Shasthya Nirapotta Scheme: a financial safety net for sanitation workers in Bangladesh

5 min ler
Kona Nagmoni Lata, 34, removes waste from a dusty street in Dhaka City, Bangladesh.
Image: WaterAid/ DRIK/ Habibul Haque

Sanitation workers play an essential public health role, but struggle to access social protection and insurance. To change this, WaterAid Bangladesh and Waada.Insure launched the Shasthya Nirapotta Scheme – an insurance scheme that offers sanitation workers and their families health protection and financial security at an affordable cost.

Sanitation workers are the unsung heroes of keeping our environments clean and protecting human health. In cities where sanitation systems, such as latrines and septic tanks, serve most households and institutions, they carry out the jobs that others avoid: ensuring some level of separation between humans and their waste. Without these workers, there would be a major gap in the sanitation service chain leading to overflowing systems, clogged drains and sewers, dirty public toilets, and broken or dormant treatment facilities.

The number of people who do this work worldwide is unknown. But in Bangladesh, the workforce is significant. There are an estimated five to six million "sweepers" – a term used for both sanitation workers and solid waste workers. By comparison, there are an estimated 531,454 government and non-government health workers (PDF) in Bangladesh, including health professionals, health associate professionals and personal care workers. There are also an additional 243,754 informal (non-qualified and non-recognised) health workers in the country.

Health risks for sanitation workers

Mohammad Delowar Hossain, 44, a self-employed septic tank cleaner, works at a local community toilet without any safety gear.
Mohammad Delowar Hossain, 44, a self-employed septic tank cleaner, works at a local community toilet without any safety gear.
Image: WaterAid/ DRIK/Habibul Haque

Like healthcare workers, sanitation workers are exposed to conditions and situations that risk their health – and often their lives: cholera, typhoid, hepatitis, respiratory ailments and asphyxiation from harmful gases, injuries related to falls, and lacerations due to other objects being disposed of in drains and toilets. Additionally, poverty, poor nutrition, inadequate housing, drug and alcohol misuse, discrimination, social stigma and societal neglect all exacerbate the impact of these exposures, making it more difficult for workers and their families to break the cycle of poverty, despite their crucial work.

Healthcare and social protection access for sanitation workers

Globally, access to social protection and insurance for sanitation workers is limited. While targeted support for sanitation workers is available in some countries, it is often sporadic and limited in scale, leaving most workers to manage any impacts on their health, income and rising expenses on their own.

In Bangladesh, formal workers may be able to access health services, but the increasing numbers of informal workers – including those with short-term contracts, daily wages and ghost employment (where the actual work is done by vulnerable workers on low wages while formal or municipal workers take a commission) – are excluded from contributory schemes such as health and life insurance, retirement benefits and pensions. On the other hand, non-contributory social protection schemes can have complicated enrolments, or they are not widely known about, meaning they are seldom used.

This lack of social protection, which the COVID-19 pandemic exacerbated, leaves sanitation workers and their families with few economic means to pay for services or cope with loss – and corresponding lower income – when a worker is injured or killed.

Changing the tide: Shasthya Nirapotta Scheme

In response to the COVID-19 pandemic and in recognition of the risks experienced by sanitation workers, 14,000 workers in Bangladesh received two doses of the COVID-19 vaccine in 2021. Following this initiative, WaterAid, insurance broker Waadaa.Insure, and insurer Chartered Life, launched Shasthya Nirapotta, an insurance scheme for sanitation workers, low-income communities and other vulnerable occupational groups. Translated as the Health Protection Scheme, the initiative aims to improve access to healthcare for sanitation workers and their families, and address the financial shocks a family experiences if its main earner dies.

Since August 2022, WaterAid has been implementing the scheme with local partners across Dhaka North City Corporation, Dhaka South City Corporation, Chattogram City Corporation and Khulna City Corporation, extending to the municipalities of Lakshmipur, Lalmonirhat, Sakhipur, Saidpur and Teknaf. As of March 2024, more than 18,000 families have joined the scheme, including more than 10,000 sanitation workers.

How does the Shasthya Nirapotta Scheme work?

The Shasthya Nirapotta Scheme, which is the only limited insurance scheme accessible at a low annual premium, is currently open to sanitation workers – including sweepers and emptiers – between the ages of 18 and 63. Workers under the age of 18 are excluded because their employment is considered child labour; while this does occur in Bangladesh, it is illegal.

All candidates must also have a national ID card to be insured. But as many sanitation workers do not have IDs, the first step is to support them to get the relevant documentation.

Upon enrolment – at a cost of BDT 199 (£1.46) per year – the worker receives a health card that entitles them to:

  • Individual life insurance. In the event of the death of the primary cardholder, the nominee or family receives a life insurance payout of BDT 30,000 (£220)
  • Discounted health services for their family. All family members of the cardholder, without exclusion, are eligible for health discounts ranging between 5% and 45% for different services – including outpatient and inpatient procedures, medication and diagnostics – from more than 250 partner hospitals, clinics and diagnostics centres across Bangladesh. Members simply present the health card to receive the discounted services, and the approved facilities are suitable and affordable for sanitation workers, with many located close to their places of work or homes.

The partnerships making the Shasthya Nirapotta Scheme a reality

WaterAid Bangladesh works closely with local partner organisations to deliver this important initiative. Waadda.Insure identifies, brokers and onboards the scheme’s insurance partners: Chartered Life Insurance and relevant local hospital networks. WaterAid supports this coordination through community mobilisation, orientation and member registration through its implementing partners. The premiums from members are directly deposited to Waadaa.Insure, which works with insurance partners to ensure members and their families are provided with the necessary support and claims settlement in the event that a member of the scheme is injured or dies.

To ensure the scheme is sustainable, its implementing partners have been focusing on increasing the number of members. WaterAid Bangladesh has already facilitated additional agreements between Waadaa.Insure and several partner NGOs (the Bangladesh Association for Social Advancement Foundation, Dushtha Shasthya Kendra, Nabolok, Rupantar, the Sajida Foundation, SKS Foundation and the Village Education Resource Centre) to scale the scheme to reach more people. These organisations will implement the scheme through various programmes, including microfinance. WaterAid is also incorporating the insurance scheme in other projects across Bangladesh, particularly focusing on the industrial zones.

  • Stay tuned for more blogs in this series, which will explore learnings from the Shasthya Nirapotta Scheme, challenges related to underage and proxy workers, and what insurance claims data tells us about sanitation workers in Bangladesh.
  • M M Mamshad was Programme Delivery Expert, WaterAid Bangladesh. Laura Kohler is Programme Advisor and Acting Senior Policy Analyst – Sanitation at WaterAid UK