Development, public health, sewage, and frontline workers: faecal sludge management in Harar City, Eastern Ethiopia

Abstract

This case study of Harar City, eastern Ethiopia, demonstrates that, while Ethiopia’s ambitious post-Millennium Declaration (Goal 7) sanitation agenda has produced both considered policies and a level of implementation, serious challenges remain, particularly regarding policy enforcement. Few data are available on the hazardous exposure levels faced by frontline sanitation workers in Ethiopia but, as we demonstrate, direct contact with untreated faecal sludge is often frequent and sustained. Across fourteen focus group discussions and seven key informant interviews, we highlight, through lived experiences, the challenges workers confront due to insufficient regulation enforcement, which regularly leaves them navigating underdeveloped sewage infrastructure without acceptable levels of support, training and expertise. Our study highlights how ambitious policymaking must translate to strongly coordinated governance and a greater emphasis on capacity building if frontline workers in Ethiopia, and their surrounding communities, are not to be dangerously exposed to a host of ongoing health risks.