Healthcare Waste Management in Low-Income Countries: Lessons from High-Income Models - A Comparative Analysis of Mozambique and Shanghai

Abstract

Healthcare waste management presents significant challenges in low-income countries, where inadequate systems and improper disposal methods threaten environmental integrity and public health. This study compares the healthcare waste management practices of Mozambique and Shanghai, highlighting the differences in waste classification, collection, and disposal. In many low-income settings, such as Mozambique, healthcare waste is poorly categorized into hazardous and non-hazardous types, resulting in substantial underreporting of hazardous materials. Despite existing legislation, ambiguities in the classification of infectious items lead to inefficiencies in waste sorting and treatment, often resulting in incineration practices that can release harmful pollutants. High-income countries typically generate more medical hazardous waste per hospital bed than their low-income counterparts. However, the consequences of mismanaged hazardous waste are more pronounced in less affluent nations due to weak infrastructure and regulation. Approximately 85% of healthcare-generated waste is deemed general and non-hazardous, while the remaining 15% includes potentially infectious or toxic materials. Healthcare professionals and the public face increased risks due to improper disposal methods, particularly concerning the handling of sharps and other medical waste. To address these issues, it is crucial to enhance awareness and educational initiatives among healthcare workers and the general populace. This comparative analysis aims to provide insights into effective healthcare waste management strategies, drawing lessons from high-income models to improve practices in lower-income settings and ultimately safeguard public health and the environment.

Introduction

Human activities generate significant waste, with waste management posing serious environmental and public health risks—especially in low-income countries like Mozambique. In these countries, waste collection is often inadequate, leading to improper disposal that spreads disease, worsens flooding, and harms ecosystems. Healthcare waste (HCW) in low-income regions is poorly classified and managed, increasing health hazards from infectious, toxic, and sharps waste. Despite producing less hazardous medical waste than high-income countries, low-income countries face greater risks due to insufficient infrastructure and waste management systems.

Mozambique struggles with weak healthcare infrastructure, poor waste segregation, illegal dumping, and reliance on incineration, which can release harmful pollutants like dioxins and mercury. The country also faces major infectious disease burdens (HIV/AIDS, malaria, tuberculosis) exacerbated by poor sanitation and water access. Its healthcare system is fragile and heavily dependent on international aid.

In contrast, Shanghai, China, as a high-income urban center, has developed advanced healthcare waste management technologies and strict regulations since the 1990s. It employs both incineration and non-incineration methods with environmental safeguards and has dedicated infection control teams in hospitals. China's regulatory framework has evolved through laws, standards, and strategic plans promoting safe, efficient HCW disposal.

The study compares Mozambique’s challenges with Shanghai’s successes, highlighting the need for improved infrastructure, regulation, education, and safer waste disposal methods in low-income settings.

Conclusion

The study highlights significant disparities in healthcare waste management (HCWM) between Mozambique, a low-income country, and Shanghai, a high-income urban center. Mozambique faces severe challenges due to inadequate infrastructure, poor waste segregation, and weak regulatory enforcement. The country’s reliance on unsafe incineration methods contributes to environmental pollution and public health risks, including the spread of infectious diseases such as HIV, malaria, and tuberculosis. In contrast, Shanghai has developed an advanced HCWM system characterized by centralized disposal facilities, strict regulations, and innovative non-incineration technologies. The presence of dedicated infection control teams and well-defined policy frameworks ensures efficient waste handling and minimizes health hazards. While both regions generate hazardous medical waste, Mozambique suffers disproportionately due to systemic weaknesses in its healthcare and waste management systems. The lack of proper disposal methods, coupled with insufficient funding and awareness, exacerbates the risks to both public health and the environment. On the other hand, China’s experience—particularly its post-SARS reforms—demonstrates how strong policies, technological investment, and regulatory enforcement can significantly improve HCW

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Copyright

Copyright © 2025 Percida Angelina Jose Gove, Ousman A. Bojang. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.