Boots, gloves, masks. Is providing PPE enough to protect sanitation workers?

5 min read
Image: WaterAid/ CS Sharada Prasad

With COVID-19 increasing safety risks to sanitation workers, and in light of some observations of their reluctance to wear personal protective equipment (PPE), we wanted to find out why workers in tropical countries don't always wear the PPE provided, and how this can be resolved. Prerana Somani and Andrés Hueso share what we learned.

Without sanitation workers, the efforts to achieve Sustainable Development Goal 6 on sanitation would fail – yet these workers’ rights to safety, dignity, health and wellbeing are not prioritised. In many countries, sanitation workers, such as sewer cleaners and pit emptiers, work in conditions that put their health and lives at risk.

The World Health Organization (WHO) recommends that sanitation workers are adequately protected. However, sanitation workers in many countries lack access to PPE – which is critical in ensuring their occupational health and safety. COVID-19 has put the spotlight on workers’ access to PPE as one of the elements that can contribute to their safety – one not always provided.

However, there have also been observations that, even when workers do have access to PPE, many don’t wear it regularly. This can be due to the type of PPE being uncomfortable to wear and work in, or not adapted to the needs of workers in tropical and hot climates. Do we need to go beyond distributing more PPE to protect our sanitation workforce? We set out to learn more.

Baljeet, a sanitation worker, putting on safety gloves to protect themselves while servicing sewers in Delhi, India.
Baljeet, a sanitation worker, putting on safety gloves to protect themselves while servicing sewers in Delhi, India.
Image: WaterAid/ CS Sharada Prasad

What demotivates sanitation workers from using PPE regularly?

Ramesh (name changed to protect his identity), a drain cleaner from India, shared experiences common to many other sanitation workers we spoke to working in hot and humid places:

Due to the nature of COVID-19 pandemic, I now have received a set of PPE from my employer. However, I cannot continue to wear my gumboots and mask for more than ten minutes as I start sweating in them.

I do not like to wear gloves and mask while working as it slows down my speed. I need to finish my work on time as I have to walk a lot due to the lack of public transportation amidst the lockdown. I do wear mask, when not working, to protect myself from coronavirus. I also wear all PPE when a supervisor visits me to oversee my work.

To delve deeper and identify the factors that result in sub-optimal use of PPE by sanitation workers in tropical countries, we held discussions with experts from countries including Tanzania, South Africa, India, Madagascar, Senegal and Burkina Faso. The main findings, captured in detail in this report, are:

  1. One of the most common complaints of workers in these hot and humid environments is that the PPE provided is not breathable, providing very little ventilation. Like Ramesh, workers feel suffocated and sweaty while working in it, causing them to feel exhausted more quickly than they usually would.
  2. The design of protective gear is often inappropriate. For instance, if a sanitation worker works on wet ground, with spilled water and sludge around them, gumboots provided must have anti-slip features to give traction. Boots were reported to often lack anti-slip soles, increasing the risk of the worker falling. The poor grip of gloves was also reported to hinder sanitation workers’ performance.
  3. The limited level of dexterity that PPE allows for various tasks demotivates workers from using it regularly. And glasses worn together with masks were reported to fog up, disrupting workers’ vision.
  4. The fit of most PPE is unsuitable for many workers. Most is available in a few standard sizes and with few adjustable features, leaving no space for customisation to fit an individual’s body type. This is particularly true for female sanitation workers, as PPE is usually produced under the assumption that the sanitation sector is dominated by male workers.

The wider picture

The experts we interviewed all shared similar views: there is a dearth of understanding among local municipal bodies and private employers about specific problems sanitation workers face while using PPE, which is why due attention is not given to enhancing use of it among workers. They cited:

  • Lack of awareness among stakeholders, including sanitation workers, about the importance of using PPE at work
  • Bulk procurement of PPE causing fitting and sizing issues
  • Delayed provision of PPE and very poor replenishment rate leading to poor development of habits of wearing and working in PPE
  • Lack of cleaning and storage facilities resulting in the additional workload of carrying PPE to and from workstations and cleaning it after every day of work
  • Lack of training on donning, removing and maintaining PPE, resulting in PPE losing its integrity and function after multiple uses
Sanitation workers using a 120 foot long jetting hose connected to a mechanised truck to service sewers on streets of Delhi, India.
Sanitation workers use a 120-foot jetting hose connected to a mechanised truck to service sewers on streets of Delhi, India. 2019
Image: WaterAid/ CS Sharada Prasad

Ensuring provision of comfortable PPE for the safety of sanitation workers

In the report, we suggest design considerations that should ensure ease in performing tasks, and material considerations that make PPE effective in protecting the worker from spillages while maintaining comfort in tropical climates.

Providing comfortable PPE is just a small piece of the puzzle of solving the poor conditions of sanitation workers. Society fails to give them due recognition, leading to marginalisation and discrimination. Further, there is a lack of prioritisation among policy makers of improving their working conditions, and a sense of apathy among employers. Long-term efforts and deep changes are needed to address these issues.

In the meantime, solving problems around PPE can offer some quick wins and become an entry point for wider change. PPE is now, partly because of the COVID-19 pandemic, well-recognised as the last line of protection for sanitation workers. To reduce the perils of sanitation workers through optimum and adequate protective gear, stakeholders can work together on the following:

  • Governments in affected countries must develop and strengthen legislation and specifications for provision of comfortable and effective PPE for sanitation workers.
  • Academia, safety experts, WASH (water, sanitation and hygiene) organisations, private sector and workers’ groups should come together for research and advocacy on innovation, which is key to ensuring human use-centric design, barrier protection and ventilation in PPE.
  • National and local governments need to provide funding for provision of adequate PPE to sanitation workers, plus training, and changing and washing facilities. Reformation of procurements systems will be necessary to ensure regular and timely provision.

The COVID-19 pandemic poses unprecedented risks, but also provides a unique opportunity to reduce the risks sanitation workers face in their work environment and to prevent deaths. Realising the opportunity demands immediate attention and action from all stakeholders.

Prerana Somani is Program Manager at the Urban Management Centre and a former WaterAid volunteer. Andrés Hueso is Senior Policy Analyst – Sanitation at WaterAid. Follow him on Twitter at @andreshuesoWA