July 2024 Shasthya Nirapotta Scheme: a financial safety net for sanitation workers in Bangladesh M M Mamshad and Laura Kohler

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.

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.

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.

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.

WaterAid Bangladesh works closely with local partner organisations to deliver this important initiative. Waadda. Insure identifies, brokers and on boards 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.