Integrated life cycle assessment-systems thinking approach for medical waste management in Ghanaian hospitals

This study integrates life-cycle assessment (LCA) with systems-thinking to evaluate medical-waste treatment options in five Ghanaian hospitals (KBTH, KATH, CCTH, BRH, UCCH). Using a functional unit of 1 kg mixed hospital waste, inventories were modelled in Brightway2/biosphere3 and characterised with CML v4.8 across eight impact categories. We compared current practice and five improvement scenarios and ranked options via entropy-weighted TOPSIS. Autoclaving emerged as the optimal treatment method with a TOPSIS score of 0.994 (CI: 0.992–0.997), followed by pyrolysis (0.990) and microwave treatment (0.986), while incineration plus landfill performed worst across toxicity and climate indicators. Reductions reported herein are relative (%) changes versus the baseline scenario at each facility. Scenario analysis demonstrates that smaller facilities can achieve complete impact reductions (-100 %) across most environmental categories through improved segregation and technology adoption, while larger facilities show varied improvements ranging from −56.4 % to −84.8 % relative to the baseline. Sensitivity analysis indicated that incineration and landfill treatments are highly sensitive to waste composition and segregation efficiency. Systems-feedback analysis highlights waste-segregation efficiency and emission controls as dominant levers. Findings indicate that upgrading segregation to ≥ 80–95 % and deploying non-burn technologies can yield large relative reductions in human-toxicity and climate-change impacts, supporting Ghana’s policy goals. This combined LCA–systems framework provides a transparent, replicable decision basis for hospital and regional planners. This is the first Ghana-focused framework that integrates LCA, systems thinking, and MCDA to rank hospital waste-treatment choices under uncertainty, quantifying facility-specific, relative impact reductions. It operationalizes evidence into a replicable decision tool for Cleaner Production in LMIC health systems. Practical relevance: across five Ghanaian hospitals, pairing non-burn treatment with ≥ 80–95 % segregation delivers 56–100 % relative reductions in toxicity indicators and ∼75–89 % in climate-change impacts versus baseline. The integrated LCA–systems–MCDA tool is directly usable by hospital planners for Cleaner Production decisions. • Autoclaving demonstrates superior environmental performance compared to traditional incineration. • Facility size significantly influences potential environmental impact reductions from treatment methods. • Treatment efficacy shows strong dependence on waste segregation and technology selection. • Alternative treatment methods reduce environmental impacts by up to 100 % in smaller facilities. • Systems thinking reveal critical links between operational scale and environmental performance.