Globally, effective management of solid waste is both an economic and human security concern. In recent years, the problems associated with the management of solid waste have become acute [1
] in developing countries because of rapid urbanization and poor spatial planning in cities [3
]. For developing countries to meet the 2030 target for clean and healthier cities [SDG 11], the active participation of governments, private sector players, and the support of the citizenry is necessary [2
]. The active participation of relevant stakeholders in solid waste management ensures synergy and continuity in dealing with the technical, environmental, financial and socio-cultural exigencies related to waste management [5
In Ghana, a Waste Management Department was established in 1985 to manage urban waste [8
]. However, poor waste management practices by Metropolitan, Municipal and District Assemblies (MMDAs) led to a policy shifts towards public–private sector partnership (PPP) in managing waste [9
]. In the PPP arrangement, an organizational culture was built in which public actors such as MMDAs work with large to medium size private companies who employ Domestic Waste Collectors (DWCs) to collect and dispose of solid waste. Yet still, the PPP arrangements for managing waste in Ghana have been generally described as poor [10
]. Evidence in Ghana suggests poor organizational culture attributes such as poor stakeholder engagements and lack of transparency in waste management contracts and poor quality assessment procedures regarding solid waste management in Ghana [10
]. Often neglected in many of these contractual arrangements is improving the welfare of DWCs who are integral to the success of any PPP arrangement in managing waste.
The DWCs play critical roles along the waste management value chain, particularly in developing countries where the collection, sorting, and disposal of solid waste are largely performed manually [13
]. DWCs daily exposure to waste during collection and disposal makes them vulnerable to occupational health hazards such as skin irritation, bronchitis, hypersensitivity pneumonitis, and dermatitis among others [14
]. Poor measures regarding work design, organizational policies, and management practices contribute to work-related stress for DWCs, which is reflected in both personal and environmental outcomes such as depression and workplace violence [17
]. Furthermore, persons engaged in the solid waste collection are often people of low socioeconomic and educational status who often are not prioritized regarding their health and safety at the workplace. However, DWCs play an important role in helping to make cities and environments cleaner [22
Earlier studies in Ghana on DWCs have reported work-related accidents, absenteeism from work due to varied illness, and deaths among DWCs [9
]. Despite DWCs’ important roles in collecting and processing waste in Ghana, research on their physical and psychosocial health and well-being is limited. A recent study found high reports of respiratory infections, reduced pulmonary function and a higher prevalence of dermatological diseases among DWCs in Tema Municipality of Ghana [28
]. Respiratory tract symptoms, headaches, body pains, and stomach discomfort were also reported in another study in the city of Accra [29
To contribute further to the understanding of the occupational needs and hazards among DWCs in the context of solid waste collection and disposal in Ghana, this qualitative study investigated psychosocial risk factors, work-related stress, and job satisfaction needs among DWCs in the Ho Municipality, Ghana. Specifically, the objective of the study was to understand the views and experiences of DWCs and their managers or supervisors regarding personal health and safety risks, work-related stress, and job satisfaction needs in two waste companies in Ghana. The findings are relevant to inform policy-makers of the occupational and health hazards that DWCs encounter daily, and to inform future waste management policies aimed at improving sanitation and hygiene procedures, as well as improving the health and well-being of DWCs in both the formal and informal sectors in Ghana.
2. Materials and Methods
2.1. Study Design and Ethical Approval
A qualitative phenomenological approach was applied to understand both DWCs’ and their managers and supervisors’ views and experiences regarding risk, work-related stress, and job satisfaction needs along the waste management value chain in the study setting. The phenomenological design was applied since the research team were interested in understanding the perspectives and lived experiences of the phenomenon of interest [30
The Ethical Review Committee Psychology and Neuroscience (ERCPN) of the Faculty of Psychology and Neuroscience, Maastricht University (approved research line ERCPN-188_10_02_2018) and Ghana Health Service Ethics Review Committee (GHSERC 08/05/17) approved the study. During the study, each participant completed a consent form before participating, after being informed about the objective and procedure of the study. Participants’ identities were concealed by ensuring that participants do not mention their names on tape during the recording and interviewing processes. The study participants were assured that the information provided is handled with confidentiality and analysis of the data is done at the aggregate level of the group to ensure anonymity. The research team assured the participants that the information shared with the researchers will not be used to harm their job in the future. This generated a lot of confidence among the study participants and ensured a higher level of participation during the interviews.
2.2. Study Setting and Population
The study was conducted in the Ho Municipality, located in the Volta Region of Ghana. The 2018 projected population of Ho Municipality is estimated at 213,960, comprising 105,195 males and 108,765 females [32
]. Spatial planning in the municipality is poor [33
], with solid waste being poorly managed, and waste collection, management, and disposal largely the responsibility of the household members. The Municipality is regarded as the commercial center of the Volta Region due to its strategic location and its proximity to the Republic of Togo as well as easy crossing to Districts and Regional capitals such as Accra. The Municipality was chosen for the study because of its solid waste management challenges, and the state of environmental conditions in the municipality suggests a lot more needs to be done. Two waste management companies operating in the Municipality were included in the study. The waste management companies and participants were anonymized (the two participating companies are referred to as Company A and B). The two waste companies work with several DWCs to manage solid waste in the Ho municipality. DWCs contracted by the two waste companies as waste collectors, and the waste companies’ managers and supervisors, were eligible participants in this study. Waste company managers are responsible for recruiting and training DWCs, while supervisors are principally involved in monitoring the daily activities of the DWCs.
2.3. Study Instrument
In-depth interview (IDI) and focus group discussion (FGD) guides were developed for conducting interviews among managers/supervisors and DWCs, respectively. On average, IDIs lasted 50 min, while FGDs lasted for 1:15 min. The design of the interview guide was informed by the core attributes of the Copenhagen Psychosocial Questionnaire (COPSOQ) [34
]. COPSOQ aims to improve and facilitate research and intervention design at workplaces. The study adapted the short, medium and the long versions of the Copenhagen Psychosocial Questionnaire (COPSOQ) scales. All the versions were modified to meet the objective(s) of this study. Specifically, we created a mix of scales to measure psychosocial risk, work-related stress, and job satisfaction. The interviews with DWCs were partly conducted in “Ewe”, the indigenous language in the study area and English for non-Ewi speaking. Interviews with managers and supervisors were conducted in English. The interview guide was pilot tested among ten DWCs, five each from the two companies. No content changes were made to the instrument except for some small textual edits. All field data were collected between June and August 2017.
2.4. Sampling and Interview Procedures
The principal investigator (SYL) consulted the Municipal Environmental Health Officers (MEHOs) to identify study sites in the Ho Municipality to conduct the study. A sampling frame was created after obtaining anonymized details of DWCs from the two companies operating in the Municipality. Overall, 70 DWCs met the eligibility criteria of having minimal work experience as DWC of one-year. Different work profiles among the DWCs were included in the study such as cleaners, sweepers, janitors, and drivers who worked for the two waste companies handling solid waste along the value chain, 46 from Company A and 24 in Company B. However, six (6) DWCs were excluded because of their non-availability at the time of data collection. We had 64 DWCs for the interviews. Company A had a total of 43 DWCs listed, while company B had 21 DWCs listed for our sampling frame. We applied proportionate sampling to ensure equal representation of participants in the interviews. Convenience sampling is a non-probabilistic sampling procedure that results in the recruitment of subjects of the population that are easily accessible to the data collectors [35
]. A total of 25 managers and supervisors from company A, and ten from company B, were included in the study. They were selected based on the inclusion criteria of a minimum of one-year continuous work experience with their present company.
Three research assistants (RAs) were recruited to assist in data collection based on their level of education, prior demonstrated experience and performance during training in conducting field research observations, and a good understanding of ethical procedures in research. Fluency in the local language (Ewi) and good background knowledge of the study setting were also considered in recruiting RAs. The RAs were trained on how to undertake field observations and to administer informed consent to study participants. The principle investigator led all interviews, while RAs assisted to take short notes during the conduct of these interviews. Short notes from the three RAs were later corroborated with audio recordings after transcriptions were concluded and there were no significant differences between the transcripts and the notes from all RAs. During field data collection, RAs visited dumping sites and documented field observations on types of solid waste generated, methods of solid waste collection and disposal, as well as use of Personal Protective Equipment (PPE) in a notebook.
After a prior introduction and familiarization visits to the two companies, dates were fixed for the principal investigator to meet the management of the two companies to explain the purpose of the study further and to gain their support to conduct the study. In these meetings, the principal investigator and management of the companies agreed on the timeline for data collection among DWCs, supervisors, and managers. A week before the interviews, DWCs were informed through their managers of the schedule for data collection by the team. During the period of data collection, DWCs were requested to select a place and agreed time at their convenience for the interviews.
Six focus group discussions were conducted as follows: four FGDs were conducted in company A, while two FGDs were conducted in company B. Four of the six FGDs had ten participants each participating in the discussions. Two FGDs were used: one, in company A, had 13 participants, while another FGD, in company B, consisted of 11 participants. The use of focus discussion made the participants express their opinions and real-life experiences on research topics. All six FGDs were conducted at separate times and locations. In addition, 35 IDIs were conducted among managers and supervisors. For each IDI respondent, interviews were conducted until at a point where saturation was reached among each interviewee. The principle investigator led all interviews while RAs assisted by taking short notes during the conduct of interviews and field observations. Short notes from the three RAs were later corroborated with audio recordings after transcriptions were concluded and there were no significant differences between the transcripts and the notes from all RAs.
2.5. Data Analysis
All interviews were audiotaped and transcribed verbatim to English. Two native Ewe teachers were hired to transcribe Ewe audiotapes into written English and then later translated into English. Each transcriber’s work was cross-validated with the other transcriber. The transcribed MS word documents were exported into QSR NVivo 11.0 software (QSR International, Burlington, MA, USA) for analysis. Data were analyzed using inductive and deductive content procedures. Subjecting the data to inductive analysis, all transcripts were repeatedly read by the research team and relevant statements were extracted from the transcripts. The process was repeated twice to ensure that relevant statements were not left out. All extracted statements were then put into categories to form subthemes. Deductions were further conducted on the subthemes by reading and making deductive inferences, leading to the emergence of four main themes. The final themes were organized according to psychosocial risk factors, work-related stress demands, and job satisfaction needs among DWCs. Relevant quotations from the DWCs, managers, and supervisors, and the deduced meanings, are presented within each theme that emerged.
This study applied a qualitative design to examine psychosocial factors, work-related stress, and job satisfaction needs among DWCs in the Ho Municipality of Ghana. Although the study did not aim to assess gender differences, we highlight some key gender issues that are worth mentioning. There were fewer females among the study participants at the level of managers and supervisors compared to males. This is the opposite to the amount of DWCs, since more females constituted this level of study participants. DWCs’ job roles are the lowest along the waste management value chain, indicating that females tend to occupy lower job roles in managing waste. This finding is consistent with current waste management operations across Ghana. Some reasons, such as culture, and socio-cultural value systems that regard jobs such as cleaning, sweeping and waste collection as traditional roles for women, may be influencing low socio-economic women’s desire for domestic waste collection job roles, as seen from this study. Policies that will empower women working in the waste management sector to take a leadership position and assume higher responsibility and roles will enhance family livelihoods, decision making, and bridge the inequality in the job role specifications in the waste management sector in Ghana and across similar settings.
The findings suggest that DWCs are frequently exposed to health-related risks and often fail to observe occupational safety practices at the workplace, partly due to not being provided with protective wear such as PPEs. DWCs non-compliance to wearing PPEs, poor risk perceptions towards potential infectious pathogens associated with direct exposure to waste, and belief that dirt is “harmless” can put DWCs at risk of adverse health outcomes. Our findings also show that DWCs work under challenging conditions: their contractual agreement with their employers is often unclear, they are poorly remunerated, hardly receive refresher training on safety issues regarding their work, and do not enjoy healthy working relationships with both colleagues and supervisors. Waste collection is generally perceived by the public as a job for people of low socio-economic standing and DWCs frequently feel stigmatized when people refer to them as “Borla Borla” people.
The finding that DWCs do not often use protective wear to protect them from potential infectious diseases is partly because their managers and supervisors do not pay attention to providing the necessary PPE is worrying. Several studies have linked various adverse health outcomes such as respiratory infections, injuries, skin rashes, lack of concentration at the workplace, anxiety, and loss of sleep to unsafe waste collection practices [14
]. Despite the health risk associated with their work, one essential health need that is often neglected is meeting medical expenses for DWCs when accessing and using health care services. The inability of some DWCs to afford health care costs often results in self-medication, delays in seeking care or resorting to non-certified herbal practitioners. Asase and colleagues reported that, in Ghana, DWCs often resort to non-certified herbal medicines in times of ill-health, a phenomenon that affects their quality of life in the long-term [40
]. The occupational hazards associated with the work of DWCs could be minimized through the consistent use of PPE. However, DWCs recounted working in poor conditions, including frequently not using PPE, and not being adequately trained on safety measures associated with their work to reduce health risks. These conditions seem to inform their poor knowledge in identifying the psychosocial risks associated with their work environment and adopting the necessary health and safety measures. This finding corroborates two Ethiopian studies that reported that poor work environments and lack of adequate training among industry workers on identifying health-related risks and adherence to safety practices contributed to workers’ poor knowledge of occupational health and safety at the workplace [41
]. These findings do not only call for waste management companies to provide adequate protective wear to domestic waste workers, but also to regularly conduct on-the-job training on the health risks and occupational hazards associated with waste collection.
Our findings also showed that DWCs have low-risk perception towards possible infectious diseases associated with waste collection, which is partly informed by the normative belief that dirt is “harmless”. Such beliefs could mean that even if they are provided with full protective wear, they may still fail to observe safety measures consistently. Although DWCs were of the opinion that they fully understood the implications of dirt having direct effects on health, their expressions and beliefs that not all dirt was harmful was strong enough to prevent their use of PPE, or adherence to other prescribed health and safety rules at their place of work. Additionally, DWCs’ low-risk perceptions from this study were also a result of poor knowledge of the potential health hazards from the direct and indirect effects of the unhygienic handling of solid waste during collection and disposal by DWCs. DWCs’ expressions of low-risk perceptions and belief that dirt was harmless may have been driven by low social esteem, and the low socio-economic and educational levels of DWCs in this study. One repeated assertion by managers and supervisors on DWCs’ normative beliefs and low-risk perception was that these were the result of waste companies’ non-compliance to standard operating procedures on waste management. Workplace policies that provide a system of continuing education and awareness on occupational health and safety can address gaps, misconceptions and poor normative beliefs on the causes of infectious diseases and their prevention among DWCs, as found in this study.
Poor interpersonal relationship among DWCs, their managers, and supervisors can impact negatively on DWCs’ work balance and health outcomes, as narrated by participants of this study. This finding has been corroborated by another study that found poor work and working relations between managers and their subordinates to be associated with subordinates’ reports of mental health conditions such as depression, fatigue, and stress [43
]. Specifically related to waste control and management, other studies also found that the lack of mutually respectful relationship experiences of DWCs could be due to the poor nature and conditions of service of DWCs, disregard and poor supervision from their managers, as well as poor communication regarding clarity of the work of waste collectors [43
]. There is evidence that work-related stress results in a decrease in the quality of relationships with managers, supervisors, and family members [45
]. DWCs further indicated that they are more comfortable with managers and supervisors who have their wellbeing at heart. Studies found that the more cordial the relationship between supervisors and managers and workers or DWCs, the more likely it is that the DWCs will perform their duties in a healthy and safe manner [46
]. To improve DWCs’ working conditions and build cordial work relations that promote DWCs’ work balance and health outcomes, there is need for workplace strategies to provide safe environments in which healthy work–life balance programs are established and promoted among employers and their employees in order to promote productive work environments.
Furthermore, DWCs revealed that they encounter poor social interactions due to the stigma associated with their work and lack support from supervisors and managers in dealing with the situation, a phenomenon that results in low job satisfaction. Lack of social support for waste collectors impacts negatively on the psychosocial well-being and health outcomes of waste collectors, as previously reported [47
]. DWCs also avowed the existence of poor contractual agreements with their employers, low wage earnings and ‘erratic’ payments of salaries and benefits from employers as contributing to their work-related stress and low motivation, leading to poor job satisfaction. A study [42
] conducted in Ethiopia among textile workers corroborates the findings from this study that poor contractual agreements and low wages are psychosocial risk factors that can result in work-related stress and poor job satisfaction among workers. Similarly, psychosocial risks and work-related stress are known to determine job satisfaction in the work environment [50
The findings presented in this study also reveal the stigmatization associated with the job roles of waste collection and disposal. This study found that citizens’ wrongful perception and disregard for the important job role of DWCs in supporting the collection and disposal of waste influences how citizens support Municipal city authorities to manage what waste is generated and disposed of. This wrongful perception by citizens of who “owns” waste or has the responsibility to “take care” of waste often leads to indiscriminate waste disposal, and the poor perception that waste could be disposed of everywhere, since DWCs are available to collect this waste. The stigmatization of DWCs may result in disrespect, isolation, harassment and invariably produces low work ethics and productivity, as recounted by some DWCs during interviews. This study advocates for broader social and legislative policies that ensure that citizens develop a sense of social responsibility in the collective management of waste. Specifically, Municipal authorities will need to develop behavior change communication (BCC) strategies that target improving citizens’ awareness of and support for collective waste management. There is also a need to develop legislative policies that prohibit indiscriminate waste disposal, and ensure support for DWCs’ and waste management companies’ continued roles in managing Municipal waste.
The findings from this study also point to the high expectations and demands from employers for DWCs to meet work schedules given the tons of waste generated in the city on a daily basis, despite the rudimentary manner in which waste is still collected across cities in Ghana. The volume of waste to be collected daily and the rudimentary daily routine of using tricycles and other low-tech equipment for collecting and disposing of waste was identified by DWCs as contributing to work-related stress and poor job satisfaction. Studies across many settings among waste workers corroborate our study finding on workloads and stress-related effects [42
]. There is also evidence to suggest that human resource practices and remuneration or wage policies are important determinants of job satisfaction [57
To address the concern about the volumes of waste generated and how these could be better managed at the household level, there is need for waste company managers and supervisors to provide ideal equipment and tools to assist DWCs in the effective and appropriate modern standard of solid waste management. This could minimize DWCs’ direct or indirect contact with solid waste to prevent the potential health-related risk of exposure to solid waste among DWCs. For DWCs to be satisfied with their job, there should be a timely and available supply of PPE, a flexible work schedule and reasonable demand of how their work is done to reduce excessive pressure on DWCs or workers, and regular payment of wages to prevent DWCs from using their scanty wages to purchase equipment for the work. There is a need for workplace policies that address flexible work schedule demands for DWCs such as the opportunity for leave breaks after a period of work, and conducive job schedule times based on individual needs and preferences. In addition, the workplace under which DWCs work must be comfortable enough for them to feel safe and enhance the conditions of work to meet their needs. This flexible work schedule could enable DWCs to meet their basic job requirements and personal responsibilities to help minimize stress related to their job schedules.