Supporting The Global Fund to strengthen healthcare waste management systems worldwide

Delivering safer healthcare waste management at global scale

Mott MacDonald worked closely with TGF, national stakeholders and end users to deliver a coordinated technical advisory programme to improve healthcare waste management systems in 22 countries across Sub-Saharan Africa, Asia Pacific and the Caribbean.

The need for the programme was driven by the wide variety in approaches to healthcare waste management across the developing countries supported by TGF. According to a 2022 report by the World Health Organization and UNICEF, at least one in three healthcare facilities in low and middle-income countries do not manage their waste safely, with many relying on open burning or poorly functioning incinerators for healthcare waste disposal. These challenges were intensified by Covid‑19, which generated large quantities of waste – from masks and PPE to vaccination needles and testing kits – with no safe disposal mechanism.

TGF recognised the urgent need to address the post-pandemic waste challenge and establish more effective systems for managing healthcare waste in the future. The solution had to be rapidly deployable, while remaining sustainable, compliant with international standards and adaptable to diverse national contexts across multiple geographies, languages and regulatory environments.

One size does not fit all

Delivering consistent, high-quality outcomes across multiple countries and contexts required a different approach to typical project delivery. "What we might recommend in the UK is often not appropriate in low and middle-income countries—and even then, every country requires a tailored approach," says Dan Jacobs, Mott MacDonald technical director and project lead. "Solutions that are effective in one context are not always transferable to another. Each setting has distinct capacities, infrastructure, and constraints, so the focus was on flexible, pragmatic solutions to improve healthcare waste management."

Rather than applying a single model solution, Mott MacDonald developed a scalable framework for providing advisory services that could be adapted to each country’s level of health system maturity, capacity, existing infrastructure and funding landscape.

To deliver a programme of this scale, local knowledge and collaboration were critical. Alongside close engagement with the client, national authorities, healthcare providers, donors and suppliers, Mott MacDonald drew on its global expertise. French and Portuguese-speaking consultants supported communication, while colleagues in France and South Africa brought valuable regional experience. These connections continue to benefit other international waste projects.

The challenges of working globally

Communicating across continents brought its own set of challenges, particularly in countries where digital connectivity is limited. The team also overcame language barriers, often relying on live translation from colleagues based in other offices to discuss the project and fully understand each country’s challenges.

Mott MacDonald established lead consultants for each country, taking ownership of country-specific work and delivery to ensure continuity and build strong relationships with stakeholders. As face-to-face communication is the norm in many of these countries, the team carried out visits to healthcare facilities, undertook on-the-ground situational analysis and assessment of waste management practices and infrastructure. “By visiting hospitals, assessing existing practices and engaging directly with stakeholders, we ensured solutions were practical and tailored to local contexts,” recalls Grace Peel, deputy project manager. “This hands-on approach helped build trust, embed local ownership and increase the likelihood of long-term success.”

From the outset, the objective was not simply to deliver infrastructure, but to build systems and capability that would endure beyond the life of the project.

Country-specific outcomes

This combination of global waste management expertise, local knowledge and in-country engagement enabled the team to support the implementation of healthcare waste infrastructure and develop tailored technical solutions across waste segregation, collection, treatment and procurement.

As the project progressed, the team maintained periodic in-country presence, delivering workshops and training to build local capability and confidence. Mott MacDonald also provided ongoing technical and operational support during infrastructure installation and commissioning, helping to ensure effective handover and long-term operation of the equipment.

Creating lasting value

“From the outset, the objective was not simply to deliver infrastructure, but to build systems and capability that would endure beyond the life of the project,” says Dan Jacobs. “The tools, guidance and training developed through this collaboration with TGF were designed to enable countries to continue improving healthcare waste management independently.”

A key principle was prioritisation. Recognising that countries cannot address all challenges simultaneously, the team focused on high-impact interventions, complemented in some cases by longer-term planning to support phased improvement of healthcare waste systems.

“Ultimately, the programme is not just about installing equipment—it is about equipping countries with the systems, knowledge and confidence to manage healthcare waste safely and effectively over time.”

When the 26-month programme concluded in July 2026, it was already delivering tangible environmental, social and public health benefits at scale. 71 new waste management facilities have been constructed with the capacity to around 16,000kg/hr of waste from unsafe disposal. In addition, over 60 people have been trained in healthcare waste management practices, along with the development of national strategies, roadmaps and technical guidelines, supporting the systematic improvement and long-term operation of equipment.