Lived experience of occupational health and safety among street sweepers in Dhaka city: A qualitative study

Abstract

Background: Street sweepers play a critical role in urban waste management, but are still a marginalized occupational group in low and middle-income countries. Dhaka, being one of the most densely populated cities, generates large volumes of waste every day, putting this group of people in the front line of urban sanitation under hazardous conditions. The street sweepers are continuously exposed to various physical, chemical, biological, and ergonomic hazards due to their working conditions and poor institutional support. While existing studies have documented health hazards and disease prevalence, limited qualitative evidence exists on how street sweeper in Dhaka perceive their health risks, seek care or manage with the ongoing demand of the occupation.

Objectives: To explore the lived experiences of occupational health and safety, perceived health risk, occupation-related health problems, health-seeking behaviour, and coping mechanisms among the street sweepers in Dhaka city.

Methods: A qualitative study was conducted with six wards of Dhaka North City Corporation (DNCC) in Badda, Mohakhali, Rampura, and Mirpur. 22 In-depth interviews with street sweepers, 7 key informant interviews with their direct supervisors, and 4 non-participant observations were held using snowball sampling, guided by the principle of data saturation. Thematic analysis approach was used for conducting the data analysis using deductive and inductive coding.

Results: Four themes emerged from the data analysis:1) Perceived health risks, 2) Health problems, 3) Health-seeking behaviour, 4) Coping and adaptation mechanisms. The perceived health risks were mixed among the street sweepers, where some could identify their workplace hazards while others underestimated the risks or perceived illness as a matter of fate. Musculoskeletal pain was the most frequently reported health concern, followed by respiratory illness, chronic disease, skin diseases, and gastrointestinal problems. The street sweepers described mental exhaustion, financial tension, restlessness, and loss of peace of mind, showing up through irritability, anger, crying, and family conflict rather than being separately named as a mental health issue. Health care seeking was consistently delayed or avoided, primarily due to low income, time constraints, and cost of care, with pharmacies serving as the first and often only point of care, followed by public and private facilities if felt necessary. Street sweepers coped through normalising hardship, self-medication, peer support, and religious faith.

Conclusions: Street sweepers in Dhaka face increasing occupational health hazards and safety issues. Despite existing legal protection, there are unenforced labour laws, limited access to healthcare, and organizational support being absent in practice. Ensuring permanent employment benefits, provision of workplace facilities, enforcement of existing labour laws, and focused occupational health interventions are in urgent need to protect the safety and health of the overlooked occupational group, street sweepers.