Policy gaps, actor dynamics, and implementation challenges in sustainable medical waste management in Bangladesh.

Sustainable solid waste management is crucial for development, contributing to public health, environmental protection, and economic stability. Effective practices reduce pollution, mitigate greenhouse gas emissions, and conserve resources through recycling and waste-to-energy innovations. In Bangladesh, medical waste management (MWM) is equally critical for healthcare delivery, playing a key role in safeguarding health, protecting the environment, and supporting economic growth. Despite its importance, MWM services in Bangladesh are underutilised, posing significant challenges. While literature highlights the importance of effective MWM in low-income countries and its impact on public health and the environment, it often lacks a socio-economic or institutional perspective on policy issues. This study explores Bangladesh's MWM capacity through a qualitative approach, analysing policy documents, interviewing Key Informants (KIs) from various organisations, and observing healthcare establishments (HCEs). Using Walt and Gilson's Policy Triangle Framework (1994), it identifies the strengths and weaknesses of current policies and practices and comes up with recommendations for sustainable practice interventions. Document analysis reveals that Bangladesh introduced a MWM policy in 2008, several decades after its independence. While the policy outlined the characteristics of medical waste, introduced the use of colour-coded bins for segregation, and defined the roles and responsibilities of government and non-government authorities, it failed to address the associated health and environmental risks comprehensively. Moreover, the policy has not been reviewed or updated in alignment with the WHO's 2018 guidelines. KIs reported poor collaboration and coordination among policy actors and unclear operation of MW committees at different government levels. Field observations indicated inadequate training, motivation, and ethics for waste handlers, a lack of public awareness, and no record-keeping of MW production and management. Urgent policy revisions, stakeholder collaboration, enhanced training, awareness programmes, and citizen empowerment and engagement are crucial for achieving sustainable MWM practices in wider community.