Unpacking healthcare waste management at rural village health clinics in the Ntcheu District (Malawi) Madalitso Mmanga & Wales Singini & Veronica Di Bella & Mary Grace Flaherty & Rochelle H. Holm Received: 4 September 2018 /Accepted: 8 February 2019 /Published online: 20 February 2019 # Springer Nature Switzerland AG 2019 Abstract Management of healthcare waste in low- and middle-income countries lacks a straightforward solu- tion, especially where rural health services are provided. The purpose of our case study was to explore the knowledge and practices of health surveillance assis- tants operating at rural village health clinics in Ntcheu District, Malawi, with regard to the collection, segrega- tion, transportion, treatment, and disposal of healthcare waste. Data were collected from 81 clinics. The results indicated that while general gaps in both knowledge and practice were observed, sharps (e.g., needles) manage- ment was generally being done well. An opportunity for scale-up was found in one clinic, in which local mate- rials had been used to construct a low-cost innovative sharps disposal receptacle that had been modified from a pit latrine design. This study recommends waste man- agement training suitable for rural settings, the promo- tion of low-cost sharps disposal receptacles using local materials, further opportunities for low-cost incinera- tors, central waste collection, and encouraging grass- roots innovation in healthcare waste management. Keywords Government . Healthcare waste . Health clinic . Knowledge . Malawi . Rural . Sharps management Introduction Globally, only 15% of total healthcare waste generated is hazardous; this may include infectious waste, sharps, pharmaceuticals, or pathological waste, while the re- maining waste is general healthcare waste that does not pose biological, chemical, radioactive, or physical hazards (World Health Organization [WHO] 2017). In low- and middle-income countries, healthcare waste is a known challenge; it is reported that only 39% of healthcare facilities have appropriate storage of infec- tious waste, 61% have appropriate disposal of infectious waste, and 75% have appropriate storage areas for Environ Monit Assess (2019) 191: 175 https://doi.org/10.1007/s10661-019-7306-6 Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10661-019-7306-6) contains supplementary material, which is available to authorized users. M. Mmanga Department of Water Resources Management and Development, Mzuzu University, P/Bag 201, Mzuzu 2, Malawi M. Mmanga Ministry of Health, National TB Control Program, Mtunthama Drive, Area 3, P/Bag 65, Lilongwe, Malawi W. Singini Department of Fisheries, Mzuzu University, P/Bag 201, Mzuzu 2, Malawi V. Di Bella CDC Group plc, 123 Victoria Street, London SW1E 6DE, UK M. G. Flaherty School of Information and Library Science, University of North Carolina at Chapel Hill, 100 Manning Hall, Chapel Hill, NC 27599-3360, USA R. H. Holm (*) Centre of Excellence in Water and Sanitation, Mzuzu University, P/Bag 201, Mzuzu 2, Malawi e-mail: rochelle@rochelleholm.com