Sanitation workers on COVID-19 front lines: How to save the warriors?

Sanitation workers are the backbone of the waste management system, but most of them work under inhumane conditions — without safety gear and social security. With the novel coronavirus disease (COVID-19) pandemic showing no signs of abating, sanitation workers and manual scavengers are at an increased risk of exposure.

India is home to five million sanitation workers who clean garbage, sewers and public toilets. They come in direct contact with human waste and toxic gases and are often at risk of chronic diseases.

Past cases

Several incidents in the last two months have shone the spotlight on the abysmal conditions under which sanitation workers continue to function. In Mumbai, for example, at least 6,500 contract workers were employed by the Mumbai government but were not given any protective equipment or hazard pay.

In New Delhi, meanwhile, sanitation workers without masks or gloves have been specially assigned to disinfect and sanitise the outside of homes of known COVID-19 patients, according to Yogendra Rai, secretary of the Delhi-based Bharatiya Mazdoor Sangh, a central trade union.

A sanitation worker in Mumbai’s Dharavi recently tested positive for the novel coronavirus. He, inadvertently ended up passing it on to his wife, who died on April 12. Like most other urban poor families in metropolitans, his family did not have adequate residential space that allowed for physical and social distancing.

The situation is particularly dire for the manual scavengers — sanitation workers who manually remove human waste from latrines. According to government estimates, more than 182,000 Indians do such work as manual scavengers, while human rights groups peg the number at 770,000.

While the Supreme Court of India lambasted the government for not providing safety gear to these workers, the state has made little effort to address the extreme dangers of their work.

These cases have raised concerns about the lives of the sanitation workers during the pandemic. Sanitation workers come under the essential services category and are on the frontlines. The state governments need to ensure they are equipped with safety gear.

What does it mean if a sanitation worker gets infected?

From cleaning streets to lifting, dumping garbage, emptying septic tanks handling bio hazards, sanitation workers have been performing their duties without adequate safety kits, including sanitisers and masks.

Sanitation workers reside mostly in informal settlements / slums with high population density. They don’t, in most cases, have toilets and hence resort to community / public toilets or, in the worst case scenario, are obligated to open defecate. The transmission of COVID-19 via faecal-oral transmission is high, as studies have claimed.

So how will COVID-19 be contained in informal settlements / slums or even in densely populated areas / wards / cities in India under such circumstance?

There are five million sanitation workers in India. Even if 0.001 per cent of this population is infected, it will equate to 500 workers. But in reality, 500 families could be infected (2,500 people in total if each family has five members), if not they are not adequately quarantined.

To address this problem, the office of the principal scientific adviser to the Government of India (GoI) issued guidelines for hygiene and sanitation in densely populated areas during COVID-19 pandemic which has ensured safe access to sanitation and hygiene in low-income settlements.

However, according to School of Water & Waste (SWW) of Centre for Science and Environment (CSE), dissemination of information to stakeholders working on the ground is a big challenge which requires regular awareness generation and capacity building to promote the use of Personal Protective Equipment (PPE).

Not only this, there is a need for considering or recognising the informal workers and other sanitary workers.

They also highlighted that the advisory by MoHUA titled Safe Management of Water Supply and Sanitation Services during COVID-19 crisis, April 2020  was an adaptation of other international guidelines and misses the local context. In general, it talked about usage of PPEs for wastewater workers, but did not specify regular specific medicines / vaccinations to be administered to sanitation workers.

For users of community and public toilets, it recommended that facilities be properly maintained and cleaned, and all sanitary workers protected. But it failed to specify the types of protection required.

Way forward

Urban local bodies (ULB) need to act beyond providing them just PPE kits. We need a decentralised local response, like the IEC activities conducted by CSE’s team in the Uttar Pradesh, for and with the sanitation workers on ground. Testing, contact tracing and isolation have to be done at the community level, with responsibility given to local public health authorities to implement them.

Key government advisories have been issued by the central and state governments such as the Ministry of Housing and Urban Affairs, Central Pollution Control Board, Ministry of Health and Family Welfare etc, to address the emerging challenges of urban water and sanitation, particularly with focus on health and safety of sanitary workers.

In view of this, CSE developed a COVID-19 repository for the easier access of issued government advisories, best practices, communication collaterals by various ministries at one place.

• CSE’s Technical Support Unit in Bijnor has supported the Bijnor Nagar Palika Parishad by providing multilingual communication posters, thermal scanners, 300 sets of PPE and training for sanitary workers on May 3, 2020, for personal safety and regular temperature checkup of sanitation warriors
• CSE’s Programme Support Unit in Lucknow developed a pocketbook for health and safety of sanitary workers during COVID-19 pandemic, which provide recommendations for reducing health and safety risks to sanitation workers.

Here is a brief summary of our efforts in collating information to protect sanitation workers on ground. ULBs can consider Union government issued advisory and guidelines and World Health Organisation guidance for sanitation workers, along with CSE’s efforts in protecting sanitation workers:

• Workers should be trained on symptoms of COVID-19 and precautions taken
• Workers should be provided health checkup and setting-appropriate vaccinations.
• Workers should adhere to basic hygiene practices including frequently washing of hands with soap or use of alcohol-based sanitiser, especially after handling human waste. They should avoid touching their faces with unwashed hands. Workers should not eat, drink, chew gum, tobacco or smoke while handling human waste. If waste contacts eyes, clean water should be used to flush eyes thoroughly.
• Workers should wear appropriate PPE, including rubber gloves, head band, reusable mask, gumboots, wrist band and safety jacket.
• They should be provided with special protective clothing in case of biomedical waste handling from quarantine households, isolation wards and homecare centers as per issued guidelines by MOHUA & CPCB
• Workers should maintain at least a meter distance from each other and general public
• Work clothing (reusable PPE and regular clothing) should be decontaminated daily. Wash gears and clean tools and PPE with water and disinfectant and keep in sun for drying
• All work should be done by following standard operating procedures by properly trained sanitation workers and using appropriate equipment and tools.

Comprehensive worker protection includes more than a list of recommendations. To read more about health, safety and legal protection for sanitation workers, please see a repository of COVID-19 resources prepared by CSE. It includes government advisories and guidelines, multilingual communication collaterals, best practices and blogs on COVID-19 response.

Sanitation workers should be considered essential and allowed to continue their work even if movement restrictions are implemented. They should follow standard safety precautions and hygiene practices when handling or working near human waste.

Additional COVID-19 related precautions are necessary only to prevent person to person transmission between workers in the workplace including physical distancing and frequent hand hygiene.