Towards Sustainable Healthcare Risk Waste Management in South Africa: A Systematic Review of Treatment Practices and Policy Gaps

Background: Effective treatment of healthcare risk waste (HCRW) is essential for preventing pathogen transmission, reducing toxic emissions, and protecting public and environmental health. South Africa faces a growing burden of HCRW driven by expanding healthcare services, population growth, and increased use of medical technologies. Methods: This systematic review critically examines governance frameworks, treatment technologies, and sustainability gaps in healthcare risk waste management in South Africa. The review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Searches were conducted in PubMed, Scopus, and Web of Science for studies published between 2014 and 2025. Eighteen studies met the inclusion criteria and were analysed using a qualitative and semi-quantitative synthesis approach. Results: The findings indicate persistent systemic weaknesses in healthcare risk waste management. Incineration remains the dominant treatment method, reported in 72% of the included studies, and is often associated with ageing infrastructure and environmental compliance concerns. Policy fragmentation and weak regulatory enforcement were identified in 67% of studies, while 61% reported training gaps among healthcare workers and waste handlers. Poor segregation practices and illegal dumping were also frequently documented. Only 22% of studies explicitly addressed sustainability or circular economy principles, highlighting a significant policy–practice gap. Conclusions: Healthcare risk waste management in South Africa is therefore constrained by fragmented governance, limited infrastructure, and insufficient integration of sustainable treatment technologies. Strengthening regulatory coordination, expanding non-burn treatment technologies, and embedding circular economy principles are critical to improving environmental performance and advancing Sustainable Development Goals 3 and 12.