Healthcare Waste Management Practices and Facilitators and Barriers in Primary Healthcare Facilities: A Mixed‐Methods Study in Kathmandu, Nepal
Kripa Thapa Magar, Ganesh Bhandari, Kamal Ranabhat, Sujata ShakyaABSTRACT
Background and Aims
Effective healthcare waste management (HCWM) is crucial for preventing infection and protecting the environment. Primary healthcare facilities (HCFs) in low‐resource settings often demonstrate inadequate practices. This study assessed HCWM practices and explored facilitators and barriers to safe HCWM practices in the public primary healthcare facilities of Kathmandu District, Nepal, focusing on segregation, internal collection, storage, treatment, and disposal practices.
Methods
A cross‐sectional study using a concurrent triangulation mixed‐methods approach was conducted in public primary healthcare facilities under four local government units in Kathmandu District. For the quantitative component, 24 facilities were purposively selected. Data were collected through interviewer‐administered structured questionnaires with the HCWM focal person or facility in charge as well as through facility observations using the Minimum Service Standards (MSS) assessment tool. For the qualitative component, in‐depth interviews (IDIs) were conducted with focal persons or facility in‐charges from 11 facilities selected from the 24 using convenience sampling. HCWM practices were categorized based on MSS scores. Quantitative data were analyzed using descriptive and inferential statistics, while qualitative data were analyzed thematically using Braun and Clarke's framework.
Results
Overall, 70.8% of HCFs scored below 50% on MSS, indicating poor HCWM performance. While waste segregation at the source was high (95.8%), adherence to color‐coded bins and labeling was low (45.8% each). Sharp waste segregation was universal, but 37.5% reported unsafe safety box accumulation. Only 12.5% had autoclaves, and 83.3% disposed of infectious waste without prior treatment, and 70.8% disposed of infectious waste via municipal systems. Key barriers were limited space, inadequate training, weak supervision, and a lack of disposal mechanisms, whereas facilitators included staff awareness, designated handlers, MSS programs, and external support.
Conclusion
The findings highlight gaps in HCWM practices in primary HCFs. The results suggest that interventions such as centralized or on‐site treatment of hazardous waste, along with regular staff training and supervision, may help improve HCWM practices.