Exploring pharmaceutical waste management in Southern Africa: a scoping review.

Pharmaceutical waste management is an emerging health and environmental concern, particularly in low- and middle-income countries with limited waste infrastructure. This scoping review examined pharmaceutical waste practices and policies in Botswana, Eswatini, Lesotho, Namibia and South Africa at the healthcare facility and household levels. We systematically searched databases and grey literature sources from 2004 to 2024. Out of 729 research studies and 129 reports identified, we included 28 publications. The results were synthesised to show segregation, treatment and disposal practices. Regulatory frameworks existed in most countries, but often lacked detailed guidance and effective enforcement. Definitions of pharmaceutical waste varied, and documentation practices were inconsistent. Inappropriate practices of pharmaceutical waste management, such as inadequate incineration and landfilling conditions, were frequently reported. These findings are concerning and indicate a need for clearer, context-appropriate policies, stronger implementation mechanisms, improved segregation systems and further research, particularly at the household level.