A public toilet in Chennai, India. Photo: Arun Sankar/AFP via Getty Images

As developing countries continue to improve plumbing and provide toilets, many have left sanitation workers suffering from weak legal protections, poverty and social stigma, according to a recent joint report from the World Bank, WHO, ILO and WaterAid.

Why it matters: The workers who connect and clean toilets and sewers are on the front lines of a major global health campaign. According to UN Water, 4.2 billion people live without safely managed sanitation and 673 million use no toilet at all, a situation that compounds poor hygiene in causing 432,000 diarrhea deaths every year.

How it works: Access to a toilet is only the first step to improving sanitation.

  • Many subsequent services — such as emptying pits and treating wastewater or fecal sludge — are missing in developing countries, where most households rely on a septic pit or tank, often emptied manually by sanitation workers.
  • In some areas, these laborers also clean city sewers, often without proper equipment or protective gear. In India, 50 workers died in the first half of 2019 from drowning, asphyxiation and other serious accidents during this work.

What’s next: Some countries are making strides to identify and protect sanitation workers by helping them organize, buy equipment and charge set fees for their services.

  • South Africa passed a series of laws to protect workers formally employed by the government and private sector. Employers are responsible for minimizing safety risks, providing training and offering health benefits.
  • Bangladesh has created worker registries, acknowledged workers in the private formal market and provided state employees union membership, housing and and health insurance.

Yes, but: In India, an estimated 182,505 families still perform manual scavenging. The National Commission for Sanitation Workers, set up by an Act of Parliament, recently issued a report encouraging the government to help eradicate the practice.

  • Many states have not yet complied with a 2014 Supreme Court Order to identify all sanitation workers who had died on the job and to compensate their families.

The bottom line: Even amid tremendous progresssuch as India's installation of more than 110 million toilets — grave risks remain to the workers who ensure that sanitation infrastructure is maintained and services are delivered.

Tanvi Nagpal is the director of the International Development Program at Johns Hopkins School of Advanced International Studies.

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