Assessing the levels of utilisation of WHO-recommended healthcare waste disposal practices at healthcare service delivery points in Uganda

Inadequate healthcare waste management (HCWM) poses substantial challenges to public health, environmental sustainability and community wellbeing. Safe healthcare waste disposal practices (HWDP) at healthcare facilities are essential to protect staff, patients, caregivers, and the wider public. Achieving this requires consistent use of appropriate final waste disposal practices at each healthcare facility. This study assessed the level of utilisation of World Health Organisation (WHO) - recommended healthcare waste disposal practices at healthcare service delivery points (HSDP) in Uganda. A cross-sectional survey was conducted among 681 randomly selected HSDP from 15 sub-regions of Uganda between September and December 2023. Facilities were categorised into primary, secondary and tertiary levels. The sample was drawn from a national sampling frame of 6,929 HSDP reported through the District Health Information System platform in 2020. At each HSDP, the study assessed the extent to which WHO-recommended HWDP were utilised. Findings showed that over 70% of the surveyed HSDP utilised WHO non-recommended HWDP such as on-site burning, burial, and disposal with general waste. Among primary-level facilities, 30.2% disposed of healthcare waste with regular garbage, 17.3% burnt the waste, and 24.3% buried it within facility grounds. In contrast, 31.7% of secondary-level facilities reported using centralised collection services by specialised agencies. Over half of tertiary facilities (58.3%) disposed of waste with regular garbage, while only 12.5% used incinerators. Regional differences were evident, with disposal alongside general garbage particularly high in Kampala (92.7%) compared to Karamoja (5.3%). Urban HSDP were also more likely to use this method (59.4%) than rural facilities (19.5%). Overall, the nation-wide assessment presents critical gaps in the availability and utilization of WHO-recommended healthcare waste disposal practices across HSDP levels, management types, residence settings, and regions. Addressing these gaps requires targeted interventions, including strengthening guideline enforcement, improving infrastructure, and enhancing compliance with healthcare waste management regulations.