Climate-smart healthcare waste management in urban primary health care facilities in Abuja, Nigeria: A situation analysis, proof-of-concept comparative baseline assessment of environmental sustainability practices and system readiness across four facilities

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Abstract Background Unsafe healthcare waste management in primary health care (PHC) facilities contributes to healthcare-associated infections, occupational injuries, and environmental degradation, including greenhouse gas emissions from open burning. Despite growing global emphasis on climate-smart health systems, evidence on integrating environmental sustainability into PHC waste management in sub-Saharan Africa remains sparse. As a pilot proof-of-concept, this study assessed the baseline status of climate-smart and environmentally sustainable healthcare waste management practices across four PHC facilities in Abuja, Nigeria, to test the assessment approach and inform intervention design. Methods We conducted a proof-of-concept comparative baseline assessment across four purposively selected PHC facilities (Apo PHC, Kagini PHC, EHA Clinics, and Lugbe PHC) in Abuja, Federal Capital Territory. This pilot was designed to establish the feasibility of a structured facility audit approach and to generate baseline data ahead of the ClimateSENSE intervention, rather than to produce population-level prevalence estimates. Using a structured 14-domain audit tool, data were collected through direct observation, staff interviews, and document review. Composite scores were computed for each domain, and an overall readiness score (maximum 275) was derived for each facility. Facility-level waste-related carbon dioxide (CO 2 ) emissions were estimated using a WHO-aligned approach (0.2 kg of waste per patient per day; emission factor 0.8 kg CO 2 per kg of waste). Findings are reported across all domains, with emphasis on environmental and climate practices, waste treatment, and disposal. Results Composite readiness scores ranged from 43.6% (Kagini PHC, low-to-moderate) to 84.7% (EHA Clinics, high readiness). Waste segregation was the strongest domain (75–100% across facilities), but data systems were weak: 50% of facilities did not measure waste quantities, and 75% kept no records. Half of the facilities stored waste for more than 48 hours. Environmental and climate practices were the weakest domain: only one facility (25%) used renewable energy for waste treatment, 75% did not track carbon emissions, and open burning was the primary disposal method in 75% of facilities, with all facilities (100%) using fuel accelerants. Functional autoclave capacity was limited to 50% of facilities. Estimated baseline waste-related emissions totalled approximately 7.7 tonnes CO 2 per year across the four facilities (WHO patient-load basis); self-reported waste volumes were substantially higher and internally inconsistent with patient load. Over two years, facilities reported an average of 1.5 needle-stick injuries and 1.5 staff exposure incidents, despite universal Hepatitis B vaccination coverage. Conclusions Healthcare waste management in these facilities is partially functional but uneven, with the most critical failures concentrated at treatment and disposal, where environmental sustainability remains peripheral. Open burning, absent emission tracking, and the non-use of renewable energy represent critical gaps in climate-smart practice. The ClimateSENSE intervention, which deploys solar-powered autoclaves, strengthens segregation systems, and builds frontline capacity, is well-positioned to address these gaps. These proof-of-concept findings support the feasibility of the assessment approach and motivate larger, representative studies of environmentally sustainable PHC waste management across Nigeria and comparable low- and middle-income country settings.