Introduction: Although the decentralization of governance in Nepal has delegated oversight of healthcare waste management (HCWM) to municipalities, comparisons of the performance of public and private hospitals under this localized framework remain limited. This comprehensive municipal census of all hospitals in Bheemdatta Municipality offers a novel, system-level evaluation of HCWM performance across both sectors within a decentralized context.
Methods: A cross-sectional census of all eligible hospitals (1 public, 2 private) employed the WHO and Nepal hospital definitions. HCWM performance was assessed via the standardized UNDP I-RAT (61 yes/no indicators) covering governance/administration (Domain I) and operations/ infrastructure (Domain II). Domain and aggregate scores were calculated as percentages of full compliance.
Results: Public hospital (A) achieved an overall score of 88.7% (“Excellent”), with strong performance in both governance (77.7%) and operations (94.5%). In contrast, private hospitals (B & C) scored 38.4% and 44.2% overall (both “Poor”), driven primarily by weak governance capacity (26.6–43.6%) and near-absence of compliant infectious-waste treatment (2.1%). Despite this, all facilities demonstrated uniformly high performance in segregation, handling, and sharps management (> 98%). This revealed a consistent pattern of systematic segregation without compliant treatment in private hospitals.
Conclusion: In Bheemdatta Municipality, HCWM disparities were primarily due to governance deficiencies and insufficient infectious-waste treatment facilities within private hospitals– not routine waste-handling practices. These findings offer local-level evidence to strengthen regulatory oversight, scale centralized treatment infrastructure, and reinforce accountability through targeted policy interventions, facilitating progress toward SDGs 3 and 6.