“I have just accepted it”: Hierarchies of Power and Healthcare Waste Management Practices in Blantyre, Malawi

Medical waste management practices in the Majority World have gained traction in the academic sphere, catapulted by studies detailing the knowledge, attitudes, and practices of healthcare workers in resource-constrained systems. Yet, by restricting the analytical space to surface determinants such as ostensible staff conduct, and material factors involved in this conduct, broader socio-cultural structures associated with waste management practices have largely evaded scholarly attention. This article thus draws on qualitative fieldwork to investigate these structural phenomena by way of semistructured interviews. The purpose of this work is to unearth the power hierarchies that inform operational inadequacies and structural mechanics responsible for daily operation at Queen Elizabeth Central Hospital in Blantyre, Malawi. Findings suggest that embedded gender and power dynamics, complemented by chronic resource and labour shortages, jointly determine and complicate best practices in healthcare waste management. Notably, safety hazards posed by sharps mismanagement and respiratory ailments were two main consequences derived from these findings. Proposing recommendations for mitigation efforts would benefit from broadening the scope of this research. By opening channels of academic dialogue into Southern waste management contexts, we hope to build a more inclusive and comprehensive waste management discourse.