Green Laboratory Technologies and Waste Management in Healthcare Institutions of Low- and Middle-income Countries: A Critical Review of Sustainable Laboratory Practice

Clinical and public health laboratories occupy an ambiguous position within the environmental sustainability agenda. They consume energy, water, single-use plastics and hazardous reagents at intensities disproportionate to their physical footprint, and they generate waste whose infectious and chemical hazards constrain the reduction strategies available elsewhere in healthcare. The relevant literature has developed along two largely separate paths: a green laboratory literature originating in well-resourced research and clinical institutions of high-income countries, and a healthcare waste management literature centred on segregation failure, treatment infrastructure and occupational risk in developing and least-developed countries. This review examines whether the concepts, technologies and evidence generated in the first tradition can be defensibly transferred to the settings addressed by the second. Evidence was drawn from peer-reviewed publications identified through structured searching of accessible bibliographic databases and scholarly indexes, supplemented by citation searching and authoritative institutional guidance. The synthesis indicates that the descriptive evidence base on waste generation and management practice in low-resource settings is substantial but constrained by non-comparable denominators, reliance on modelled rather than measured generation rates, cross-sectional and self-reported designs, and pronounced geographical concentration. Evidence on green laboratory interventions derives almost entirely from high-income institutions and consists predominantly of single-site demonstrations without control conditions or sustained follow-up. Life-cycle and economic analyses are few, rarely replicated, and dependent on inventory assumptions that may not hold where open burning, informal recycling and intermittent electricity supply are common. Comparisons of treatment technologies frequently report disinfection efficacy against endpoints weaker than sporicidal validation and seldom account for residual leachate and exhaust burdens. The most defensible conclusion is that upstream demand reduction and segregation discipline are supported more consistently than technological substitution, and that the field requires context-specific effectiveness research rather than further descriptive audit.