Sanitation workers are out in full force tasked with disinfecting the public spaces as COVID-19 crisis continues to impact the country on top of other serious challenges faced by our WASH sector. Sanitation workers are those who work in any part of the sanitation chain: cleaning toilets, emptying pits and septic tanks, cleaning sewers and manholes and operating pumping stations and treatment plants and so on. The pandemic has further exacerbated their exclusion and vulnerabilities.

“Despite providing an essential public service, an uncounted number of sanitation workers around the world work in conditions that are hazardous and stigmatising – heavily compromising both their dignity and basic human rights. The recovery plan by governments to deal with the health and economic impacts of COVID-19 needs to back approaches that are sustainable, integrate ecological protection and tackle inequalities,” said V R Raman, Head of Policy, WaterAid India.

Raman was delivering a talk on ‘Sanitation workers amid the pandemic: Woes of guarding public and environmental health, and ways forward’ co-organised by the Impact and Policy Research Institute and India Water Portal as a part of the #PlanetTalks series: The state of the environment.

Sanitation workers are left behind

There has been a significant rise in waste generation over the years and more than a tenth of the world's waste is generated in India. Those responsible for sanitation work, household collection and management, maintenance of toilets as well as sewer or septic tank cleaners are faced with a host of challenges, ranging from health to finances, but most importantly the stigma associated with their work.

Despite calls and initiatives for recognizing and respecting them as COVID ‘warriors’, such initiatives have not gone down beyond superficial or tokenistic levels across India, with few instances of exceptions.

In the absence of realistic and reliable data on numbers of sanitation workers, Raman presented the numbers WaterAid India had arrived at based on projections by Dalberg and a general literature review. Sanitation workers are guardians of public health and their numbers exceed over 71.4 lakhs nationally, yet they lack visibility and barely receive the respect and dignity that they deserve.

Being informal workers with no legal protection or rights, a vast majority of them continue to be marginalized and stigmatized. Caste system in India adds to this already complex and vulnerable intersection. They work under vulnerable and unsafe conditions and provide a fundamental public service, yet they often face extreme health hazards and safety risks and receive a limited amount of rehabilitation support.

To explore the foundation of the problem, he threw light on the issue of the deep-rooted relationship between waste and caste and how that is guided by people’s idea of purity and pollution. He further discussed how the perceptions towards people who handle ‘waste’ and polluted water lead to further marginalisation and discrimination of these workers.

“This manifests into coercion and thousands of lives are claimed every year with their families having access to little legal recourse. People who work on waste management often belong to the castes that have been historically involved in the work, in a scenario close to cent per cent reservation. Working as families involving young (and often child) members of the family, this involvement becomes inter-generational. The structural silence - lack of proper data on deaths and lives of sanitation workers showcases the treatment accorded to them by our system, institutions and individuals,” he said.

Moving on to the relationship between waste and pandemic, he discussed how traces of SARS-CoV-2 were detected in untreated wastewater in research in Australia as also in many parts of India. He drew a comparison between sanitation workers with health workers and discussed that despite sanitation workers having to deal with faecal matter and putting their lives at risk, they do not get an equal or at least a fair amount of attention as health workers.

"Not much is being done on protecting sanitation workers’ rights unlike that of health workers. Though a good number of sanitation workers got infected with the disease with a proportion of them losing lives, we don’t have data available on this. What does this reflect on us, as a society, and a state?" he said.

Study of the situation of sanitation workers during COVID-19

A study by the Urban Management Centre and WaterAid India based on telephonic and face-to-face interviews of 95 sanitation workers and 12 Urban Local Body (ULB) officials from 18 cities/towns across 9 states/UTs, combined with review of secondary data, held during May 26 to June 8, 2020, looked at the situation of sanitation workers during the pandemic.

The study shows how there was a high level of awareness of symptoms of COVID-19 among sanitation workers. However, adequate Personal Protective Equipment (PPE) was not available for sanitation workers. Additionally, around 40% lacked access to hand hygiene facilities in their workplaces, along with only 20% of sanitation workers being medically examined. Even high-risk groups, like medical waste workers and hospital cleaners, reported not having access to all types of PPE that is required to carry out their work safely.

Yet, despite the risks and the dire conditions of their work, sanitation workers continued to do their job.

Discussing the livelihood issues and financial implications of the pandemic, the speaker discussed how 13% of workers were out of work since the lockdown due to a loss of parallel and part-time work opportunities, whereas others faced partial resumption of work, income reduction, payment delays, challenges in meeting day-to-day necessities which led to borrowing by some to deal with financial constraints. Some of them also reported a loss of income during the lockdown being compounded by a rise in food prices and additional expenditures such as for safety gears.

“Hunger is more dangerous than COVID-19. Our situation is very bad,” said a dry service latrine cleaner during the study. Since the work performed by them constitutes an essential public service, it continued even during the pandemic. There was, however, an uneven distribution of work with sanitation workers in hospitals reported having to work for longer shifts and increased working hours, which was usually uncompensated and domestic waste collectors, office cleaner and workers in trucks carrying wastes reporting a reduced workload.

The study also found that only 35% of the workers had insurance coverage and informal workers were fully excluded from such coverage or government provisions for sanitation workers, except for some general welfare measures. Even the government extended COVID-related support measures to the general public in the form of cash assistance and ration support were received by very few of these workers, with around 77% of the sanitation workers enjoying no social welfare support whatsoever.

Looking through the gender lens, the study also focused on the additional woes faced by women sanitation workers whose numbers were higher in the informal workforce over permanent staff or contractual staff. This led to greater implications on their livelihoods as a result of even lower-income security and limited social welfare coverage. They also faced additional difficulties during menstruation as many public toilets were closed during the pandemic. They faced additional workload and were forced to leave children at home due to the absence of any child support or care arrangements.

If these tangible issues weren’t enough, many even faced discrimination and pressure from neighbours to not return home after work, or due to demands from landlords to vacate their homes- amid the fear and stigma created by the pandemic. However, some did receive recognition for their work from their employers and the public in general for providing essential services during the pandemic, in a few instances reported during the study.

To acknowledge these issues, they demanded more targeted welfare measures in the form of bonuses or financial aid, rations or insurance coverage; and regularisation of the informal sector or at least their inclusion in the safety nets and welfare measures put in place.

Some other studies, such as the ones held by IIHS Chennai and other organisations, also showed similar situations and challenges across India, he said. WaterAid did a study in some of the other south Asian countries too- Pakistan, Bangladesh and Nepal, in addition to India. The situation of sanitation workers requires similar improvements in these settings as well.

The way forward 

Raman suggested that national and state governments need to set up frameworks, plans, projects and investments to protect sanitation workers, along with the cooperation of municipal authorities, private employers, civil society organizations, research institutions, development partners to implement actions that can improve the conditions in which they operate.

Frameworks, protocols and guidelines are needed outlining measures for sanitation workers such as organised testing, medical check-ups and thermal testing along with measures of quarantine periods or isolation protocols for suspected cases. Additionally, access to water, sanitation and health facilities has to be ensured for the workers in their workplaces and communities.

An adequate supply of proper PPE needs to be ensured for all workers, particularly those at the risk of encountering COVID-19 patients, such as cleaners in health facilities. The power of research, technology and innovation can and should be harnessed such as to develop better PPE suited for the tropical climate that we are in, often with hot and humid days, wherein the current design and material of PPE are not at all comfortable to wear. At this point, such innovative thoughts and action for sanitation workers are extremely minimal.

Collectivisation in the form of workers unions, professional associations, worker-owned enterprises can also go a long way in ensuring better living and working conditions for them. Sanitation workers should be provided with COVID-19 specific training, health and safety measures so they can respond to the crisis in a better way. In addition to this, social security schemes need to be strengthened so they can access emergency fund and access health insurance.

"We need to address vulnerabilities of these workers due to caste as well as its intersectional aspects with gender, informal work etc. There is a need to ensure that budgets allocated for the welfare and rehabilitation of sanitation workers are used fully for the allocated purpose, unlike the far below optimum level currently. While we have written intent in place, the action that proves the will for these workers is missing. This needs to be built up by fixing responsibilities and accountabilities, including criminal culpabilities wherever required. Incentives for ensuring the welfare of these workers and disincentives for those who shy away from their responsibilities should be introduced," said Raman.

To conclude, he pointed out some of the recent best practices in this regard, which can serve as a model for many states. He mentioned the ‘Garima’ scheme by the Government of Odisha wherein the most vulnerable section of sanitation workers have been recognized as core sanitation workers and the state is in the process of declaring them equivalent to professional and skilled workers. They, supported by civil society and technical expert organisations, have introduced measures for understanding the difficulties of sanitation workers, including in the use of PPE and other measures.

Some cities such as Warangal in Telangana have introduced very useful support measures for the workers. These examples indicate that we can acknowledge and support the sanitation workers for what they do for us. The final point was about our internal desire and readiness to do something as individuals, society, government official or authority, for the sanitation workers.

Acknowledgement: Manoswini Sarkar is research intern at Impact and Policy Research Institute (IMPRI) and Masters Candidate of Development Studies at the Graduate Institute of International and Development Studies, Geneva, Switzerland.