Moreover, it is not possible to achieve the health related agenda of Sustainable Development Goal (SDG-3) of ensuring healthy lives and promoting the well-being for all at all ages if we ignore these vulnerable community. Coverage for slum and street dwellers are limited not just in terms of health but also in family planning and nutrition. Absence or paucity of service facilities in urban areas means that the disadvantaged are the worst sufferer which is evident from the health status of the urban people living in slums (General Economic Division, 2016).

Access to Health according to the Constitution, Laws and Policies in Bangladesh:The Government of Bangladesh has a constitutional obligation to ensure access to health for all. According to Article 15(a) of constitution of Bangladesh:

“The provision of the basic necessities of life, including food, clothing, shelter, education and medical care shall be a fundamental responsibility of the State to attain...15 (d) “The right to social security, that is to say, to public assistance in cases of undeserved want arising from unemployment, illness or disablement, or suffered by widows or orphans or in old age, or in other such cases”.

Introduction:Waste pickers are the representatives of the poorest citizen of a city especially children and women who are trying to secure their livelihood by collecting and selling wastes from different streets, dustbins and dump sites. In Bangladesh, they are also well known as “Tokai”. According to a study of Grambangla Unnayan Committee and a globally reputed researcher Martin Medina (Medina 2007), approximately 400,000 people of this country are making their living by waste picking and selling (Maksud, 2011).

The National 3R (Reduce, Reuse, Recycle) Strategy for Waste Management of the Department of Environment of Government of Bangladesh mentioned that in Dhaka city, 120,000 poor people are engaged in recycling and reusing 15 percent of the total wastes; and from that business, the country earns approximately Tk.1,071 million per year (Department of Environment, 2009). According to Women in Informal Employment: Globalizing and Organizing (WIEGO) there is growing recognition that waste pickers contribute to the local economy, to public health and safety, and to environmental sustainability…they often face low social status, deplorable living and working conditions, and little support from local governments (WIEGO).

Why Access to Health for the Waste Pickers is Important?The right to health is one of the fundamental rights which has been recognized by WHO and approved as an instrument of welfare by the Universal Declaration of Human Rights (UDHR) and the International Covenant on Social, Economic and Cultural Rights (ICSECR).According to World Health Organization (WHO) health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. It is also one of the important indicators of Human Development Index (HDI).That’s why access to health is important for the achievement of health equity and for increasing the quality of a healthy life for everyone.

POLICY BRIEFPOLICY BRIEFWaste Pickers in Bangladesh &their Right to Access to HealthWaste Pickers in Bangladesh &their Right to Access to Health

Children are working as waste picker at Matuail waste dump in Dhaka

In Article 18. (1), it has been stated that:

“The State shall regard the raising of the level of nutrition and the improvement of public health as among its primary duties”.

Moreover as the signatory of Declaration of Alma-Ata, Article 25(1) of Universal Declaration of Human Rights (UDHR), Article 12 of International Covenant on Economic, Social and Cultural Rights, Article 12 of the Convention on the Elimination of All Forms of Discrimination against Women (CEDAW), Article 24 of United Nations Convention on the Rights of the Child (UNCRC), Bangladesh is committed to improve the health services situation of the country. Bangladesh is also committed to achieve the vision of SDG within 2030.

It has been clearly stated in the National Urban Health Strategy 2014 of the Government of Bangladesh that the main objectives of that strategy are to ensure universal health coverage for urban population with a pro-poor focus, strengthen preventive and primary health care management system, ensure urban poverty reduction, and achieve national nutrition targeted. In the section of Implementation of the National Urban Health Strategy, it has been said that “The National Urban Health Strategy shall be implemented through integrated efforts at different levels. The urban poor will be the main focus of urban health care and the system will be gender responsive” (Local Government Division, 2014).

In National Plan of Action (NPA) for 2012-2016 to implement the National Child Labour Elimination Policy 2010, it has been said that access to health and nutrition education has to be ensured for all households with working children or those at risk of sending children for labour and working adolescents aged 14 to less than 18 years are protected from hazardous work; Children protected from trafficking and sexual exploitation.

“Vision 2021” is a vision of the government of Bangladesh for the socio-economic development of the country. In “Vision 2021” for promoting human development the present government of Bangladesh aims to remove food deficiency and to ensure nutritional requirements of 85% of the population. Besides that it is committed to eliminate contagious diseases and ensure primary health care and sanitation for all (National Health Policy 2011). The third principle of National Health Policy 2011 of Government of Bangladesh is to take special care of the health issues of poor, deprived, marginalized, and old and the people with physical and mental disability and to ensure fair distribution and effective use of resources to solve the health problem.

Access to Health and the Reality of Waste Picker Community of Bangladesh:Waste-pickers are one of the most disadvantaged and neglected groups in Bangladesh, working in hazardous conditions. Often, they become injured or victim of accidents during collecting wastes. They are exposed to different health risks due to different sharp objects, broken glass and medical wastes. Their work results in poor health and often disability. They are compelled to work in the most unhygienic conditions without wearing boots, gloves or masks and become easy prey of different diseases.

The present mode of solid waste management by the Dhaka City Corporation poses a number of environmental health risks. First, the city does not have separate waste disposal systems for clinical and industrial wastes. The disposal of hazardous and medical wastes in urban areas is a major cause of concern for urban life, particularly for the poor who are engaged in scavenging activities (General Economics Division, 2008).

The issue of health hazard of waste pickers due to medical waste was raised in National Strategy for Accelerated Poverty Reduction, Bangladesh in 2009. Because of bad disposal system, they are highly susceptible to typhoid, cholera, tuberculosis, dysentery, diarrhea, HIV, various types of skin diseases, jaundice, pneumonia, malaria etc. Moreover, sometimes, they have cuts from sharp objects or lose their limbs because of the accident with hydraulic leveling machine and become disabled. These accidents happen due to the ignorance of waste pickers. Besides diseases, the waste pickers also suffer from different health issues due to serious malnutrition, inadequate sanitation and unhygienic environment. In this situation, their access to health services is very poor. As a result, sometimes, they become victim of death.

Mobile food vendor sells food items at the Matuail waste dump

Because of poverty the waste picker children and women suffer from malnutrition. They are also highly vulnerable due to physical, mental and sexual harassment. The situation of reproductive health care seeking behavior is poor. Early marriage is a common practice in this community. The adolescent girls do not have sufficient knowledge and are not aware about health issues. As a result, after marriage, they suffer from different health problems like anemia, less physical growth, gyneacological problems etc. Moreover, in most of the cases, they have very little knowledge about the modern contraceptives. As a result, the incident of early pregnancy is also high.

Demands to Ensure Health for Waste Pickers: 1 Implementation of the health rights, policies and

strategies for the urban poor those have been depicted in the Constitution of Bangladesh, Health Policy 2011 and National Urban Health Strategy 2014.

2 Design and deliver a unified Social Safety Net Program for the waste pickers.

3 Adopt legal framework for an improved and well managed solid waste disposal system. It is important to adopt and implement legal framework for health protection and securing livelihood. It is also important to adopt and implement legal framework to dispose organic, inorganic, reusable and harmful wastes in different bins.

4 Consider different occupational hazardous issues that causes harm to waste pickers’ health like collecting wastes without personal protection, accident due to hydraulic leveler etc. and design and implement occupational safety training.

5 Ensure appropriate occupational safety measures through imparting training at workplace.

6 Adopt an effective program to ensure water and sanitation facilities.

7 Adopt an effective program to stop early marriage and ensure family planning services.

8 Adopt a comprehensive strategy to reduce health hazards and to ensure a healthy life.

9 Effective implementation of Child Act, 2013 and raise awareness among the officials of Zila and Upozila Child Welfare Board, Police officers and juvenile court to strengthen those institutions to maintain a child friendly environment.

Reference: • Department of Environment, Ministry of Environment and

Forests, Government of the People’s Republic of Bangladesh (2009). National 3R (Reduce, Reuse, Recycle) Strategy for Waste Management, Dhaka.

• General Economics Division, Planning Commission, Government of the People's Republic of Bangladesh (2008). Moving Ahead: National Strategy for Accelerated Poverty Reduction II FY 2009 - 11, p.180, Dhaka, Bangladesh.

• General Economics Division, Planning Commission, Government of the People's Republic of Bangladesh (2016). 7th Five Year Plan FY 2015/16-FY 2019/20: Accelerating Growth, Empowering Citizens, p.84, 472, 473 & 510, Dhaka, Bangladesh.

• Local Government Division, Ministry of Local Government, Rural Development and Cooperatives, Government of the Peoples’ Republic of Bangladesh (2014). National Urban Health Strategy, Dhaka, Bangladesh.

• Maksud, A K M (2011). Inhuman Conditions of the Waste Picker Women and Children in Bangladesh, Dhaka.

• Medina, Martin (2007): The World’s Scavengers: Salvaging for Sustainable Consumption and Production, UK.

• Women in Informal Employment Globalizing and Organizing (WIEGO) (http://wiego.org/informal-economy/ occupational-groups/waste-pickers)

• The Constitution of the People’s Republic of Bangladesh• National Health Policy 2011 • (http://mohfw.gov.bd/index.php?option=com_content

&view=article&id=74&Itemid=92&lang=en)• Ministry of Labour and Employment, Government of the

People’s Republic of Bangladesh (2013). National Plan of Action for Implementing the National Child Labour Elimination Policy, 2012-2016

• The Children Act, 2013

Contact

GRAMBANGLA UNNAYAN COMMITTEEHouse 93, Road 1 (1st Floor)

Mohammadia Housing Society, Mohammadpur, Dhaka-1207, Bangladesh

E-mail: grambangla@yahoo.com, web: www.grambanglabd.org

Phone: +88-02-8105000, +88 01715020055

Children are picking waste very near to the waste leveling machine like hydraulic excavator

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†mvmvBwU, †gvnv¤§`cyi, XvKv-1207, evsjv‡`k

B‡gBj: grambangla@yahoo.com, I‡qe: www.grambanglabd.org,

†dvb: +88-02-8105000, +88 01715020055

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6. eR©¨Rxex‡`i Rb¨ weï× cvwb I m¨vwb‡Ukb welqK Kvh©Kix

e¨e¯’v MÖnY Kiv|

7. eR©¨Rxex KwgDwbwUi g‡a¨ cÖPwjZ evj¨weev‡ni weiƒc cÖ_v

`~i Kiv I cwiKwíZ cwievi MV‡b mnvqZv Kiv|

8. m‡e©vcwi, eR©¨Rxex‡`i Rb‡Mvôxi ¯^v¯’¨ SuywK Kwg‡q G‡b

Zv‡`i Rb¨ GKwU my¯^v¯’¨ I Kj¨vYgq cwi‡ek m„wó Kiv|

9. eR©¨Rxex wkïi cwic~Y© kvixwiK, gvbwmK I mvgvwRK ¯^v¯’¨

Dbœq‡b wkï AvBb 2013-Gi AvIZvq mswkøó †Rjv I

Dc‡Rjv wkï Kj¨vY †evW©, _vbvi wkïwelqK cywjk Kg©KZ©vi

†W¯‹ Ges wkï Av`vjZ cÖwZôvbmg~n‡K AwaKZi Kvh©Ki I

wkïevÜe Ki‡Z mnvqK Kvh©µg ev¯Íevqb Kiv|

Z_¨m~Î:• Department of Environment, Ministry of Environment and

Forests, Government of the People’s Republic of Bangladesh (2009). National 3R (Reduce, Reuse, Recycle) Strategy for Waste Management, Dhaka.

• General Economics Division, Planning Commission, Government of the People's Republic of Bangladesh (2008). Moving Ahead: National Strategy for Accelerated Poverty Reduction II FY 2009 - 11, p.180, Dhaka, Bangladesh.

• General Economics Division, Planning Commission, Government of the People's Republic of Bangladesh (2016). 7th Five Year Plan FY 2015/16-FY 2019/20: Accelerating Growth, Empowering Citizens, p.84, 472, 473 & 510, Dhaka, Bangladesh.

• Local Government Division, Ministry of Local Government, Rural Development and Cooperatives, Government of the Peoples’ Republic of Bangladesh (2014). National Urban Health Strategy, Dhaka, Bangladesh.

• Maksud, A K M (2011): Inhuman Conditions of the Waste Picker Women and Children in Bangladesh, Dhaka.

• Medina, Martin (2007): The World’s Scavengers: Salvaging for Sustainable Consumption and Production, UK.

• Women in Informal Employment Globalizing and Organizing (WIEGO) (http://wiego.org/informal-economy/ occupational-groups/waste-pickers)

• The Constitution of the People’s Republic of Bangladesh• National Health Policy 2011 • (http://mohfw.gov.bd/index.php?option=com_content

&view=article&id=74&Itemid=92&lang=en)• Ministry of Labour and Employment, Government of the

People’s Republic of Bangladesh (2013). National Plan of Action for Implementing the National Child Labour Elimination Policy, 2012-2016

• The Children Act, 2013