Determinants of access to waste management services in healthcare facilities in 14 low- and middle-income countries

Healthcare waste management is crucial in preventing infections and injuries. However, only an estimated 31% of healthcare facilities in least-developed countries had basic waste management in 2023. We employed multilevel modelling to assess healthcare facility-level and country-level predictors of 6 elements of safe waste management (e.g. having a functional incinerator, having bins for waste segregation) across 2002 healthcare facilities in 14 countries. Eight percent (<i>n</i> = 154) of the surveyed facilities had basic waste management. Facilities with working electricity had higher odds of having a functional waste incinerator (odds ratio (OR): 1.26, <i>p</i> < 0.01), bins for safe waste segregation (OR: 1.28, <i>p</i> = 0.02), and proper sharps waste disposal (OR: 1.48, <i>p</i> < 0.01). Facilities that followed protocols for operations and maintenance had higher odds of having a functional waste incinerator (OR: 1.26, <i>p</i> <i><</i> 0.01) and proper disposal of infectious waste (OR: 1.34, <i>p</i> <i><</i> 0.01). At the country level, a higher water, sanitation and hygiene budget as a proportion of GDP was associated with higher average odds of having a functional waste incinerator (OR: 1.17, <i>p</i> <i><</i> 0.01), proper infectious waste disposal (OR: 1.12, <i>p</i> <i><</i> 0.01) and adequate sharps waste disposal (OR: 1.12, <i>p</i> <i><</i> 0.01). Findings underscore the importance of multi-tiered approaches in enhancing healthcare waste management. Strengthening management and operations and maintenance at the healthcare facility level and creating and financing national healthcare waste policies may support healthcare waste management practices.