A Systematic Review of Health Care Waste Management Practices and their Impact on Environmental Performance in Developing Countries

Authors

  • Farwa Nisar M.Phil Scholar of Business Administration, The Superior University Lahore, Pakistan
  • Shaherbano Rizvi Master in Business Administration, Federal Urdu University for Arts Science & Technology, Karachi, Pakistan

DOI:

https://doi.org/10.47067/ramss.v8i2.516

Keywords:

Health Care Waste Management, Hospital Waste Management, Environmental Performance, Environmental Knowledge, Environmental Awareness, PRISMA, Thematic Analysis, Pakistan

Abstract

Health-care waste poses a significant threat to environmental sustainability and public health, necessitating effective waste management strategies. This study investigates the influence of Health Care Waste Management (HCWM) on Environmental Performance in Pakistan, with a specific focus on the role of employee knowledge in improving waste management practices. A systematic literature review was conducted using the PRISMA methodology, leading to the selection of 10 relevant studies. Through narrative synthesis and thematic analysis, the findings revealed that poor HCWM—such as inadequate segregation, weak regulatory enforcement, and improper disposal-contributes to severe environmental and health risks. Moreover, a lack of environmental knowledge among healthcare personnel often results in ineffective waste management systems. The study confirms a significant relationship between HCWM and environmental performance, highlighting that better staff understanding of HCWM leads to improved outcomes. However, the study is limited by its reliance on secondary data, a narrow scope, and the absence of quantitative analysis. Future research should adopt a longitudinal design with broader scope and include quantitative methods for more robust insights.

References

Agrawal, S., Oza, P., Kakkar, R., Tanwar, S., Jetani, V., Undhad, J. and Singh, A. (2024) ‘Analysis and recommendation system-based on PRISMA checklist to write systematic review’, Assessing Writing, 61, pp. 100866. https://doi.org/10.1016/j.asw.2024.100866

Akkajit, P., Romin, H. and Assawadithalerd, M. (2020) ‘Assessment of knowledge, attitude, and practice in respect of medical waste management among healthcare workers in clinics’, Journal of environmental and public health, 2020(1), pp. 8745472.

Alboliteeh, M., Alrashidi, M. S., Alrashedi, N., Gonzales, A., Mostoles, R. J., Pasay-an, E. and Dator, W. L. (2022). Knowledge management and sustainability performance of hospital organisations: the healthcare managers’ perspective. Sustainability, 15(1), 203. https://doi.org/10.3390/su15010203

Ali, M., Wang, W., Chaudhry, N., Geng, Y. and Ashraf, U. (2017) ‘Assessing knowledge, performance, and efficiency for hospital waste management—a comparison of government and private hospitals in Pakistan’, Environmental monitoring and assessment, 189, pp. 1-9. https://doi.org/10.1007/s10661-017-5903-9

Ali, S., Mahmood, U., Malik, A. U., Aziz, F., Naghman, R. B. and Ahmed, I. (2015) ‘Current hospital waste management practices in Pakistan: case study and curative measures’, Public Health Prevent Med, 1(3), p. 125-9.

Ashtari, A., Tabrizi, J. S., Rezapour, R., Maleki, M. R. and Azami-Aghdash, S. (2020) ‘Health care waste management improvement interventions specifications and results: a systematic review and meta-analysis’, Iranian journal of public health, 49(9), pp. 1611. doi: 10.18502/ijph.v49i9.4074

Aslam, N., Javaid, H., Munir, M. W., Sultan, A., Sanaullah, A., Fatima, N. and Rafique, M. N. (2025) ‘KNOWLEDGE, ATTITUDE AND PRACTICES ABOUT HOSPITAL WASTE MANAGEMENT AMONG RURAL AND URBAN HEALTH CARE WORKERS’, The Research of Medical Science Review, 3(1), pp. 1463-1477.

Association, A. P. H. (2023) ‘Advancing environmental health and justice: a call for assessment and oversight of health care waste.(APHA Policy Statement Number 20224, Adopted November 2022)’, NEW SOLUTIONS: A Journal of Environmental and Occupational Health Policy, 33(1), pp. 51-59.

Azeem, N., Arslan, C. H., Rashid, H. and Sattar, A. (2018) ‘Comparative study of hospital waste management practices at different health care units in district Faisalabad for the development of improvement strategies’, Earth Sciences Pakistan, 2(2), pp. 16-21. http://doi.org/10.26480/esp.02.2018.16-21

Baaki, T. K., Baharum, M. R. and Ali, A. S. (2019) ‘Determining a conceptual framework for safe and sustainable health-care waste management (SSHCWM) implementation in health-care facilities’, Journal of Facilities Management, 17(1), pp. 40-56. https://doi.org/10.1108/JFM-11-2017-0059

Bashir, B., Zareen, H., Shah, S. H. and Shah, S. (2024) ‘An Investigation of Waste Management Practices in Pakistan: A Case of Ayub Teaching Hospital Abbottabad’,

Bennett, M. and James, P. (2017) ‘ISO 14031 and the future of environmental performance evaluation’, In Sustainable Measures, pp. 76-97. Routledge.

Blass, A. P., da Costa, S. E. G., de Lima, E. P. and Borges, L. A. (2017) ‘Measuring environmental performance in hospitals: A practical approach’, Journal of cleaner production, 142, pp. 279-289.

Chaudhary, M. N., Ahmad, S. R. and Asim, R. M. (2023) ‘Perception of Health Care Workers About Medical Waste Management Based on KAP Analysis. A Case Study of Tertiary Care Hospital Lahore, Pakistan’, Pakistan Journal of Scientific & Industrial Research Series A: Physical Sciences, 66(3), pp. 234-243.

Conti, A., Viottini, E., Comoretto, R. I., Piovan, C., Martin, B., Albanesi, B. and Campagna, S. (2024) ‘The effectiveness of Educational interventions in improving waste management knowledge, attitudes, and practices among healthcare workers: a systematic review and meta-analysis’, Sustainability, 16(9), pp. 3513.

Cozendey-Silva, E. N., da Silva, C. R., Larentis, A. L., Wasserman, J. C., Rozemberg, B. and Teixeira, L. R. (2016) ‘Cross-cultural adaptation of an environmental health measurement instrument: Brazilian version of the health-care waste management• rapid assessment tool’, BMC public health, 16, pp. 1-12. https://doi.org/10.1186/s12889-016-3618-4

Doylo, T., Alemayehu, T. and Baraki, N. (2019) ‘Knowledge and practice of health workers about healthcare waste management in public health facilities in Eastern Ethiopia’, Journal of community health, 44, pp. 284-291.

Dri, M., Canfora, P., Antonopoulos, I. S. and Gaudillat, P. (2018) ‘Best environmental management practice for the waste management sector’, JRC Science for Policy Report. jrc111059_bemp_waste_2018_final_04_2. pdf.

Ezirim, I., & Agbo, F. (2018). Role of national policy in improving health care waste management in Nigeria. Journal of Health and pollution, 8(19), 180913.

Franzosi, F., Teresinha-Kist, L., Ribas-Moraes, J. A. and Machado, Ê. L. (2018) ‘Diagnosis of the health care waste management system of hospitals in the west of Santa Catarina State-Brazil’, Producción+ Limpia, 13(1), pp. 54-64.

Fuzi, M. Y. A., Yatim, S. R. M., Dom, N. C., Ilias, K., & Asfiradayati, R. (2025). Factors Influencing Healthcare Waste Management Effectiveness: Challenges and Interventions. Environment-Behaviour Proceedings Journal, 10(31), 197-203.

GHASEMI, M. K. (2018) ‘DEVELOPMENT OF A SUSTAINABLE HEALTHCARE WASTE MANAGEMENT MODEL USING HYBRID MULTIPLE DECISION MAKING MODEL’.

Hamed, A. E. M., Sefouhi, L., Ibrahim, M. I. T., Attia, A. S., Barakat, A. M. and Elsayed, E. E. (2025) ‘From knowledge to impact: revolutionizing nursing practices in biomedical waste management for sustainable healthcare excellence’, BMC nursing, 24(1), pp. 469. https://doi.org/10.1186/s12912-025-03073-1

Hasan, M. M. and Rahman, M. H. (2018) ‘Assessment of healthcare waste management paradigms and its suitable treatment alternative: a case study’, Journal of environmental and public health, 2018(1), pp. 6879751. https://doi.org/10.1155/2018/6879751

Hassan, A. B., Zia, M. H. and Khawaja, A. B. (2020) ‘Knowledge, attitude and practices regarding biomedical waste management among health care professionals of private sector hospitals in Pakistan’, International journal of business and economic affairs, 5(6), pp. 272-280.

Hosny, G., Samir, S. and El-Sharkawy, R. (2018) ‘An intervention significantly improve medical waste handling and management: A consequence of raising knowledge and practical skills of health care workers’, International journal of health sciences, 12(4), pp. 56.

Islam, M. M. (2023) The Management of Medical Waste in Bangladesh: A Policy and Practices Analysis (Doctoral dissertation, Doctoral dissertation, Teesside University, UK).

Janik-Karpinska, E., Brancaleoni, R., Niemcewicz, M., Wojtas, W., Foco, M., Podogrocki, M. and Bijak, M. (2023, January) ‘Healthcare waste—a serious problem for global health’, In Healthcare, 11(2), pp. 242. MDPI. https://doi.org/10.3390/healthcare11020242

Kenny, C. and Priyadarshini, A. (2021, March) ‘Review of current healthcare waste management methods and their effect on global health’, In Healthcare, 9(3), pp. 284. MDPI. https://doi.org/10.3390/healthcare9030284

Khan, B. A., Cheng, L., Khan, A. A. and Ahmed, H. (2019) ‘Healthcare waste management in Asian developing countries: A mini review’, Waste management & research, 37(9), pp. 863-875. https://doi.org/10.1177/0734242X19857470

Khan, B. A., Khan, A. A., Ahmed, H., Shaikh, S. S., Peng, Z. and Cheng, L. (2019) ‘A study on small clinics waste management practice, rules, staff knowledge, and motivating factor in a rapidly urbanizing area’, International journal of environmental research and public health, 16(20), pp. 4044.

Khobragade, D. S. (2019) ‘Health care waste: Avoiding hazards to living and non living environment by efficient management’, Fortune Journal of Health Sciences, 2(2), pp. 14-29.

Kimuyu, J. M. (2021). Evaluation of Compliance to the National Health Care Waste Management Guidelines of 2008 by Health Facilities in Machakos Sub County, Kenya (Doctoral dissertation, UON).

Kumar, R., Somrongthong, R., Ahmed, J. and Almarabheh, A. J. (2018) ‘Correlates of knowledge, attitude and practices about health care waste management among hospital workers of Pakistan’, Journal of Liaquat University of Medical & Health Sciences, 17(01), pp. 01-07.

Largan, C. and Morris, T. M. (2019) ‘Qualitative secondary research: A step-by-step guide’.

Leonard, C. M., Chunga, C. C., Nkaama, J. M., Banda, K., Mibenge, C., Chalwe, V. and Mwale, F. K. (2022) ‘Knowledge, attitudes, and practices of health care waste management among Zambian health care workers’, PLOS Global Public Health, 2(6), pp. e0000655. https://doi.org/10.1371/journal.pgph.0000655

Maeda, Y., Caskurlu, S., Kozan, K. and Kenney, R. H. (2023) ‘Development of a critical appraisal tool for assessing the reporting quality of qualitative studies: a worked example’, Quality & Quantity, 57(2), pp. 1011-1031. https://doi.org/10.1007/s11135-022-01403-y

Mishra, S. S., Muduli, K., Dash, M., Parida, U. C. and Pumwa, J. (2018) ‘When sustainable development matters in health care supply chain: An analysis of influential factors of waste management’, Indian Journal of Public Health Research & Development, 9(12), pp. 229-236. DOI: 10.5958/0976-5506.2018.01838.7

Mol, M. P. G., Zolnikov, T. R., Neves, A. C., Dos Santos, G. R., Tolentino, J. L. L., de Vasconcelos Barros, R. T. and Heller, L. (2022) ‘Healthcare waste generation in hospitals per continent: a systematic review’, Environmental Science and Pollution Research, 29(28), pp. 42466-42475. https://doi.org/10.1007/s11356-022-19995-1

Mukhtar, S., Khan, H., Kiani, Z., Nawaz, S., Zulfiqar, S. and Tabassum, N. (2018) ‘Hospital waste management: execution in Pakistan and environmental concerns—a review’, Environ Contam Rev, 1(1), pp. 18-23. http://doi.org/10.26480/ecr.01.2018.18.23

Ntloana, S. (2021) Health Care Waste Management Knowledge and Practices in Chris Hani Baragwanath Academic Hospital, South Africa. University of Johannesburg (South Africa).

Nwachukwu, N. C., Orji, F. A. and Ugbogu, O. C. (2013) ‘Health care waste management–public health benefits, and the need for effective environmental regulatory surveillance in federal Republic of Nigeria’, Current topics in public health, 2, pp. 149-178.

Okweso, J. A. (2016) ‘Report on the review of the Kenya national guidelines for safe management of health care waste, injection safety and safe disposal of medical waste national communication strategy and health care waste management standard operating procedures’, Nairobi: Ministry of Environment and Natural Resources, pp. 1-181.

Olaifa, A., Govender, R. D. and Ross, A. J. (2018) ‘Knowledge, attitudes and practices of healthcare workers about healthcare waste management at a district hospital in KwaZulu-Natal’, South African Family Practice, 60(5), pp. 137-145.

Padder, A. H. (2019) ‘Healthcare waste management’, Int. J. Trend Sci. Res. Dev, 3, pp. 908-911.

Padmanabhan, K. K. and Barik, D. (2019) ‘Health hazards of medical waste and its disposal’, In Energy from toxic organic waste for heat and power generation, pp. 99-118. Woodhead Publishing. https://doi.org/10.1016/B978-0-08-102528-4.00008-0

Qamar, A. U., Faridi, T. A., Moazzam, M., Fatima, W., Hassan, S. B., Khan, M. A. and Gilani, S. A. (2021) ‘Performance Evaluation of Waste Management Practices at DHQ Hospital Sheikhupura’, Pakistan BioMedical Journal, 4(2), pp. 251-257. https://doi.org/10.54393/pbmj.v4i2.146

Qassim, A. A. (2024) ‘Exploring the Influence of Green Human Resource Management (GHRM) Practices on Employees’ Pro-Environmental Behaviours in Egyptian Hospitals’.

Quttainah, M. A. and Singh, P. (2024) ‘Barriers to Sustainable Healthcare Waste Management: A Grey Method Approach for Barrier Ranking’, Sustainability, 16(24), pp. 11285.

Reinhardt, P. A. (2018) Infectious and medical waste management. CRC Press.

Riaz, A., Ajaib, F. M., Abbas, R. Z., Hameed, K. and Mariam, T. (2022) ‘Comparative Assessment of Awareness, Knowledge, Attitude and Practices of Health Care Waste Management among Paramedical Staff: Findings from Lahore, Pakistan’.

Robat, D. S., Sany, S. B. T., Siuki, H. A., Peyman, N. and Ferns, G. (2022) ‘Impact of an educational training on behavioral intention for healthcare waste management: application of health action model’, Community Health Equity Research & Policy, 42(3), pp. 299-307.

Ruoyan, G., Lingzhong, X., Huijuan, L., Chengchao, Z., Jiangjiang, H., Yoshihisa, S. and Chushi, K. (2010) ‘Investigation of health care waste management in Binzhou District, China’, Waste management, 30(2), pp. 246-250.

Shakoor, A., Arif, M. ., Akhtar, N. ., Khalil, M. Z. and Pasha, S. (2024) ‘Quantitative and Qualitative Assessment of Hospital Waste Management at Capital’s Health Care Facility, Pakistan’, Bulletin of Business and Economics (BBE), 13(1). https://doi.org/10.61506/01.00210

Shehzad, S. (2018) ‘HOSPITAL WASTE MANAGEMENT-A GROWING HEALTH CONCERN’, Journal of Gandhara Medical & Dental Sciences (JGMDS), 4(2), pp. 1-2.

Sherman, J. D. and Singh, H. (2023) ‘Bringing environmental sustainability into the quality agenda: time to act on reducing health care pollution and waste’, Joint Commission Journal on Quality and Patient Safety, 49(6), pp. 336-339.

Silva, T., Santos, Â. R. S., Maciel, R., Santos, S. M. and Florencio, L. (2024) ‘Use of the value-focused thinking methodology to understand health care waste management under the perspective of occupational and environmental health’, Journal of Cleaner Production, 479, pp. 144036. https://doi.org/10.1016/j.jclepro.2024.144036

Singh, A., Singh, A. and Maurya, N. K. (2019) ‘Health-care waste management’, Int J Sci Res Rev, 16(6), pp. 1060.

Tessema, D. H., Yesilada, F. and Aghaei, I. (2025) ‘Enhancing pro-environmental behavior through green human resource management practices: evidence from Ethiopian private hospitals’, Journal of Health Organization and Management.

Thakur, V., Mangla, S. K. and Tiwari, B. (2021) ‘Managing healthcare waste for sustainable environmental development: A hybrid decision approach’, Business Strategy and the Environment, 30(1), pp. 357-373. https://doi.org/10.1002/bse.2625

Tseng, M. L., Ardaniah, V., Bui, T. D., Lim, M. K. and Ali, M. H. (2022) ‘Sustainable waste management in the Indonesian medical and health-care industry: technological performance on environmental impacts and occupational safety’, Management of Environmental Quality: An International Journal, 33(2), pp. 549-569. https://doi.org/10.1108/MEQ-07-2021-0160

Waqqar, S., Sheikh, S. H., Issac, A., Hanook, S., Azhar, H. and Ansari, F. (2016) ‘Health care waste management workers in pakistan: a population presenting highest burden of hepatitis B and hepatitis C.’, IOSR J Dent Med Sci, 1, pp. 55-61.

Downloads

Published

2025-06-18

How to Cite

Nisar, F., & Rizvi, S. . (2025). A Systematic Review of Health Care Waste Management Practices and their Impact on Environmental Performance in Developing Countries. Review of Applied Management and Social Sciences, 8(2), 785-804. https://doi.org/10.47067/ramss.v8i2.516