Abstract Healthcare Waste Management (HCWM) is paramount for public health, environmental protection, and ensuring safety in healthcare facilities. Despite its global recognition and alignment with several United Nations Sustainable Development Goals, including health, sanitation, and environmental conservation, HCWM remains under-resourced in many countries, including Malawi. The nation's healthcare system, spanning public to private sectors, has established regulatory frameworks and policies to guide HCWM, such as Malawi Standards and the National Environmental Health Policy. This study seeks to critically assess HCWM in Malawi, highlighting its current strengths and weaknesses, with an aim to identify challenges and suggest avenues for improvement to ensure a safer healthcare ecosystem. This study evaluates the nation's HCWM practices, identifies challenges, and recommends improvements to foster a safer healthcare system. The assessment of Healthcare Waste Management (HCWM) in selected Malawian healthcare facilities revealed inconsistencies in waste quantification, segregation, and treatment. Facilities exhibited unsafe waste transportation and storage, with prevalent use of inadequate incineration methods. Additionally, waste handlers lacked essential Personal Protective Equipment and were unvaccinated against Hepatitis B. Despite a comprehensive HCWM policy, notable gaps persist in the legal framework and practical application.