Impact Statement
Medical waste management in Bangladesh sits at the intersection of two imperatives that are too often treated as separate: protecting human health and protecting the environment. The evidence suggests that moving toward a circular model requires more than installing treatment technologies or expanding physical infrastructure. It begins much earlier with how waste is segregated, handled, and understood by the people who encounter it every day. Workforce competence, institutional coordination, and regulatory oversight therefore become as important as the technologies themselves. Within this broader system, reduction, safe reuse, and recycling offer practical pathways for moving beyond a disposal-oriented model. When embedded within routine healthcare operations, these practices can reduce unnecessary disposal, recover materials that would otherwise be lost, and improve the efficiency with which limited resources are used, without compromising infection control or patient safety. The transition, however, depends on the organizational conditions that allow such practices to become routine rather than exceptional. For healthcare organizations and policymakers, the direction is therefore relatively clear: strengthen segregation at the point of generation, build workforce capability, improve treatment and recycling infrastructure, and establish stronger mechanisms for coordination and monitoring. Such measures do not require environmental protection to be pursued at the expense of public health. Rather, they point toward a model in which safer healthcare, more efficient resource use, and environmental responsibility reinforce one another. In resource-constrained settings, circularity need not begin with technological abundance; it can begin with better decisions about what is generated, how it is handled, and what is ultimately allowed to become waste.
1. Introduction
Medical waste management has become a critical global environmental and public health challenge due to the rapid expansion of healthcare services, urbanization, population growth, and increasing consumption of disposable medical products. Healthcare facilities generate a wide range of hazardous and non-hazardous wastes, including infectious materials, sharps, pharmaceuticals, and chemical residues that require safe segregation, treatment, and disposal to prevent adverse impacts on human health and the environment [Reference Nematollahi, Tuysserkani and Nematollahi1]. Inadequate medical waste management increases the risks of occupational exposure among healthcare workers, contaminates soil, water, and air, and contributes to greenhouse gas emissions and ecosystem degradation [Reference Thiagarajan, Yuvarajan and Channappagoudra2]. These challenges have become more pronounced following the COVID-19 pandemic, which significantly increased the volume of disposable personal protective equipment (PPE), syringes, masks, and testing materials worldwide [Reference Al Asmar, Khafaoui and Châtelet3,Reference Jakimiuk, Koda and Goli4].
Bangladesh faces particularly acute challenges in managing medical waste because of its rapidly expanding healthcare infrastructure and increasing patient demand. The Health Services Division has introduced several initiatives to improve healthcare waste management, while the Medical Waste (Management and Processing) Rules, 2008, and the Hospital Services Management Guidelines from 2016 provide the country’s primary regulatory framework [Reference Ahmed, Noman, Hasan and Ahmed5,Reference Dihan, Nayeem and Roy6]. Despite these policy efforts, implementation remains inconsistent due to inadequate infrastructure, insufficient financial resources, weak institutional monitoring, and limited training among healthcare personnel and waste handlers [Reference Ahmad, Pervin and Md Hossain7,Reference Islam, Zaman, Ferdous and Sarker8]. Consequently, infectious and hazardous wastes are frequently mixed with municipal solid waste, creating substantial environmental and occupational risks while reducing opportunities for resource recovery.
The persistence of these problems reflects the continued dominance of a linear “take-make-dispose” model of healthcare waste management that prioritizes disposal rather than resource efficiency. Such an approach not only accelerates environmental degradation but also overlooks the economic and environmental value embedded in recoverable healthcare materials [Reference Vederhus, Saha and Nath9]. In contrast, the circular economy (CE) promotes a regenerative system that minimizes waste generation, extends product life cycles, and recovers valuable resources through the principles of Reduce, Reuse, and Recycle (3R) [Reference Patwa, Sivarajah and Seetharaman10]. The 3R approach has increasingly been recognized as an effective strategy for improving resource efficiency, reducing environmental pollution, and supporting sustainable healthcare systems by transforming waste from an environmental burden into a valuable resource [Reference Ismail, Zhongdong and Waheed11].
Although medical waste management has attracted considerable scholarly attention, important gaps remain in the existing literature. From a theoretical perspective, previous studies have largely emphasized waste generation, disposal technologies, regulatory compliance, and environmental risks, while limited attention has been given to applying the CE as an integrated theoretical framework for understanding sustainable healthcare waste management [Reference Alfina, Ratnayake, Wibisono, Mulyono and Basri12–Reference Asperti, Foglia, Petruzzelli and Urbinati14]. Consequently, the transformative role of the 3R approach in shifting healthcare systems from a linear to a circular model remains insufficiently explored.
From a contextual perspective, empirical evidence from Bangladesh remains relatively limited despite the unique institutional, regulatory, and socioeconomic conditions of the country [Reference Al Asmar, Khafaoui and Châtelet3,Reference Ahmad, Pervin and Md Hossain7]. Existing findings from developed countries cannot be readily generalized because healthcare infrastructure, waste collection systems, regulatory enforcement, and resource availability differ substantially across contexts [Reference Chew, Khaw and Alnoor15,Reference Menekşe and Akdağ16]. Understanding how CE principles can be operationalized within the healthcare system of Bangladesh therefore represents an important research need.
From a methodological perspective, most previous studies have relied predominantly on quantitative waste estimation, environmental assessments, or policy evaluations, providing limited insight into the experiences and perceptions of frontline healthcare stakeholders who directly generate, segregate, transport, and manage medical waste. Qualitative evidence capable of explaining institutional barriers, behavioral challenges, and practical opportunities for implementing the 3R approach remains scarce, particularly in developing-country settings.
Addressing these theoretical, contextual, and methodological gaps is particularly important in light of the United Nations 2050 Agenda for Sustainable Development. Sustainable medical waste management contributes directly to Sustainable Development Goal (SDG) 3 (Good Health and Well-being), SDG 12 (Responsible Consumption and Production), and SDG 13 (Climate Action) by reducing pollution, improving healthcare safety, promoting efficient resource utilization, and mitigating environmental impacts. Integrating CE principles into healthcare waste management therefore offers an opportunity to simultaneously strengthen public health protection, environmental sustainability, and economic resilience.
Accordingly, this research aims to explore how the 3R approach can enhance sustainable medical waste management in Bangladesh through the lens of CE principles. Specifically, the study seeks to (1) examine existing medical waste management practices and associated challenges in healthcare facilities; (2) identify opportunities and barriers for implementing 3R strategies; (3) explore healthcare perceptions of the stakeholders regarding circular medical waste management; and (4) develop practical policy recommendations for improving sustainable healthcare waste management in alignment with the SDGs.
To achieve these objectives, the study addresses the following research questions: (RQ1) What challenges characterize current medical waste management practices in healthcare facilities of Bangladesh? (RQ2) How can the 3R approach improve the sustainability of healthcare waste management? (RQ3) What institutional, technical, and behavioral barriers influence the implementation of CE practices in healthcare facilities? and (RQ4) What policy interventions can facilitate the transition toward sustainable and circular medical waste management in Bangladesh?
This study contributes to the existing literature in four important ways. First, it extends CE theory to the underexplored context of healthcare waste management in Bangladesh. Second, it applies the 3R framework as a comprehensive analytical lens for examining sustainable healthcare waste management practices. Third, unlike most previous studies that primarily employ quantitative approaches, this research adopts a qualitative methodology to capture the lived experiences and perceptions of healthcare professionals, administrators, cleaners, and waste handlers who are directly involved in waste management operations. Finally, by integrating CE principles with the SDGs, this study provides evidence-based policy recommendations that support the development of more sustainable, resilient, and resource-efficient healthcare waste management systems in Bangladesh and other developing economies.
The remainder of this article is organized as follows. Section 2 presents the literature review, covering the theoretical foundation of CE theory and the 3R mechanisms, medical waste typologies and their role in circular resource recovery, regulatory frameworks for sustainable medical waste management, global and Bangladeshi evidence on 3R-based medical waste management, and the identified literature gap. Section 3 describes the participants, research approaches, and sampling strategy. Section 4 presents the thematic analysis, beginning with medical waste management as an integrated system and examining reduction, reuse, and recycling practices. Section 5 discusses the findings in relation to the existing literature and CE theory. Section 6 outlines the theoretical, practical, and policy implications of the study. Section 7 highlights the study’s limitations and proposes directions for future research. Finally, Section 8 concludes the article by summarizing the key findings and contributions.
2. Literature Review
2.1. Theoretical Foundation: Circular Economy Theory and the 3R Mechanisms
Circular economy theory provides a comprehensive theoretical foundation for understanding sustainable medical waste management by redefining waste as a valuable resource rather than an unavoidable by-product of healthcare activities. Unlike the traditional linear economic model of “take-make-dispose,” CE advocates restorative and regenerative systems that minimize resource extraction, extend product lifecycles, and recover material value through closed-loop resource flows [Reference Geissdoerfer, Savaget, Bocken and Hultink17]. Within healthcare systems, where increasing volumes of hazardous and non-hazardous waste pose serious environmental and public health risks, CE offers an integrated framework that aligns environmental protection with resource efficiency and sustainable development. Rather than focusing solely on end-of-pipe disposal, the theory emphasizes redesigning waste management systems to prevent waste generation, maximize material recovery, and promote long-term environmental resilience [Reference Kirchherr, Reike and Hekkert18,Reference Morseletto19].
The operational core of CE in healthcare is embodied in the 3R hierarchy – Reduce, Reuse, and Recycle – which functions as the primary mechanism through which circularity is achieved. The reduction principle seeks to minimize waste generation at its source through sustainable procurement, improved inventory management, digital healthcare systems, and optimized clinical practices. Reuse extends the functional life of medical products through sterilization, remanufacturing, and safe reprocessing technologies, thereby reducing demand for virgin materials and lowering disposal volumes. Recycling, the final mechanism, enables non-hazardous materials such as plastics, glass, metals, and paper to re-enter production systems after appropriate segregation and treatment, transforming waste into secondary resources while reducing landfill dependence and greenhouse gas emissions [Reference Shah, Anuar and Panizan20–Reference Sepetis and Parlavantzas22]. Collectively, these mechanisms create closed-loop material cycles that improve resource productivity while minimizing environmental degradation.
Although the relevance of CE to healthcare waste management has gained increasing scholarly attention, existing studies have largely adopted the framework descriptively, focusing on policy recommendations, recycling initiatives, or waste treatment technologies without adequately explaining the mechanisms through which CE principles generate sustainable outcomes, particularly in resource-constrained healthcare systems. Recent studies in Bangladesh have acknowledged the importance of CE concepts for healthcare waste management [Reference Dihan, Nayeem and Roy6,Reference Ahmad, Pervin and Md Hossain7,Reference Islam, Zaman, Ferdous and Sarker8]; however, they primarily emphasize policy implementation and technical waste management practices rather than providing a theoretically integrated explanation of how the complete 3R hierarchy facilitates environmental sustainability, resource efficiency, and institutional resilience. Consequently, important questions remain regarding how CE principles can be operationalized within healthcare institutions facing infrastructural limitations, weak regulatory enforcement, and financial constraints.
Drawing on CE theory, the 3R framework is conceptualized here as an interconnected system rather than three isolated waste management practices. It argues that effective waste reduction improves segregation efficiency, which subsequently enhances opportunities for safe reuse and high-quality recycling, ultimately creating a circular healthcare waste management system that generates environmental, economic, and public health benefits [Reference Kihila, Wernsted and Kaseva23]. By examining these interdependent mechanisms within the context of Bangladesh, this extends the application of CE theory beyond its predominant focus on industrial production and manufacturing to healthcare waste management in developing economies. In doing so, it contributes to the growing CE literature by demonstrating how circular principles can be translated into practical strategies for sustainable medical waste governance under institutional and resource constraints.
2.2. Medical Waste Typologies and Their Role in Circular Resource Recovery
Effective medical waste management begins with a comprehensive understanding of waste typologies, as the classification of healthcare waste determines appropriate handling, treatment, and resource recovery pathways. The World Health Organization classifies healthcare waste into hazardous and non-hazardous categories, including infectious, pathological, pharmaceutical, chemical, radioactive, sharps, and general waste, each requiring distinct management strategies [Reference Nematollahi, Tuysserkani and Nematollahi1]. Accurate waste typology not only minimizes health and environmental risks but also forms the foundation for implementing CE principles by enabling efficient segregation, material recovery, and recycling [Reference Aslan, Salman, Konakci and Akan24]. Within the CE framework, waste is no longer regarded solely as an end product requiring disposal but as a potential secondary resource that can be reintroduced into productive systems through appropriate recovery processes [Reference Das, Hossain and Khan25].
The existing literature consistently recognizes source segregation as the most critical prerequisite for successful circular resource recovery in healthcare facilities. Proper classification allows recyclable materials, such as uncontaminated plastics, glass, paper, and selected metals, to be separated from hazardous waste streams, thereby reducing unnecessary incineration and increasing opportunities for recycling and reuse [Reference Asperti, Foglia, Petruzzelli and Urbinati14]. Jaipakdee et al. [Reference Jaipakdee, Vibhatabandhu, Vitayavarawat and Supakata26] argued that waste typology serves as the operational basis of Integrated Solid Waste Management, where accurate classification enhances recycling efficiency while reducing treatment costs. Similarly, Prieto-Sandoval et al. [Reference Prieto-Sandoval, Mejia-Villa, Lopez, Torres-Valdivieso and Baumgartner27] emphasized that typological mapping supports CE implementation by improving traceability and aligning waste treatment technologies with material characteristics. Despite this broad agreement, previous studies primarily focus on classification systems themselves rather than explaining how improved waste typology facilitates circular resource flows and sustainable value recovery within healthcare systems.
Recent technological developments have further strengthened the relationship between medical waste typologies and circular resource recovery. Digital innovations, including Internet of Things (IoT)-enabled monitoring systems, artificial intelligence-assisted waste sorting, and color-coded segregation protocols, have significantly improved classification accuracy and recycling performance in several developed healthcare systems [Reference Ishaq, Mohammad and Bello28]. However, these approaches remain difficult to implement in many developing countries due to inadequate infrastructure, limited financial resources, weak institutional capacity, and insufficient staff training [Reference Alfina, Ratnayake, Wibisono, Mulyono and Basri12]. Consequently, mixed waste streams continue to reduce recycling potential while increasing environmental and public health risks. Therefore, understanding medical waste typologies extends beyond regulatory compliance; it represents a fundamental mechanism through which CE principles operationalize resource efficiency, minimize hazardous waste generation, and promote sustainable healthcare waste management [Reference Shah, Anuar and Panizan20]. This perspective provides the conceptual foundation for examining how improved waste classification can strengthen circular resource recovery within Bangladesh’s resource-constrained healthcare system.
2.3. Regulatory Framework for Sustainable Medical Waste Management
Effective regulatory frameworks are fundamental to ensuring that medical waste is managed in a manner that protects public health, conserves environmental resources, and supports the transition toward a CE. Regulatory systems establish the legal, institutional, and operational requirements governing waste segregation, collection, transportation, treatment, and final disposal while promoting accountability among healthcare providers and waste management stakeholders [Reference Yang, Du, Sun, Meng and Li29]. The WHO emphasizes that approximately 15% of healthcare waste is hazardous and requires specialized handling, making comprehensive regulatory oversight essential for minimizing environmental contamination and infection risks [Reference Singh, Yt and Mishra30]. However, regulations are most effective when they extend beyond compliance and actively encourage waste prevention, resource recovery, and recycling, which are central principles of the CE framework [Reference Maalouf, Garcia-Tabar and Castro31].
Although there is broad consensus that robust regulations improve healthcare waste management, the literature reveals considerable variation in their effectiveness across different institutional and economic contexts. In developed economies, regulatory instruments such as the European Union Waste Framework Directive and the CE Action Plan prioritize waste prevention, reuse, recycling, and producer responsibility, thereby embedding CE principles into healthcare waste governance [Reference Rubino, Mastrorocco and Gerbasi32]. Similarly, Japan and South Korea have successfully integrated policy mechanisms such as Extended Producer Responsibility and Pay-As-You-Throw schemes, which combine regulatory enforcement with economic incentives to reduce waste generation and improve resource recovery [Reference Kim, Cho and Jang33,Reference Yu, Liu, Yu and Okubo34]. These experiences demonstrate that effective regulations function not merely as compliance tools but as strategic mechanisms that facilitate circular resource flows and sustainable healthcare operations.
Evidence from many developing countries suggests that regulatory shortcomings are less attributable to the absence of legislation than to weaknesses in implementation, institutional coordination, and enforcement capacity. Studies consistently report that inadequate monitoring systems, fragmented institutional responsibilities, and limited technical infrastructure significantly constrain the practical application of sustainable medical waste policies [Reference Or21]. In Bangladesh, despite the existence of national medical waste management regulations, implementation remains inconsistent because of insufficient financial resources, weak regulatory oversight, and limited stakeholder collaboration. Consequently, healthcare facilities often continue to rely on linear waste disposal practices rather than adopting CE-oriented strategies that emphasize waste reduction, reuse, and recycling [Reference Al-, Al- and Ali35,Reference Shozib, Islam and Patwary36].
From a CE perspective, regulatory frameworks should be viewed as enabling mechanisms that create institutional conditions for sustainable resource management rather than merely prescribing disposal standards. Adaptive governance, stakeholder collaboration, standardized waste segregation, and incentive-based compliance collectively strengthen the implementation of the 3R hierarchy within healthcare systems [Reference Ali13,Reference Aslan, Salman, Konakci and Akan24]. Therefore, strengthening regulatory capacity in resource-constrained countries such as Bangladesh is essential not only for improving environmental compliance but also for operationalizing CE principles in medical waste management, thereby advancing both environmental sustainability and public health resilience.
2.4. Global and Bangladeshi Evidence on 3R-Based Medical Waste Management
The global transition toward 3R-based medical waste management reflects the broader adoption of CE principles as a strategy for minimizing environmental impacts while improving resource efficiency in healthcare systems. Unlike the traditional linear model, the CE framework promotes waste prevention, material recovery, and value retention throughout the product life cycle [Reference Das, Hossain and Khan25]. International evidence suggests that successful implementation of 3R practices depends not only on technological innovations but also on effective governance, institutional capacity, and stakeholder collaboration. For example, several European Green Hospital initiatives have demonstrated that integrating waste segregation, sterilization, reusable medical devices, and material recycling can substantially reduce hazardous waste generation while improving environmental and economic performance [Reference Dolcini, Ferrè, Brambilla and Capolongo37]. These experiences indicate that CE-driven healthcare waste management requires systemic transformation rather than isolated recycling initiatives.
Despite broad agreement regarding the environmental benefits of 3R practices, the literature reveals differing perspectives on the primary determinants of successful implementation. While studies from developed economies emphasize advanced treatment technologies, digital waste-tracking systems, and stringent regulatory enforcement as critical success factors [Reference Zorpas38]. Research conducted in developing countries highlights institutional weaknesses, financial constraints, inadequate segregation practices, and limited technical capacity as the principal barriers to circular healthcare waste management [Reference Anokye, Darko and Agyemang39]. These contrasting findings suggest that the effectiveness of CE strategies is highly context-dependent, indicating that models developed in high-income countries cannot be directly transferred to resource-constrained healthcare systems without considering local institutional and socioeconomic conditions.
Within Bangladesh, recent studies have increasingly examined healthcare waste management through a CE perspective. For instance, Dihan et al. [Reference Dihan, Nayeem and Roy6] emphasized the potential of circular resource recovery and improved waste segregation to enhance environmental sustainability, while Islam et al. [Reference Islam, Zaman, Ferdous and Sarker8] highlighted policy reforms and sustainable treatment technologies for strengthening healthcare waste governance. Although these studies provide important contributions, they primarily focus on policy recommendations, technological solutions, or descriptive assessments of waste management practices. Consequently, limited attention has been given to understanding how the complete 3R hierarchy operates as an integrated CE strategy that simultaneously links waste reduction, reuse, recycling, institutional governance, and environmental sustainability within healthcare facilities. Addressing this gap, the present study advances the existing literature by synthesizing global evidence with the Bangladeshi context to explain how CE principles can be operationalized through the 3R framework in resource-constrained healthcare systems [Reference Barkaoui and Abdallah40]. In doing so, the study contributes not only by claiming to be the first application of CE in Bangladesh but also by providing a more comprehensive theoretical and practical understanding of sustainable medical waste management.
2.5. Literature Gap
Despite the growing body of literature on medical waste management, significant knowledge gaps remain regarding the application of CE principles in healthcare systems, particularly in developing countries. Existing studies have primarily examined medical waste typologies, disposal technologies, or regulatory compliance as independent issues, while relatively limited attention has been given to integrating these dimensions within a comprehensive CE framework that emphasizes the interconnected roles of waste reduction, resource recovery, and sustainable value creation. Although recent studies in Bangladesh have begun to explore CE-oriented approaches to healthcare waste management [Reference Dihan, Nayeem and Roy6,Reference Shozib, Islam and Patwary36], their primary focus has been on policy recommendations, waste treatment practices, or recycling opportunities, providing limited theoretical explanation of how the complete 3R hierarchy can function as an integrated mechanism for achieving environmental, economic, and public health sustainability.
Furthermore, the literature offers limited exploratory evidence on how contextual challenges, including weak institutional capacity, inadequate infrastructure, fragmented regulatory enforcement, and resource constraints, influence the implementation of CE principles in healthcare waste management within developing economies. Consequently, the theoretical applicability of CE in resource-constrained healthcare settings remains insufficiently understood. Addressing these gaps, the present study develops a comprehensive perspective by integrating medical waste typologies, regulatory frameworks, and 3R practices within the CE framework. In doing so, the study advances the application of CE theory beyond its traditional industrial focus by demonstrating how circular resource management principles can support sustainable medical waste governance in Bangladesh and other developing countries facing similar environmental and institutional challenges.
3. Participants, Approaches, and Sample
This is an exploratory investigation. The researchers employed a qualitative methodological approach to investigate the waste management system and how it significantly contributes to the economy. Data were collected through face-to-face, in-depth semi-structured interviews with healthcare staff in Bangladesh. This is a cross-sectional study carried out between January and April 2026 using a mixture of purposive and snowball sampling.
Purposive sampling was initially adopted to recruit participants with direct knowledge and practical experience in healthcare waste management, including cleaners, nurses, ward masters, waste collectors, waste management plant workers, and management authorities. After the initial participants were recruited, snowball sampling was employed whereby participants recommended other information-rich individuals who met the study inclusion criteria. This combination of sampling techniques facilitated access to diverse stakeholder groups while ensuring the inclusion of participants possessing substantial practical experience with medical waste management.
A semi-structured questionnaire with 15 main and probing questions was developed based on the existing literature and the study objectives. The interview guide remained sufficiently flexible to allow participants to elaborate on emerging issues during the interviews.
Each interview lasted approximately 35–60 minutes and was conducted primarily in Bangla, the native language of the participants, to encourage open communication and minimize language barriers. Prior to data collection, informed consent was obtained from each participant, and permission was requested to audio-record the interviews. In cases where participants declined recording, detailed field notes were taken throughout the interview.
The participants in this study were healthcare workers, including cleaners, nurses, hospital staff, doctors, waste collectors, and management authorities, from healthcare establishments across Bangladesh. A total of 31 respondents participated in the study using a combination of purposive and snowball sampling. Their demographic characteristics, including professional roles and other relevant background information, are presented in Table 1. Sample size adequacy in a qualitative study is relative. For certain kinds of homogeneous or essential case sampling, a sample size of 10 might be considered sufficient [Reference Sandelowski41]. According to Shank and Villella [Reference Shank and Villella42], a sample size of 10 to 50 is sufficient to discern its necessary constituents in qualitative research.
Participant characteristics.
Table 1. Long description
The table contains seven columns: Participant, Participant code, Gender, Age (years), Professional role, Experience (years), and Highest education.
Key data points include:
* Participants 1 to 5 (codes H C 1 to H C 5) are cleaners with 5 to 21 years of experience and education below S S C.
* Participants 6 to 10 (codes H E N 1 to H E N 5) are nurses, all female, aged 22 to 35, with 4 to 11 years of experience and H S C education.
* Participants 11 to 13 (codes H C E W M 1 to H C E W M 3) are male Ward Masters with Bachelor's Degrees and 10 to 17 years of experience.
* Participants 14 to 21 (codes H W C 1 to H W C 8) are Healthcare Waste Collectors, mostly male except for H W C 8, with education below S S C.
* Participants 22 to 26 (codes H C W P W 1 to H C W P W 5) are male Plant Workers with 3 to 8 years of experience and education below S S C.
* Participants 27 to 31 (codes H C W M A 1 to H C W M A 5) are male Administrators or Coordinators, aged 42 to 55, all holding Master's Degrees with up to 30 years of experience.
Initialisms used: S S C (Secondary School Certificate), H S C (Higher Secondary Certificate).
Note: HC = healthcare waste cleaner; HEN = healthcare establishment nurse; HCEWM = healthcare establishment ward master; HWC = healthcare waste collector; HCWPW = healthcare waste management plant worker; HCWMA = healthcare waste management authority/administrator; SSC = Secondary School Certificate; HSC = Higher Secondary Certificate.
The recruitment process continued until thematic saturation was achieved, meaning that no substantially new themes or concepts emerged from subsequent interviews. Following data collection, all audio recordings were transcribed verbatim in Bangla. The transcripts were subsequently translated into English by bilingual researchers, and the translated versions were cross-checked against the original transcripts to preserve contextual meaning and minimize translation bias. Field notes were integrated into the transcripts during the verification process.
The interview transcripts were analyzed using thematic analysis following the six-step framework proposed by Braun and Clarke [Reference Braun and Clarke43]. Initially, the researchers repeatedly read the transcripts to become familiar with the data. Subsequently, open coding was conducted to identify meaningful segments of text. Similar codes were then grouped into broader categories, which were iteratively refined into overarching themes related to medical waste management and the 3R approach. Coding was performed independently by two researchers, and discrepancies were resolved through discussion until consensus was achieved, thereby enhancing coding reliability and analytical rigor.
To enhance trustworthiness, the study adopted the criteria of credibility, dependability, confirmability, and transferability. Member checking was conducted with selected participants to verify the interpretation of findings, while regular discussions among the research team were undertaken to ensure consistency throughout the coding process.
Researcher reflexivity was maintained throughout the study. The researchers acknowledged that their academic backgrounds in management and sustainability could potentially influence data interpretation. To minimize researcher bias, reflective memos were maintained during data collection and analysis, and analytical decisions were regularly discussed among the research team.
Ethical approval was obtained from the Institutional Animal, Medical Ethics, Biosafety and Biosecurity Committee (IAMEBBC), Institute of Biological Sciences, University of Rajshahi, Bangladesh, prior to the commencement of data collection. Participation in the study was entirely voluntary. Written informed consent was obtained from all participants before their involvement in the research. Participants were assured of the anonymity and confidentiality of their responses, and they were informed of their right to withdraw from the study at any stage without any adverse consequences.
4. Thematic Analysis
4.1. Medical Waste Management as an Integrated System
Participants (P) consistently described medical waste management in Bangladesh as a structured and sequential system that integrates internal waste management, safe collection and transportation, and centralized treatment and disposal. Across the interviews, respondents emphasized that effective waste management begins at the point of waste generation through systematic segregation and continues throughout the entire waste handling process. Participants viewed these practices not merely as regulatory requirements but as essential mechanisms for protecting public health, minimizing environmental risks, and facilitating waste reduction, reuse, and recycling.
Participants P1, P4, P5, P6, P10, P14, and P29 explained that medical waste management in Bangladesh follows a standardized three-step process beginning with sound internal management. As they stated:
Medical waste management system in Bangladesh is done in three steps: sound internal management includes creating awareness among health care facility authorities, staff, and stakeholders about medical waste management; segregation of waste in containers with specific-colored lids according to the type of waste at the point of origin of waste generation. General waste is disposed of in black containers, sharps in red containers, recyclable waste in green containers, infectious waste in yellow containers, liquid waste in blue containers, chemical and pharmaceutical waste in brown containers, and radioactive waste in silver containers. (P1, P4, P5, P6, P10, P14, and P29)
Participants consistently positioned waste segregation as the cornerstone of medical waste management. Rather than treating segregation as a routine operational activity, they regarded it as the critical stage that determines the safety and efficiency of subsequent collection, treatment, and disposal processes. The standardized color-coded segregation system was consistently viewed as an essential mechanism for minimizing cross-contamination, protecting healthcare workers, and enabling resource recovery through appropriate waste classification. This reflects the preventive orientation of CE principles, where value recovery begins with proper separation of materials at the source rather than at the final disposal stage. As illustrated in Figure 1, healthcare establishments implement a standardized color-coded container system that facilitates waste segregation at the point of generation and supports subsequent waste handling processes.
Medical waste segregation using color-coded containers.
Field observations further confirmed descriptions of the participants regarding internal medical waste management practices. Consistent with the views of P1, P4, P5, P6, P10, P14, and P29, evidence collected during field visits showed that healthcare facilities had installed color-coded containers and displayed instructional posters above each container to guide proper waste segregation. This observation was reinforced by P27 and P31, who explained:
Within healthcare establishment premises, specific color containers were found and there were posters above the containers indicating the types of waste and accordingly the cleaners put segregated waste into the respective container, which is a vital issue of medical waste management. (P27 and P31)
The consistency between interview responses and field observations strengthens the credibility of the evidence and suggests that waste segregation has become an institutionalized practice within many healthcare establishments. The visual guidance provided through posters further indicates that healthcare organizations recognize the importance of continuous awareness and behavioral reinforcement in maintaining segregation quality.
Participants also emphasized that safe handling procedures extend beyond waste segregation. P3, P8, P12, P16, P17, P27, and P28 highlighted that healthcare facilities implement appropriate waste handling, temporary storage, and collection procedures by considering occupational safety and environmental risks. As they explained:
Waste handling safety, safe waste collection, and proper temporary storage are taken inside the healthcare establishments taking into account the risks of the environment, the health risk of patients and visitors, following the guidelines given by the World Health Organization and the Bangladesh Medical Waste Regulations 2008. (P3, P8, P12, P16, P17, P27, and P28)
These responses indicate that participants view safe handling procedures as integral components of healthcare service delivery rather than isolated waste management activities. Compliance with international and national guidelines was perceived as reducing the likelihood of infection transmission while simultaneously protecting the surrounding environment.
The importance of safe transportation was consistently emphasized by P2, P4, P7, P13, P18, P19, and P20, who stated:
Ensuring safe collection and transportation of waste through skilled and trained personnel and supporting materials (special types of poly bags, vans, safety clothing, and other necessary equipment) are provided to them in consideration of environmental and human protection. (P2, P4, P7, P13, P18, P19, and P20)
Similarly, P5, P9, P15, P21, and P30 observed:
Healthcare establishments have safe waste collection and transportation procedures inside and outside that help prevent human harm and environmental pollution. (P5, P9, P15, P21, and P30)
Collectively, these findings suggest that participants perceive waste transportation as more than a logistical function. Instead, it represents a critical stage that preserves the integrity of source segregation and minimizes environmental and occupational risks throughout the waste management chain. Participants repeatedly associated trained personnel, protective equipment, and specialized transportation systems with safer and more sustainable healthcare waste management.
Finally, participants emphasized the importance of centralized treatment facilities in completing the waste management process. P21, P22, P27, P28, P29, and P31 explained:
Bangladesh has a system for proper management of medical waste by setting up hygienic and suitable central medical waste management plants with advanced technical support. Through skilled and trained personnel, the waste is finally segregated and initiated to proper treatment focusing on the CE philosophy. (P21, P22, P27, P28, P29, and P31)
Participants consistently positioned centralized treatment facilities as the institutional mechanism through which CE principles are operationalized in healthcare waste management. Rather than viewing waste as an unavoidable by-product requiring disposal, respondents increasingly recognized its potential for value recovery through reduction, reuse, and recycling when supported by appropriate infrastructure, technical capacity, and governance.
4.2. Reduction through Risk Control and Treatment
Waste reduction in Bangladesh begins at the point of waste generation through systematic segregation, temporary storage, transportation, and the application of appropriate treatment technologies. Participants consistently described waste reduction as a structured process rather than merely reducing waste volume, emphasizing that different categories of medical waste require different treatment methods before final disposal. This sequential process was perceived as essential for minimizing environmental pollution, protecting public health, and facilitating the subsequent implementation of reuse and recycling practices.
The concept of waste reduction was consistently described by P27 and P31, who explained that medical waste is treated using different technologies depending on its characteristics:
The collected wastes are treated in medical waste management plants by autoclaving, incineration, chemical disinfection, and deep burial. Some of the waste collected in special cases needs to be segregated according to sharp, infectious, and recyclable waste. Medical waste management is also managed inside the city through treatment according to the type of waste, where purification by autoclaving is one of the principal methods. (P27, P31)
This account demonstrates that participants view waste reduction as a risk-based management strategy rather than a single disposal technique. The emphasis on waste segregation before treatment indicates that effective reduction depends on identifying the characteristics of different waste streams so that appropriate technologies can be applied while minimizing environmental and occupational risks. From a CE perspective, this reflects the principle that hazardous waste must first be stabilized before value recovery or environmentally safe disposal can occur.
Participants further emphasized the importance of autoclaving as the primary method for reducing infectious waste. P15 and P23 explained:
Infectious wastes are sterilized by the autoclaving method at 135-140°C under three atmospheric pressures for 45 minutes according to the World Health Organization guidelines and the Medical Waste (Management and Processing) Rules 2008. After sterilization, the treated waste is disposed of through sanitary landfilling with a 2–3-inch daily soil cover. (P15, P23)
The participants’ accounts suggest that autoclaving serves a dual function by eliminating infectious hazards while converting hazardous waste into a safer waste stream suitable for final disposal. Rather than focusing solely on sterilization, respondents perceived this process as an important preventive measure that reduces environmental contamination and public health risks before landfilling.
Participants also highlighted the role of incineration for waste that cannot be safely reused or recycled. P25 explained:
In some cases, contaminated recyclable waste is also sterilized by autoclaving. Infectious wastes such as cotton, gauze, bandages, collected specimens, culture media with low moisture content, and expired medicines are incinerated in a two-chambered pyrolytic incinerator, which protects the environment from harm. (P25)
Supporting this view, P23 and P26 further stated:
During incineration, the first chamber operates at 800–850°C and the second chamber at 1100-1200°C, preventing the release of dioxin gas and protecting people and the environment from contamination. The resulting ash is finally disposed of in specially constructed concrete pits. (P23, P26)
These findings indicate that participants perceive modern incineration technologies not merely as waste destruction mechanisms but as environmentally controlled treatment processes. Their emphasis on temperature control and emission reduction illustrates an awareness that effective waste reduction must balance infection control with environmental sustainability, thereby supporting safer healthcare waste management practices.
Finally, participants discussed deep burial as an essential reduction strategy for highly hazardous medical waste. P26, P27, and P31 explained:
Sharp wastes collected daily are disposed of through small openings in specially constructed concrete tanks that are completely enclosed. Bleaching powder is applied as a disinfectant to ensure additional safety. Human body parts, placenta, and other highly contaminated wastes are managed in this manner, and when the tank is completely filled, it is permanently sealed. (P26, P27, P31)
Participants regarded deep burial as the safest option for waste that cannot be treated through conventional sterilization or recycling processes. The use of enclosed concrete pits and disinfectants demonstrates a precautionary approach intended to prevent environmental leakage and human exposure to highly infectious waste.
Figure 2 illustrates the principal medical waste treatment technologies employed in Bangladesh to support the Reduce principle of the 3R approach. The figure summarizes the three primary treatment – pathways autoclaving, incineration, and deep burial – that participants identified as essential for minimizing biological hazards, reducing environmental contamination, and ensuring the safe disposal of hazardous medical waste.
Medical waste treatment technologies.
4.3. Reuse through Material and Water Recovery
Participants identified reuse as an important component of sustainable medical waste management because it minimizes waste generation, reduces operational costs, and promotes more efficient use of available resources. Their accounts indicate that reuse extends beyond the direct reutilization of materials and includes recovering value from non-hazardous waste and treating wastewater for subsequent use. Participants consistently emphasized that effective decontamination, sterilization, and wastewater treatment are essential prerequisites for safe reuse, demonstrating that resource recovery in healthcare settings depends on strict environmental and public health safeguards.
One participant (P5) illustrated how non-hazardous waste materials are repurposed within healthcare facilities to generate operational value:
Paper boxes of medicines or other products used during hospital treatment that are disposed of as waste are reused as fuel for heating the clothes during laundry in these hospitals, which plays a special role in fuel cost saving of the hospital in the laundry section. (P5)
This example demonstrates that materials traditionally regarded as waste can be reintegrated into hospital operations, thereby reducing disposal volumes while simultaneously lowering fuel consumption and operational costs. Such practices reflect the practical application of the reuse principle by extending the functional life of discarded materials before final disposal. As illustrated in Figure 3, discarded medicine and product packaging are repurposed as supplementary fuel in the hospital laundry furnace, demonstrating how non-hazardous waste can be transformed into a valuable energy resource while reducing operational fuel costs.
Reuse of waste packaging as laundry fuel.
Similarly, the reuse of waste and sustainable waste management, the views of participants P16, P23, P26, P27, P28, and P31 were highly consistent. They explained that wastewater generated within healthcare facilities undergoes a comprehensive treatment process through the Effluent Treatment Plant (ETP) before it can be safely reused:
The wastewater generated is deposited in the equalization tank of the Effluent Treatment Plant (ETP) through the collection network. Then the wastewater is taken from the equalization tank to the primary tank with the help of a pump and various chemicals are applied in the prescribed amount. Then the wastewater mixed with chemicals is taken to the aeration tank, and aerated in the aeration tank. After aeration, the upper water goes to the secondary tank. As the water velocity in the secondary tank is low, the water accumulates in the bottom form of the sludge part of the tank and the upper part forms the bottom part of the tank. In addition, another pump, thereby removing the resulting dissolved impurities, pumps the upper portion into the filter media. The purified water is then pumped into a small chamber. On the other hand, the sludge collected at the bottom is pumped into the filter media with the help of a pump. On the other hand, the sludge collected at the bottom is deposited in the sludge collection pit with the help of a pump. By mixing various chemicals in wastewater treatment, if the mentioned steps are done properly, the treated water Biological Oxygen Demand (BOD) and Chemical Oxygen Demand (COD) reach within the limits of reusable water standards. (P16, P23, P26, P27, P28, and P31)
The detailed explanation of the participants demonstrates that wastewater reuse is implemented through a carefully controlled and sequential treatment system designed to ensure compliance with environmental quality standards. Their accounts indicate that reuse is not perceived merely as a cost-saving practice but as an integrated environmental management strategy that combines pollution control, resource conservation, and regulatory compliance. The emphasis on achieving acceptable BOD and COD levels before reuse reflects the importance of balancing resource recovery with environmental protection and public health safeguards.
4.4. Recycling through Biosafety and Resource Recovery
Recycling emerged as the final stage of medical waste management after waste reduction and reuse, representing the last opportunity to recover valuable materials before final disposal [Reference Sharma, Kumar and Kaur44]. Participants consistently described recycling as a structured process that converts non-hazardous medical waste into reusable resources while ensuring that public health and environmental safety are maintained through rigorous decontamination procedures. Across the interviews, P22, P23, P24, P25, P26, P27, P28, and P31 explained that recyclable materials – including plastics, glass, metals, paper, cardboard, packaging materials, plastic wrapping, containers, plastic pipes, and tubes – are subjected to systematic sterilization before entering the recycling stream. These accounts indicate that recycling is viewed not merely as waste disposal but as a value recovery mechanism that aligns environmental protection with resource efficiency. As illustrated in Figure 4, the recycling process follows a standardized sequence of chemical disinfection, washing, drying, shredding, material segregation, and resource recovery, ensuring that recyclable materials are safely reintroduced into the production cycle.
Medical waste recycling process.
In this regard, P22, P23, P24, P25, P26, P27, P28, and P31 mentioned that:
Recyclable wastes such as plastics, glass, metals, etc. sterilized in chlorine water through a three-chambered tank. The first chamber is submerged in chlorine water with a concentration of 150–250 PPM for 30-45 minutes in a special manner. Then the second chamber is immersed in 20–50 PPM chlorine water for 15-20 minutes. The sterilized waste from the second chamber is transferred to the third chamber for washing with stored clean water. It should be noted here that closed or unidirectional tube or container-shaped wastes are cut into small pieces before disinfection in the chemical disinfection method. Then the washed sterilized waste is sun-dried, separated according to the nature and type of waste, cut into small pieces by a shredding machine, and sent for recycling for the purpose of converting waste into further resources. (P22, P23, P24, P25, P26, P27, P28, and P31)
The accounts of the participants demonstrate that recycling within healthcare facilities is supported by a standardized sequence of chemical disinfection, washing, drying, shredding, and material separation before recyclable waste is transferred for resource recovery. Rather than treating recycling as a simple waste disposal activity, participants emphasized that effective decontamination is a prerequisite for safely returning materials to the production cycle. This illustrates how infection control and environmental sustainability are integrated within the recycling process, ensuring that recovered materials do not pose risks to healthcare workers, waste handlers, or the wider community.
5. Discussion
The interpretation extends the understanding of CE implementation in healthcare by demonstrating that medical waste management in Bangladesh is not perceived by stakeholders as a series of isolated technical activities but as an integrated organizational system that begins at the point of waste generation and continues through segregation, transportation, treatment, reuse, and recycling. Unlike much of the previous literature, which primarily conceptualizes healthcare waste management as a disposal or treatment challenge [Reference Ismail, Zhongdong and Waheed11,Reference Shozib, Islam and Patwary36], the present findings reveal that stakeholders increasingly view waste as a recoverable resource whose value depends on maintaining material integrity throughout the entire waste management chain. This result suggests that CE implementation in healthcare is fundamentally process-oriented rather than technology-oriented. Treatment technologies such as autoclaving or incineration become effective only when supported by institutional coordination, standardized operating procedures, and behavioral compliance during earlier stages of waste generation and segregation.
The quotes further refine the Reduce principle within CE theory. Previous CE research generally defines reduction as minimizing material consumption and waste generation [Reference Shah, Anuar and Panizan20,Reference Das, Hossain and Khan25]. However, participants in this study interpreted reduction differently within the healthcare context. Rather than simply decreasing waste volume, reduction was understood as minimizing biological and environmental risks through appropriate segregation and technology selection before final disposal. Autoclaving, controlled incineration, and secure deep burial were therefore viewed as complementary risk-management strategies that transform hazardous waste into environmentally manageable waste streams. This interpretation extends conventional CE thinking by suggesting that, in highly regulated sectors such as healthcare, the primary objective of reduction is hazard minimization rather than material minimization alone. Consequently, this study demonstrates that CE principles require contextual adaptation when public health protection becomes equally important as resource efficiency.
The analysis also contributes to the theoretical understanding of Reuse by illustrating that resource recovery in healthcare extends beyond the direct reuse of physical materials. Existing CE studies often emphasize product life extension through remanufacturing or material reutilization [Reference Vederhus, Saha and Nath9,Reference Or21]. In contrast, participants described reuse as encompassing both the repurposing of non-hazardous materials and the recovery of treated wastewater through ETPs. This broader interpretation indicates that healthcare institutions simultaneously recover material, energy, and water resources while maintaining strict environmental and public health safeguards. The outcomes therefore broaden the conceptual boundaries of reuse by demonstrating that environmental protection and resource recovery are mutually reinforcing rather than competing objectives within healthcare waste management.
Similarly, the results provide important insights into the Recycle dimension of CE theory. Previous research has consistently identified recycling as an important mechanism for reducing landfill dependence and conserving natural resources [Reference Kahalimoghadam and Thompson45]. However, participants emphasized that recycling in healthcare cannot be understood solely as material recovery because effective recycling depends upon rigorous biosafety procedures before materials re-enter production systems. Chemical disinfection, washing, shredding, and quality control were perceived as essential prerequisites for safe recycling rather than secondary operational activities. This finding refines existing CE theory by demonstrating that circularity within healthcare is conditional upon institutional biosafety governance. In other words, healthcare waste only becomes a circular resource after biological risks have been systematically eliminated, highlighting the inseparable relationship between infection control and circular resource recovery.
Collectively, these findings suggest that the 3R framework operates as an interconnected rather than sequential system. While previous CE studies frequently examine reduction, reuse, and recycling as relatively independent strategies [Reference Ćwiklicki and Pawełek46,Reference Shah, Anuar and Panizan20], participants consistently described them as mutually dependent processes in which the effectiveness of each subsequent stage relies upon the quality of the previous one. Proper segregation determines treatment effectiveness; successful treatment enables safe reuse; and effective sterilization ultimately facilitates recycling. This systems perspective advances CE theory by demonstrating that circularity in healthcare depends upon preserving material quality and safety throughout the waste management lifecycle instead of maximizing recovery at the final stage alone.
The findings also contribute to the growing literature on sustainable healthcare by illustrating how organizational governance supports circular transitions. Participants repeatedly emphasized awareness, standardized color-coded segregation systems, staff training, protective equipment, and centralized treatment facilities as enabling mechanisms. These observations support institutional perspectives suggesting that successful sustainability transitions require organizational capabilities, regulatory compliance, and stakeholder coordination in addition to technological innovation [Reference Asperti, Foglia, Petruzzelli and Urbinati14]. Consequently, this study indicates that CE implementation in healthcare should be understood as an institutional transformation involving behavioral change, governance capacity, and coordinated stakeholder participation rather than merely the adoption of advanced waste-treatment technologies.
From a sustainable development perspective, this analysis provides qualitative insights derived from participants’ accounts and interpretations that CE practices contribute simultaneously to environmental protection, public health, and resource efficiency. Rather than treating SDGs as separate policy outcomes, participants viewed environmental safety, infection prevention, resource conservation, and operational efficiency as interconnected objectives achieved through integrated waste management practices. This demonstrates that CE implementation within healthcare can generate multiple sustainability benefits simultaneously, supporting improved public health outcomes (SDG 3), responsible consumption and production (SDG 12), and climate-related environmental protection (SDG 13).
6. Implications
6.1. Theoretical Implications
Three theoretical contributions emerge from the analysis of CE theory within the context of healthcare waste management. First, it demonstrates that circularity in healthcare is fundamentally process-driven rather than technology-driven. While existing CE literature largely emphasizes resource recovery through technological innovation, the data reveal that successful circularity depends on preserving waste quality throughout an integrated sequence of segregation, safe handling, transportation, treatment, reuse, and recycling. Second, the study refines the traditional 3R framework by showing that the Reduce principle in healthcare primarily represents biological risk reduction rather than simply minimizing waste volume. Likewise, Reuse extends beyond material reutilization to include treated wastewater recovery, while Recycle is conditional upon biosafety and institutional governance before materials can safely re-enter production systems. Third, pattern indicates the notion of healthcare-specific circularity, where public health protection, infection control, and resource recovery operate simultaneously rather than as competing objectives. This extends CE theory by demonstrating that circular systems in high-risk service sectors require institutional coordination, behavioral compliance, and biosafety governance alongside technological capability. Consequently, the study broadens the applicability of CE theory beyond manufacturing by explaining how circularity can be operationalized in healthcare systems within resource-constrained developing countries.
6.2. Practical Implications
The participants’ quote provides several practical recommendations for healthcare institutions in Bangladesh. First, hospitals should strengthen waste segregation at the point of generation through standardized color-coded containers, clear visual instructions, and continuous staff training because effective segregation determines the success of subsequent treatment, reuse, and recycling activities. Second, healthcare organizations should invest in regular competency-based training for nurses, cleaners, waste handlers, and administrators to improve compliance with biosafety procedures and reduce operational errors during waste collection and transportation. Third, hospitals should establish standardized monitoring systems that routinely assess segregation accuracy, treatment efficiency, and recycling performance using measurable operational indicators. Finally, healthcare facilities should maximize existing infrastructure by integrating autoclaves, ETPs, and centralized recycling systems into a coordinated waste management program instead of operating these facilities independently. These interventions are realistic because they primarily strengthen existing practices identified in this study rather than requiring major structural changes, enabling hospitals to improve environmental performance, occupational safety, and operational efficiency simultaneously.
6.3. Policy Implications
Participants emphasized that policymakers should shift medical waste governance in Bangladesh from a disposal-oriented approach toward a CE framework that prioritizes waste prevention, resource recovery, and institutional accountability. Updating the Medical Waste (Management and Processing) Rules, 2008 to incorporate explicit guidance on segregation, safe reuse, recycling, and centralized treatment would provide greater consistency across healthcare facilities. In addition, the Ministry of Health and Family Welfare, in collaboration with the Department of Environment and City Corporations, should establish a national monitoring and certification system based on standardized performance indicators and periodic compliance audits. Government investment should also prioritize expanding centralized treatment facilities, strengthening regional recycling infrastructure, and supporting hospitals with financial incentives for adopting environmentally sound treatment technologies. Finally, national training programs and technical guidelines should be developed to improve workforce competency in medical waste management across both public and private healthcare institutions. Collectively, these policy interventions would strengthen institutional capacity while creating a more coordinated and sustainable medical waste management system in Bangladesh.
7. Limitations and Future Research Directions
Several limitations warrant consideration when interpreting this analysis. First, this study employed a qualitative design based on interviews and field observations; therefore, the participants’ insights provide in-depth contextual insights but are not intended to be statistically generalizable to all healthcare institutions in Bangladesh. Second, although participants represented multiple stakeholder groups involved in medical waste management, the interviews reflect experiences within the healthcare context of Bangladesh and may differ in countries with different regulatory, institutional, and technological environments. Finally, this study focused on the implementation of the 3R approach from the perspective of CE principles and did not quantitatively assess environmental performance, economic benefits, or operational efficiency associated with different medical waste management practices.
Future research should adopt mixed-method or quantitative approaches to validate and generalize the proposed healthcare-specific CE framework across broader institutional settings. Comparative studies involving public and private hospitals or cross-country investigations could further examine how institutional capacity, governance quality, and regulatory environments influence the implementation of the 3R approach. Future studies may also integrate life cycle assessment (LCA), material flow analysis (MFA), or carbon footprint assessment to evaluate the environmental and economic impacts of circular medical waste management practices. Additionally, investigating the role of digital technologies, including IoT-based waste monitoring, artificial intelligence, and blockchain-enabled waste traceability, could provide valuable insights into strengthening CE implementation within sustainable healthcare systems.
8. Conclusion
Taken together, the evidence suggests that proper management of medical waste in the healthcare sector of Bangladesh is only possible through a paradigm shift from linear-based disposal methods to CE based on the 3Rs of reduction, reuse, and recycle concepts. The results validate the hypothesis that a strategic approach to incorporating 3R programs could significantly reduce environmental pollution, improve resource use, and coordinate healthcare activities with the SDGs of the United Nations 3 (Good Health and Well-being), 12 (Responsible Consumption and Production), and 13 (Climate Action). In theory, this study contributes to the development of CE theory by showing that it can be applied in the non-industrial sectors like healthcare where human agency, adaptive behavior, and contextual circularity are the basic drivers of sustainability transitions. In practice, it shows that the enhancement of institutional capacities, the provision of treatment infrastructure, and the establishment of multi-stakeholder cooperation are essential in order to introduce effective 3R systems. Further consolidation can be achieved through policy reforms that incentivize eco-innovation, create compliance, and make sustainability education central to medical training. Finally, the 3R model is not a waste management tool only, but a revolutionary engine of delivering environmental justice, health protection of people, and climate-resilient economic development in the emerging economies.
Open peer review
To view the open peer review materials for this article, please visit http://doi.org/10.1017/S2978168X26000039.
Declaration of generative AI and AI-assisted technologies in the writing process
During the preparation of this manuscript, the authors used ChatGPT (OpenAI) for language editing and proofreading support. The tool was used to improve clarity, grammar, and overall readability of the manuscript. All intellectual content, analysis, and interpretations presented in this study remain the sole responsibility of the authors.
Author contributions
Conceptualization: M.S.U., M.S.R., M.M.R.; Data curation: M.S.R.; Formal analysis: M.S.R., M.M.R.; Investigation: M.S.U., M.S.R., M.M.R.; Methodology: M.S.U., M.M.R.; Project administration: M.S.U., M.M.R.; Resources: M.S.U.; Supervision: M.S.U.; Validation: M.S.U., M.M.R.; Visualization: M.S.R., M.M.R.; Writing – original draft: M.S.U., M.S.R., M.M.R.; Writing – review and editing: M.S.U., M.S.R., M.M.R. All authors have read and approved the final version of the manuscript.
Acknowledgments
The authors thank all participants and the healthcare institutions for generously contributing their time, knowledge, and experiences to the data collection process. The authors also appreciate the support and cooperation provided by the participating institutions throughout the interview process.
Financial support
No specific funding was received from any public, commercial, or nonprofit funding agency.
Competing interests
The authors declare that they have no competing interests.
Data availability statement
The data of this study are available from the corresponding author upon reasonable request.
Ethical standards
Ethical approval was granted by the Institutional Animal, Medical Ethics, Biosafety and Biosecurity Committee (IAMEBBC), Institute of Biological Sciences, University of Rajshahi, Bangladesh (Memo No. 336/320(79)/IAMEBBC/IBSc).
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Comments
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