Regulatory Non-Implementation in Infectious Waste Management: Procedural Failures, Stakeholder’s Fragmented Coordination, and Context-Specific Solutions in Punjab, Pakistan

Abstract

Pakistani Healthcare Waste Management is regulated on the national and provincial level, but unsafe segregation, storage, transportation, treatment, disposition, lack of documentation, informal recycling, and inconsistent enforcement are prevalent issues. This conceptual paper explores the reasons for the lack of uniform implementation of regulations, despite the presence of formal regulations in healthcare facilities in Punjab. The study, which employs an integrative review of academic literature, regulatory documents and policy reports, consolidates evidence of the procedural inefficiencies, coordination among stakeholders, institutional capacity, governance and contextual differences between public and private hospitals and between metropolitan and suburban settings. The principal difficulty, according to the review, is that while there are regulations, there is a lack of coordination along the healthcare waste supply chain, including among hospitals, contractors, transporters, treatment operators, regulators and informal players. Drawing lessons from these concepts, Supply Chain Risk Management, stakeholder coordination, contingency thinking, and the idea of “antifragile”, the paper introduces a conceptual framework that is context-sensitive, focusing on: responsibility mapping; risk-based governance; competency development; decentralized treatment options; and digital traceability, including RFID, IoT, AI and blockchain. The proposed framework offers a foundation to enhance the implementation of regulations and sustainable healthcare waste management and propositions for future empirical testing in Pakistan and similar developing-country contexts.