The miserable plight of sanitation workers

A report highlights the dangers for the millions of people who clean toilets, sewers and septic tanks the world over and calls for urgent action.
A latrine emptier is lifted out of a pit in Bangalore, India (Image: WaterAid/CS Sharada Prasad)
A latrine emptier is lifted out of a pit in Bangalore, India (Image: WaterAid/CS Sharada Prasad)

Many of the challenges sanitation workers face, stem from their lack of visibility in society, says a report ‘Health, Safety and Dignity of Sanitation Workers’ produced jointly by The World Bank, International Labour Organization (ILO), WaterAid and the World Health Organization (WHO). The report examines nine case studies of sanitation workers in low and middle-income countries, who empty pits and tanks, transport faecal sludge and perform sewer maintenance.

It describes the workforce as “invisible, unquantified, and ostracized” and insists that many of the challenges that sanitation workers face stem from a lack of acknowledgment for what they do. While the workers include full-time employees with health benefits, pensions and legal protection, a significant proportion comes from some of the “most marginalized, poor and abused members of society”.

The report insisted that while the workforce performs an essential public service, their own health is compromised and they are often shunned. All that is on offer for these people is “low-grade, labour-intensive and dangerous work”, the report continues, highlighting the hazardous biological and chemical agents they encounter in dangerous environments.

“It is only when those critical services fail, when society is confronted with faecal waste in ditches, streets, rivers, and beaches or occasional media reports of sanitation worker deaths, that the daily practice and plight of sanitation workers come to light,” says the report.

They are far too often invisible, unquantified, and ostracized, and many of the challenges they face stem from this fundamental lack of acknowledgment. The report also highlights where sanitation work has been officially acknowledged and formalized, citing South Africa as an example, where public and private employees follow national labour standards and has proper equipment and training.

Main findings of the study

These findings draw on evidence of sanitation working conditions in nine countries: Bangladesh, Bolivia, Burkina Faso, Haiti, India, Kenya, Senegal, South Africa, and Uganda. The working conditions of the sanitation workforce depend heavily on the wider sanitation and urban landscape, but there are commonalities, particularly in the challenges some of the most vulnerable sanitation workers face.

Key challenges and risks

  • Occupational and environmental health and safety is important because sanitation workers are exposed to multiple occupational and environmental hazards. These include coming into direct or close contact with fecal sludge and wastewater; operating equipment used in emptying, conveyance, and treatment of fecal sludge and wastewater; and working in confined and often dangerous spaces. They are exposed to hazardous gases and biological and chemical agents in septic tanks, sewers, pumping stations, and treatment plants (WHO 2018). Sanitation workers who are not protected by adequate health and safety measures risk injury, infection, disease, mental health issues, and death.
  • Sanitation workers often suffer because of weak legal protection and lack of enforcement of existing rules. Weak legal protection results from working informally, lack of occupational and health standards, and weak agency to demand their rights. The numerous operational activities along the sanitation chain—emptying and conveyance of fecal sludge, sewer maintenance, treatment, and end use/disposal (WHO 2018)—have often been invisible or at least disregarded in regulatory frameworks. Many countries either lack laws and regulations that protect sanitation workers, or the laws in place are not enforced or are not enforceable in practical terms. Manual emptying, often the riskiest sanitation work, is often characterized by informality.

Efforts to prohibit manual emptying (for example, in India and Senegal) have not necessarily curtailed the practice but instead have forced it underground. By contrast, in Bangladesh and South Africa, manual work is formally recognized as part of the sanitation services package, with workers being provided training and occupational health mitigation measures being in place.

  • Financial insecurity is a great concern because typically, informal and temporary sanitation workers are poorly paid, and income can be unpredictable. In South Africa, sanitation work is predominantly in the formal economy; public sanitation workers are responsible for sewer maintenance, and pit emptying is contracted out to the private sector. In Burkina Faso, sanitation work is predominantly informal. Pay for lowgrade, temporary, or informal work tends to be low, income is irregular, and workers are vulnerable to extortion. In India, some manual workers reported that they have been paid in food rather than money.
  • Social stigma and discrimination exist, and in some cases, are experienced as total and intergenerational exclusion. This is especially true when sanitation is linked to a caste-based structure and often allocated to castes perceived to be lower in the caste hierarchy, such as in India and Bangladesh, where sanitation work is perceived to belong to the Dalit caste. This stigma compounds the social ostracizing and limitations on social mobility that workers face and often results in intergenerational discrimination, where children of sanitation workers often struggle to escape the vicious cycle of limited opportunities and sanitation work.

Areas for action

  • Reform policy, legislation and regulation that acknowledges and professionalizes the sanitation workforce along the sanitation service chain.
  • Develop and adopt operational guidelines to assess and mitigate the occupational risks of all types of sanitation work, including national standard operating procedures, municipal-level oversight of sanitation service providers (both public and private), training, technology, and personal protective equipment for all aspects of sanitation work.
  • Advocate for sanitation workers and promote their empowerment to protect worker rights and amplify workers’ voices through unions and associations.
  • Build the evidence base to address the issues of quantification of the sanitation workforce and documentation of challenges that workers face and good practice in improving working conditions.


The World Bank allows the sharing of the summary of the report for dissemination purposes, for non-commercial purposes.  

World Bank, ILO, WaterAid, and WHO. 2019.“Health, Safety and Dignity of Sanitation Workers: An Initial Assessment.” World Bank, Washington, DC.


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