May 2025 Protect Those Who Protect Us: The Hidden Frontline of Sanitation Workers in Ethiopia Amensisa Hailu Tesfaye, Gebisa Guyasa Kabito, Kassahun Alemu Gelaye, Dagnachew Eyachew, Awrajaw Dessie, Nardos Hussein, Giziew Abere and Tesfaye Hambisa Mekonnen

... working under challenging and often hazardous conditions to manage waste, clean streets, maintain latrines, and ensure the safe removal of human excreta from private homes and public spaces. Despite their vital contributions, their occupational safety, welfare, and basic rights remain consistently neglected.

Why This Matters

Protecting sanitation workers is essential for achieving sustainable water, sanitation, and hygiene  (WASH) services. The health and resilience of communities depend on the safety, dignity, and recognition of those who keep our environments clean. As the Initiative for Sanitation Workers emphasizes, sanitation workers are indispensable public health actors, yet they remain among the most marginalized and neglected segments of the urban workforce.

What We Did

Sanitation workers play a critical role in preventing disease and promoting public health. Yet many are denied even the most basic protections that should be guaranteed to essential workers. To better understand their challenges, we conducted a mixed-methods study in Addis Ababa, Ethiopia’s largest city and diplomatic hub, home to the African Union. The study included a structured survey of 821 sanitation workers, 12 key informant interviews and 6 focus group discussions. Data collection took place between November 2021 and June 2022.

The objective was to assess health risk mitigation strategies available to sanitation workers and to identify the factors that influence access to and use of these measures.

What We Found: Exposed, Undervalued, and Unprotected

The findings uncover deep systemic and personal gaps. Over two-thirds of workers surveyed had never received any training on safe sanitation practices. Personal Protective Equipment (PPE),  essential for safe handling of waste, was unavailable in 63% of workplaces. Nearly one in four workers reported paying for PPE out of pocket, often receiving low-quality or insufficient supplies. Additionally, many workers felt discouraged from reporting occupational injuries, and 14% admitted to not following safety procedures, frequently due to a lack of clear guidance and/or institutional support.

Alarmingly, more than 23% of participants were informal workers with no legal employment status, and therefore no access to health insurance, pensions, or compensation for injuries. This leaves them particularly vulnerable to economic hardship and long-term health complications.

Behind the Numbers: Real Lives, Real Risks

During the focus group discussions, workers shared personal stories that brought the data to life. Many described their daily experiences with stigma and exclusion. One participant recounted being denied access to public transportation because of his occupation. Others reported having untreated injuries, respiratory issues, and chronic skin conditions, which are often the result of inadequate protective measures and limited access to healthcare. These health problems are not just common, they are expected, normalized, and routinely overlooked.

Despite their dedication, sanitation workers are routinely treated as disposable. Their voices remain unheard in policy discussions and/or dialogues, and their well-being is not prioritized in public health planning.

Time to Act: A Call for Inclusive and Safer Systems

One of the clearest messages from this study is that sanitation workers want to perform their jobs with dignity. They take pride in keeping their communities safe. But dignity must go beyond moral support; it demands structural and institutional change. Protecting sanitation workers is not charity; it is a matter of justice and public health.

Only 38% of workers reported adequate access to safe sanitation services, and fewer than half (40%) consistently adhered to safety protocols. These figures point not to individual neglect but to systemic gaps in training, support, infrastructure, and regulatory oversight.

To close these gaps, we call for urgent and coordinated action from government bodies, NGOs, and civil society. National sanitation policies must explicitly prioritize the well-being of sanitation workers.

Key recommendations include:

• Ensuring free, reliable access to PPE
• Mandating regular, comprehensive occupational health and safety training
• Expanding legal protections and formalizing employment pathways
• Providing social protections such as health insurance and pension schemes
• Reducing stigma through public awareness and recognition campaigns
• Promoting dignity and equity through safe, fair, and decent working conditions

Recognizing the Essential Public Health Workforce

Sanitation workers are not just labourers; they are frontline public health champions. They play a foundational role in the functioning of our cities. Recognizing their contributions is both a moral obligation and a public health imperative. Ensuring their safety protects entire communities and strengthens our resilience to disease outbreaks and environmental health risks.

It is time to bring sanitation workers out of the shadows. They deserve more than symbolic appreciation; they deserve safety, respect, and decent working conditions. By protecting them, we protect us all. Let us honor their service with action, not just words.

Note: This blog is based on findings from the research project titled “Occupational Health Risk Mitigation (HRM) Methods for Sanitation Workers: Assessment of Barriers of Access and Practice of Safe Sanitation Work (SSW) in Ethiopia.” The project team included Amensisa Hailu Tesfaye, Gebisa Guyasa Kabito, Kassahun Alemu Gelaye, Dagnachew Eyachew, Awrajaw Dessie, Nardos Hussein, Giziew Abere, and Tesfaye Hambisa Mekonnen from the Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.