Medical Waste Management and Environmental Impact in Independent Healthcare Practices: A Systematic Review

Independent healthcare practices have an important but often overlooked role in managing infectious medical waste, particularly in low- and middle-income settings. This systematic review examines 17 empirical studies published between 2015 and 2025, comparing Indonesia with selected global cases. The results show that most independent providers face ongoing challenges such as limited facilities, insufficient training, and weak regulatory enforcement. These barriers lead to improvised segregation and unsafe disposal methods, including open burning or mixing with household waste. Regulatory compliance is generally low due to gaps between policy and daily practice, especially in rural areas. The review found environmental and health risks, such as needlestick injuries, local pollution, and exposure to infectious agents, while legal protections and community rights remain weakly enforced. Although some urban areas benefit from structured systems and professional waste services, most providers still lack sufficient support and supervision. This review highlights the need for adaptive and context-based strategies, including improvements in training, infrastructure, supervision, and community involvement. Bridging the gap between policy and practice requires comprehensive and collaborative approaches to achieve safer and more sustainable medical waste management in independent healthcare settings.