A realistic and sustainable clinical laboratory waste management: challenges and opportunities in resource - limited settings.

INTRODUCTION: Laboratory medicine remains the cornerstone of disease detection, clinical management, monitoring, and public health surveillance. Increasing population needs and rising disease burdens, particularly in low- and middle-income countries (LMICs), continue to expand the volume of diagnostic testing, resulting in substantial generation of biomedical waste. Effective laboratory waste management is therefore essential for protecting personnel, maintaining high-quality service delivery, and minimizing environmental harm. However, many LMICs face persistent challenges due to inadequate infrastructure, insufficient training, limited financial resources, and weak regulatory enforcement - that compromise safe and efficient waste handling. CONTENT: This review explores affordable, scalable and sustainable measures to strengthen laboratory waste management in resource-constrained settings. It categorizes the main types of laboratory waste - infectious/biological, chemical, sharps, and general waste - and examines common barriers to appropriate disposal. Guided by various international standards including International Organization for Standardization (ISO) 15189 and 14001, Eco-Management and Audit Scheme (EMAS) and World Health Organization (WHO) recommendations, and drawing on experiences from other LMICs, the review discusses practical, low-cost interventions such as improved test utilization, workflow optimisation, Artificial Intelligence (AI)-supported waste classification and digital tracking systems. The importance of workforce training, government engagement, public-private partnerships, and involvement of non-governmental organisations is also emphasised. To foster a culture of responsible waste management, the review proposes behavioural and accountability mechanisms including linking efficiency to key performance indicators, providing institutional recognition, documenting non-conformances, and applying consequence management where necessary. SUMMARY AND OUTLOOK: Sustainable and cost-effective waste management is achievable in resource-limited settings when supported by committed leadership, coordinated stakeholder action, and continuous quality improvement. Corporate bodies can play a pivotal role by providing strategic leadership, mobilising resources and strengthening workforce capacity.