Public health, sewage, and front-line workers: fecal sludge management in Harar City, Eastern Ethiopia

Onsite sanitation – consisting mostly of pit latrines and septic tanks – is a common human waste management method in low- and middle-income countries including Ethiopia. The fecal sludge accumulated in such facilities contains pathogens and other elements that, if not properly managed, can cause considerable health and environmental issues, especially for those engaged in working with fecal sludge. There are few data available in Ethiopia with respect to levels of exposure faced by those working in the sector, and it is difficult to quantify the extent of the problems faced by those tasked with the management of fecal waste. In the absence of reliable quantitative data, this study offers a qualitative view of the lived experiences of workers within the sector. We consider, based on these experiences, issues of governance and capacity, regulation and enforcement, best practice within the sector, issues surrounding health and safety, and issues surrounding the mitigation of risk. We demonstrate that, based on these qualitative data, there is an urgent need for improved governance, a more ‘joined up’ approach by national and local government to regulating fecal sludge management, and a pressing need to improve levels of education and training for those working on the ‘front line’. An ongoing failure to address the above poses considerable risks to frontline workers and the public at large.