Assessing knowledge, performance, and efficiency for hospital waste management—a comparison of government and private hospitals in Pakistan Mustafa Ali & Wenping Wang & Nawaz Chaudhry & Yong Geng & Uzma Ashraf Received: 8 November 2016 /Accepted: 16 March 2017 # Springer International Publishing Switzerland 2017 Abstract Proper management of healthcare waste is a critical concern in many countries of the world. Rapid urbanization and population growth rates pose serious challenges to healthcare waste management infrastruc- ture in such countries. This study was aimed at assessing the situation of hospital waste management in a major city of Pakistan. Simple random sampling was used to select 12 government and private hospitals in the city. Field visits, physical measurements, and questionnaire survey method were used for data collection. Informa- tion was obtained regarding hospital waste generation, segregation, collection, storage, transportation, and dis- posal. Data envelopment analysis (DEA) was used to classify the hospitals on the basis of their relative waste management efficiencies. The weighted average total waste generation at the surveyed hospitals was discov- ered to be 1.53 kg/patient/day of which 75.15% consisted of general waste and the remaining consisted of biomedical waste. Of the total waste, 24.54% came from the public hospital and the remaining came from the private hospitals. DEA showed that seven of the surveyed hospitals had scale or pure technical inefficien- cies in their waste management activities. The public hospital was relatively less efficient than most of the private hospitals in these activities. Results of the ques- tionnaire survey showed that none of the surveyed hos- pitals was carrying out waste management in strict com- pliance with government regulations. Moreover, hospi- tal staff at all the surveyed hospitals had low level of knowledge regarding safe hospital waste management practices. The current situation should be rectified in order to avoid environmental and epidemiological risks. Keywords Waste management . Medical waste . Waste characterization . Efficiency . Data envelopment analysis Introduction Delivery of sound healthcare services is a challenge for many resource-constrained countries of the world. Pa- kistan is also such a country with a poverty head count ratio of 22.30% (Bank 2005) and where social health insurance covers only 5% of the population (Ahmed and Shaikh 2008). Thus, the people have to rely on private healthcare service providers. Some of these are support- ed by charitable institutions and hence provide an af- fordable alternative to public services. However, Paki- stan also has the highest rates of population growth and urbanization in the region (Murtaza Haider et al. 2014). Environ Monit Assess (2017) 189:181 DOI 10.1007/s10661-017-5903-9 Electronic supplementary material The online version of this article (doi:10.1007/s10661-017-5903-9) contains supplementary material, which is available to authorized users. M. Ali (*) : Y. Geng School of Environmental Science and Engineering, Shanghai Jiao Tong University, Shanghai 200240, China e-mail: aliseunanjing@gmail.com M. Ali : W. Wang Department of Management Science and Engineering, Southeast University, Nanjing, People’ s Republic of China N. Chaudhry : U. Ashraf College of Earth and Environmental Sciences, University of the Punjab, Lahore, Pakistan