Biomedical waste generation, treatment, and persistent generation–treatment gaps in India: A national analysis, 2019–2023

Introduction: Biomedical waste (BMW) management is an important public health and environmental concern, particularly in developing countries experiencing rapid expansion of healthcare services. Although India has established regulatory mechanisms for biomedical waste management, monitoring trends in waste generation, treatment and the difference between reported generation and treatment remains important. This study assessed national trends in biomedical waste generation, treatment, the aggregate generation-to-treatment ratio, and generation–treatment gaps in India from 2019 to 2023. Methods: A secondary data analysis was conducted using biomedical waste management data reported by the Central Pollution Control Board (CPCB), Government of India, for the years 2019–2023. Data on biomedical waste generation, treatment, the aggregate generation-to-treatment ratio, treatment gaps, healthcare facilities (HCFs), and Common Biomedical Waste Treatment Facilities (CBWTFs) were extracted and analysed using descriptive statistics and temporal trend comparisons. The aggregate generation-to-treatment ratio was calculated as the proportion of reported biomedical waste treated relative to the total quantity generated, expressed as a percentage. Results: Biomedical waste generation increased from 619 tonnes/day in 2019 to 743 tonnes/day in 2023, representing a 20.0% increase. The quantity of waste treated increased from 544 tonnes/day to 694 tonnes/day during the same period, corresponding to a 27.6% increase. The aggregate generation-to-treatment ratio increased from 87.9% in 2019 to 93.4% in 2023, reaching its highest value of 94.4% in 2021. The reported number of healthcare facilities increased from 322,425 to 435,257, while the number of CBWTFs increased from 202 to 234. Despite these changes, a generation–treatment gap ranging from 43 to 75 tonnes/day persisted throughout the study period. Conclusion: Biomedical waste generation and the quantity treated increased in India between 2019 and 2023, accompanied by an increase in the aggregate generation-to-treatment ratio and in the reported numbers of healthcare facilities and CBWTFs. However, a persistent difference between reported waste generation and treatment was observed across all years. Strengthening waste segregation, regulatory monitoring and implementation of biomedical waste management practices remains important. Further investigation using disaggregated data is required to understand the factors contributing to the observed generation–treatment differences and assess treatment capacity and facility utilisation.