Contributed by Niladri Chakraborti, Monisha Ravi, and Vinitha Murukesan, Tamil Nadu Urban Sanitation Support Programme
Download storySanitation workers provide an invaluable public service, but the nature of their work exposes them to various occupational and environmental hazards that put their health at risk. In many places, sanitation workers, especially septage workers, are seen working without proper safety gear. As a result, they become vulnerable to toxic substances, biohazard waste and lethal gases, which makes it essential for them to be able to access affordable healthcare and emergency services. Women sanitation workers also face health issues as a result of handling heavy pushcarts for waste collection and managing and segregating the waste. Despite government mandates and schemes, sanitation workers lack access to or are unaware of these services.
The Indian Institute for Human Settlements (IIHS)-led Tamil Nadu Urban Sanitation Support Programme (TNUSSP) supports the Government of Tamil Nadu (GoTN) in making improvements along the entire urban sanitation value chain. A key focus of the programme has been to enable Urban Local Bodies to strengthen the delivery of periodic and quality medical check-ups and treatment options for the sanitation workforce. Since 2017, TNUSSP has been partnering with local hospitals to provide periodic health camps for sanitation workers and their families living in and around the town panchayats (village or town councils) of Periyanaicken-Palayam and Narasimhanaicken-Palayam in the State’s Coimbatore district. In 2022, TNUSSP’s Coimbatore team played a pivotal role in the execution of a Memorandum of Understanding that was signed between four town panchayats and a local hospital, to provide regular and free health camps, a milestone for the organization in ensuring access to preventive healthcare for sanitation workers and their families.
Date of publication: February 2023
Problem:
Solution:
Sanitation workers provide an essential public service, yet they continue to live and work in hazardous conditions as they perform a range of tasks every day, such as sweeping the streets, collecting garbage, cleaning sewers and managing faecal sludge, which puts them in the high-risk category. Tamil Nadu’s Coimbatore district is home to approximately 3.5 million people, including more than 4,000 sanitation workers. An initial survey of the situation revealed that sanitation workers attached to bigger Urban Local Bodies (ULBs) received sporadic healthcare, while those living in smaller ULBs, informal sanitation workers and desludging operators had no access to healthcare.
With little or no access to personal protective equipment (PPE), sanitation workers are exposed to harmful chemicals, gases, pathogens and sharp objects. They face severe health problems such as musculoskeletal disorders, infections such as leptospirosis and hepatitis, respiratory ailments and cardiovascular degeneration. The direct physical threat aside, these adverse conditions also lead to a range of mental health issues as well, such as alcoholism and drug abuse.
These occupational hazards cannot be examined in isolation, systemic issues associated with caste and gender undermine the well-being of India’s sanitation workforce despite legal interventions over the years. These workers function in precarious conditions even during “normal” times, i.e. before the spread of COVID-19, a virulent disease that has significantly heightened the need for hygiene and personal protection. As unsafe practices persist even during these trying times, the health and safety of sanitation workers must be prioritized.
Comprehensive preventive healthcare for sanitation workers is mandated under the Prohibition of Employment as Manual Scavengers and their Rehabilitation Rules (2013). In addition to directing employers to provide protective gear and other safety equipment, this document also underlines the need to carry out regular medical check-ups and vaccinations. However, only a rudimentary health infrastructure currently exists. While the provision of PPE can offset these risks to a certain extent, regular and free medical check-ups will enable early detection and ensure preventive steps are taken to improve workers’ health. These health camps could also build awareness among workers about safe practices.
The Indian Institute for Human Settlements (IIHS)-led Tamil Nadu Urban Sanitation Support Programme (TNUSSP) supports the Government of Tamil Nadu (GoTN) in making improvements along the entire urban sanitation value chain. A key focus of the programme has been to enable ULBs to strengthen the delivery of periodic and quality medical check-ups and treatment options for the sanitation workforce. To ensure that the workers have access to preventive healthcare, TNUSSP partners with local hospitals to provide periodic health camps for sanitation workers and their families.
In collaboration with various private hospitals, TNUSSP has been conducting a series of regular medical camps in the cluster of town panchayats close to Periyanaicken-palayam to bring affordable healthcare and health education to sanitation workers and their families. In the past three years, more than 15 health camps have been organized, benefiting over 800 sanitation workers. Initially, the camps rendered services such as general screening, diagnostics, counselling and free medicines. The observations at the health camps identified some predominant health issues, such as high blood pressure, alcoholism, substance abuse, orthopaedic ailments, anaemia, stomach ulcer and a wide range of skin problems, among sanitation workers. This led to the addition of specialized doctors for ear, nose, and throat (ENT), gynaecology, skin, orthopaedics and physiotherapy, as per needs drawn from the results of the health camp.
The outcomes of these health camps underlined the need for a standardized healthcare system for the sanitation workforce. To make healthcare available and accessible to them on a regular basis, TNUSSP forged a partnership between a private hospital in Periyanaicken-palayam town panchayat and four town panchayats in the district — Periyanaicken-palayam, Narasimhanaicken-palayam, Veerapandi and Idigarai. A Memorandum of Understanding was signed to institutionalize the health camps to ensure long-term and sustained healthcare options for sanitation workers and their families.
This initiative is a first of its kind, intending to bring affordable healthcare and health education to the beneficiaries. The free medical camp services include blood sugar and blood pressure testing, skin care, physical check-up, medical counselling and further references for affordable treatment, with a focus on communicable diseases common among the sanitation workforce. This initiative is targeted to benefit more than 1000 sanitation workers and their family members from the four panchayats, while providing an added advantage for private hospitals to increase their client base, media outreach and exposure and explore research opportunities on occupational health hazards and preventive measures. The willingness and support received from the local authorities to institutionalize these health camps were indicative of the government’s concern over the welfare of sanitation workers. Sanitation workers now have access to free, regular and affordable healthcare services that are essential for their well-being.
The key lessons from this intervention are:
About the Author
Niladri Chakraborti is a development professional with close to two decades of experience in the domain of water, sanitation, hygiene (WASH) and public health. He currently leads the City-Wide Inclusive Sanitation Programme in Trichy. His functional areas have been water quality surveillance and monitoring, water treatment plant installation for combating arsenic, fluoride, salinity iron contamination, a periodic sanitary survey of drinking water sources, promotion of low-cost toilets with a basket of choice for the beneficiaries, fostering sanitation as a business model through women’s self-help group (WSHGs), application of CLTS for community demand generation in collaboration with Swachh Bharat Mission, facilitation of the development of WSHG/ cooperative owned and operated sani-mart to address poor sanitation supply chain management and School WASH.
Monisha Ravi works as a Technical Coordinator at TNUSSP and Keystone Foundation. She has a master’s degree in social work. She works closely with the community on the health aspects especially menstrual health, improved sanitation and hygiene. Her key areas of interest include working with women and adolescent girls and influencing behavioural change in communities regarding WASH and total sanitation.
Vinitha Murukesan is an environmental engineer by education and is currently working as the Programme Coordinator with a focus on the technical aspects of TNUSSP..
About the Organisation
Since 2016, the Tamil Nadu Urban Sanitation Support Programme, a consortium led by the Indian Institute for Human Settlements, has been proactively supporting the Government of Tamil Nadu in making improvements along the entire urban sanitation chain in cities. We work towards strengthening septage management as an economical and sustainable complement to network-based sewerage systems and aim to scale Faecal Sludge Management across 649 towns in the state, covering a total urban population of 30 million.
