User-friendliness of personal protective equipment for sanitation workers in tropical climates

4 Poster Track: Applied Research » 4 Health, safety and hygiene

Speaker: Prerana Somani

Summary – for publication in conference brochure:

Sanitation workers are vulnerable to injuries, illnesses and deaths. Even when personal protective equipment (PPE) are accessible, sanitation workers may not wear these as they feel “uncomfortable”. This may be attributed to low levels of dexterity and breathability offered by the PPEs. This study assesses feasibility of PPE for sanitation workers’ use, specifically sewer line cleaners and pit and septic tank emptiers, in tropical Low-and-Middle-Income-Countries (LMICs). The findings highlight that PPEs in these countries lack both design and material elements specifically suited for sanitation workers. Dedicated efforts from government, academia and industries will promote research and manufacturing of user-centric equipment.

Introduction, methods, results and discussion:

With their health, safety and hygiene often compromised in unsafe working environment, sanitation workers are the most overlooked stakeholder in the sanitation value chain. The situation is worse in tropical LMICs where they are exposed to serious occupational and environmental hazards without access to adequate PPEs. The threat to their health and lives has increased manifolds with the onset of Covid-19 pandemic.


This study attempted to identify factors that affected use of PPEs by sanitation workers in tropical LMICs. Desk review of literature, including grey literature- blogs, presentations and conference reports, through internet and journal search was complemented by telephonic interviews with sanitation experts from Tanzania, South Africa, India and Madagascar.


The study found that research on suitability of PPEs for concerned categories of sanitation workers was lacking. Experts unanimously agreed that appropriate PPEs for workers were missing in tropical LMICs. It was found that providing PPEs to workers hasn’t necessarily translated into high usage. The perceived barrier of wearing PPE among sanitation workers is lack of “comfort”. “Comfort” may be attributed to three key features- material, design features and fit of the PPE. Workers prefer PPEs of “breathable” material as they work in humid and hot conditions. They prefer PPEs that make the heat bearable and enable ventilation. Wearing masks suffocates them and leads to unbearable sweating. Using ill-designed PPEs hampers their work speed; for instance, wearing goggles with a mask may result in fogging and obstructs vision. Gumboots often don’t come with soles that provide anti-slip protection, a feature which is necessary to ensure that the sanitation workers can perform their job safely. Further, the design does not allow easy bending of feet and knees, a requisite for entering any septic tank. PPEs designed primarily keeping male physique in mind poses as both hindrance and increased risk for female workers. Finding right sizes of gloves to fit the comparatively smaller palms of women sanitation workers is difficult. Furthermore, employers usually tend to procure PPEs in bulk, often of same sizes, to reduce cost. PPEs that are too loose or tight offer very low level of dexterity to perform tasks for any worker.


Working without PPEs or with uncomfortable PPEs has been normalized since decades of practice. In some cases, PPEs available to sanitation workers are usually designed keeping the needs of workers of other sectors like construction, health or mining. Apart from being uncomfortable, the PPEs provided to sanitation workers are of sub-optimal quality, unable to withstand pressure or damage.


Another factor that leads to poor use of PPEs is the perception of risk amongst sanitation workers and employers alike. They are not able to gauge the impact of performing hazardous sanitation work daily without protection on their health. Use of PPEs are not always linked to prevention of injuries and deaths. Thus, the perceived disadvantages of wearing and working in PPEs outweighs the perceived benefits amongst sanitation workers, resulting in low usage of PPEs.

Conclusions and implications:

PPEs available for use by sanitation workers in tropical LMICs are ineffective in providing the desired level of safety and comfort. Often missing in LMICs is specifications for PPEs, suited to the needs of sanitation workers. Policymakers should work with academia, sanitation practitioners, safety experts and industry to promote research and development of innovative materials and designs for PPEs, keeping in mind the ergonomic needs of both male and female sanitation workers.


Addressing occupational health and safety of millions of sanitation workers is one of the prime responsibilities of all stakeholders. Prioritizing needs of sanitation worker has been lacking or going unrecognised. This can be only be changed with formulation of strong occupational health and safety legislations and stringent compliance. Manufacturing of durable, user-centric PPEs and monitoring of employers to ensure usage, play a critical role in demonstrating that the plight of sanitation workers is being taken seriously and the intent to address this exists.


Convergence of timely efforts will play a radical role in transforming the lives of sanitation workers for generations to come. These are not just relevant in contributing towards Sustainable Development Goal 6.2 but also for ensuring the basic human rights of sanitation workers.

Relevant references:

WHO (2018). Guidelines on Sanitation and Health. Available at: https://apps.who.int/iris/bitstream/handle/10665/274939/9789241514705-eng.pdf?ua=1 (Accessed: 13 July 2020)
The World Bank (2019) Health
Safety and Dignity of Sanitation Workers: An initial assessment report. Available at: https://washmatters.wateraid.org/sites/g/files/jkxoof256/files/the-health-safety-and-dignity-of-sanitation-workers_0.pdf (Accessed: 14 July 2020).
SNV (no date) The ‘invisible hand’ behind human waste disposal. Available at: http://www.snv.org/update/invisible-hand-behind-human-waste-disposal (Accessed: 14 July 2020).
Criado Pérez
Carolina (2019). Invisible Women: Data Bias in a World Designed for Men. London

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