked up manually, which commonly causes severe work-related injuries [14]. These hazards eventually result in loss of working hours with higher healthcare-related costs and, in the worst cases, sometimes result in disability. This entire phenomenon has pushed workers below the poverty line for many years. Another study in Bangladesh also supported our findings, indicating that extremely poor individuals are disproportionately represented in these high-risk hazardous professions, and accidents or health issues associated with these jobs also exacerbate poverty [40]. We also identified a clear violation of Clause 4.d.8 of the Bangladesh National Occupational Health Policy (2013) as the employers are responsible for identifying work-related risks and causes and supporting their workers [4]. Besides, poor working conditions create psychological distress for workers as they do not have a permanent job contract, resulting in depression and anxiety [41]. Moreover, they are not compensated for days lost due to work-related injuries and other sicknesses. Thus, increased salary, sufficient supply of protective equipment and health and life insurance (or free medical support) for the workers is strongly recommended. A similar study supports this statement showing that facilities that ensure a better workplace include decent wages, workplace safety, and stable job contracts that are rarely provided for most sanitation and waste workers in Bangladesh [42]. Therefore, it is essential to develop safety guidelines to guarantee the waste workers’ rights to health, safety and dignity [5].
Waste and sanitation workers were vulnerable to various occupational injuries and diseases due to their hazardous and unprotected working environment. These health risks were higher in the case of pit/septic tank emptiers and medical waste collectors. Similarly, a recent study showed that pit-emptiers in Bangladesh have died inside septic tanks due to exposure to noxious gases [25]. The same scenario can be found in neighboring countries like India [43] where pit-emptiers die from suffocation from toxic fumes [44, 45]. Sanitation and waste workers (pit and septic tank emptiers in particular) directly deal with human feces and other hazardous items commonly found in pits and drains, including sanitary products, sharp objects, and other solid wastes, which lead to injury, illness, and infections [42]. Their priorities and needs therefore require urgent attention.
Given their work circumstances, all types of waste workers were highly susceptible to COVID-19. We found that most workers were not provided with training regarding COVID-19 prevention, putting themselves and others at risk as they work under poor conditions with limited support. Not receiving proper preventive measures for work and workers’ tendency not to follow safety guidelines were common. Even the officials cannot practice proper hygiene to tackle the spread of COVID-19. Another study also demonstrated that waste workers were involved with waste collection and management, cleaning public places and providing sanitation services that require them to move across different areas and work in high-risk settings, including healthcare facilities, quarantines, and containment zones [8]. However, many waste workers and their family members have been infected with COVID-19 in Bangladesh [17], findings that have been replicated elsewhere [46].
The UNEP report for waste management during the COVID-19 pandemic outlines the requirement for raising awareness and training among waste workers for a safe and healthy working environment during the pandemic in both formal and informal sectors [23]. The current study also concludes that the lack of preventive measures taken by the waste and sanitation workers directly results from their lack of knowledge on diseases and the lack of available facilities at home and in the workplace. In many cases, not practicing handwashing results from the lack of functioning handwashing stations. Workers’ living conditions and work environment also does not allow them to practice social or physical distancing as some of the settlements are extremely densely populated with shared water/sanitation facilities. Similar previous studies by WaterAid already showed that in 60% of cases, a single toilet was being used by an average of 25 users in the areas where the waste workers lived [8], and only a few of the workers had handwashing facilities at their workplace [19].
We confirmed that waste workers in all cities did not receive sufficient PPEs from their recruiters. Medical waste handlers received more PPEs from their recruiters, particularly those recruited by an NGO, compared to other waste workers. Studies from other organizations also supported that using safety gear such as aprons, headcovers, shoes, and goggles was not common among waste workers, except among medical waste handlers [19]. Our study also identified that the number of PPEs distributed was not the same in all parts of the country. For example, waste workers from Satkhira and Rangpur got more PPEs than workers from other areas. However, according to the National OSH policy (e.g., Art. 3.a.1; Clause 4.d.7) all waste workers are supposed to get PPEs before they start working [4]. Moreover, the quality of the PPEs was questionable since many complained of suffocation. This, in turn, discouarged workers from using PPEs when they performed their job. Workers commonly had to spend their own money to buy PPEs since the supply from the employer was inadequate. Only a few waste workers received any safety instructions, though all the City Corporations and Municipalities claimed to follow the government’s safety guidelines. Recruiting authorities claim that the waste workers’ education level and unwillingness to follow guidelines and take safety measures are responsible for occupational injuries. Nevertheless, the waste workers remain deprived as they cannot maintain proper hygiene solely because they do not have the opportunity and are not provided with appropriate protective equipment. The current study has further strengthened the urge to raise awareness of both the workers and authorities and provide appropriate training on maintaining a safe work environment.
The current study significantly demonstrated that the workers who had at least one component of PPE (mostly face masks), only a few chose to wear them regularly, verifying the argument further that the waste workers were not provided with adequate knowledge regarding the importance of taking necessary measures for preventing infections which is against of nation’s existing Labor Act (78A, (3)). Lack of knowledge about infectious diseases, how they spread, and how they affect them and their families corroborates that preventive measures are largely inadequate. Two recent studies conducted in Bangladesh reported similar findings that under 5% of study participant waste workers received any institutional training [8, 25]. Despite the massive awareness campaign (with suggestions of preventive measures) on COVID-19 in mass media, the current study identified that the workers lacked the basic understanding of preventive measures such as social distancing, quarantine, and isolation, which indicated an inadequate level of impact of those messages on them. Other countries (e.g., Fiji) followed different strategies to improve the health and safety of their waste workers, for example, by providing behavior change messages [47]. Therefore, a tailored intervention is needed to increase the workers’ knowledge and attitude toward infectious disease prevention measures and create an organizational culture of maintaining occupational health safety. Research in other similar settings also recommended to consider using risk communication strategies [48] and engaging the communities for sustainable waste management [49, 50], and in the context of COVID-19, to emphasize on proper disposal of PPEs [51].
The strength of this study was to understand occupational health, safety and working conditions from the perspective of both city authorities andsanitation and waste workers. Findings from the study can potentially inform relevant local authorities to take necessary initiatives to fulfill several Sustainable Development Goals (SDGs) that involve occupational health safety, such as goal 3.9 (Reducing deaths from hazardous elements), 8.8 (Promoting safe environment in the workplace), and 16.6 (Establishing institutions that are effective, accountable and transparent) [52]. Our investigation indicates that not providing proper training, PPEs, and other facilities to the workers is a significant limitation of the administrators, which gradually exacerbates the existing health risk for the waste workers, considering the COVID-19 Pandemic. Due to the time limitation and scope of the study, we could not explore some other key challenges waste workers face, such as historical discrimination. Another limitation of this study is that we could not capture and count all types of occupational injuries from the waste workers’ perspective. Further studies are therefore required to gather a broader understanding of how occupational injuries can be categorized based on waste worker types to capture a complete illustration of health risks and trace common injuries in different locations.
Conclusion and recommendation
The COVID-19 Pandemic has exacerbated occupational health and safety challenges for waste and sanitation workers. Governing authorities should safeguard the health of these front-line workers from occupational injuries and the threats of pandemics such as COVID-19 to continue waste management services. This pandemic also presents an opportunity to highlight the essential role that these workers play across cities in Bangladesh, South Asia, and globally.
Various approaches can be taken to reduce the risk of infection, like creating a safe workplace and encouraging a culture of hygiene practice. One approach could be providing diverse practical training that will be sustainable beyond the COVID-19 period to the waste and sanitation workers to create awareness about the health risks and meet their demand for occupational safety. More risk communication, community engagement and diligence in the disposal of used PPEs are necessary. Another approach could be using social and behavioral change communication messages specially designed for these worker groups. Through the training, knowledge of the proper use of PPEs must be provided, and recruiters must emphasize the importance of wearing PPE. Institutional guidelines are also required to report and monitor health behaviors at the workplace.
Conservancy departments need to be well-equipped with sufficient funds to incorporate more automated cleaning equipment and garbage vehicles. Workers need to be up-skilled and sufficiently trained, and the city authorities have to ensure work-related safety with the provision of PPE to their staff and workers. Coordination between the conservancy and other relevant departments must be gradually increased to establish an active monitoring system. Local Government Institutions (LGIs) should ensure better job facilities for their workers, including increased salary, payment for overtime, parental leave, permanent/stable job contracts, and medical facilities, including bearing the treatment cost and sick pay. LGIs should provide the necessary infrastructure for waste and sanitation workers of all genders and backgrounds to practice personal hygiene in the workplace. Hence, targeted and tailored hygiene education and preparedness for the workers is recommended.
Nationally, more participatory research involving waste workers and officials is required to capture their opinions more deeply before designing any PPE and tailored interventions. These studies will provide potential insights to make interventions more effective for workers and increase resilience in the context of any future pandemics. Further research should also prioritize current complaints, discrepancies and underlying factors for discomfort among the workers regarding PPE use.
Supporting information
S1 Table. Thematic distribution of codes and selection.
https://doi.org/10.1371/journal.pwat.0000041.s001
(PDF)
Acknowledgments
The authors are very grateful to the City Wide Inclusive Sanitation (CWIS) Support Cell – Government of Bangladesh for providing essential support during the course of the study. We appreciate all the LGI officials from the study locations for their cooperation and active participation in this study and the support from the relevant NGO officials. We respectfully acknowledge all the data enumerators who collected primary data during the pandemic. Finally, we recognize the contribution of the study’s core characters- the waste and sanitation workers for providing their valuable time and information to complete the study.
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