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115 Waste Management Essay Topic Ideas & Examples

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Waste management is a crucial issue in today's world, as the amount of waste produced continues to grow at an alarming rate. From household trash to industrial waste, finding sustainable solutions for managing and reducing waste is essential for protecting the environment and public health.

If you're tasked with writing an essay on waste management, you may be struggling to come up with a topic that is both interesting and relevant. To help you get started, here are 115 waste management essay topic ideas and examples that you can use as inspiration for your own writing:

• The importance of proper waste management in protecting the environment
• The impact of waste management on public health
• Strategies for reducing household waste
• The role of recycling in waste management
• The benefits of composting for waste reduction
• The challenges of managing electronic waste
• The environmental impact of plastic waste
• The economic benefits of sustainable waste management practices
• The ethical implications of waste disposal methods
• The role of government in regulating waste management
• The impact of waste management on climate change
• The potential for waste-to-energy technologies to reduce landfill waste
• The importance of educating the public about waste management
• The role of businesses in implementing sustainable waste management practices
• The social justice implications of waste management
• The impact of waste management on wildlife and ecosystems
• The benefits of using biodegradable materials to reduce waste
• The challenges of managing construction and demolition waste
• The potential for using waste as a resource in circular economy models
• The role of technology in improving waste management processes
• The impact of food waste on global hunger and food security
• The benefits of implementing zero-waste initiatives in communities
• The role of NGOs in promoting sustainable waste management practices
• The potential for using drones to monitor and manage waste
• The impact of waste management on water quality
• The benefits of community-based waste management programs
• The challenges of managing hazardous waste
• The potential for using blockchain technology to track waste disposal
• The role of education in promoting sustainable waste management practices
• The impact of waste management on air quality
• The benefits of waste segregation and sorting programs
• The challenges of managing medical waste
• The potential for using robots to automate waste sorting processes
• The role of public-private partnerships in improving waste management
• The impact of waste management on urban planning and development
• The benefits of using anaerobic digestion to process organic waste
• The challenges of managing electronic waste in developing countries
• The potential for using machine learning algorithms to optimize waste collection routes
• The role of social media in raising awareness about waste management issues
• The impact of waste management on biodiversity conservation
• The benefits of implementing extended producer responsibility programs
• The challenges of managing marine litter
• The potential for using satellite imagery to monitor illegal waste dumping
• The role of indigenous communities in sustainable waste management practices
• The impact of waste management on land degradation
• The benefits of using biochar to improve soil quality
• The challenges of managing radioactive waste
• The potential for using 3D printing to create products from recycled materials
• The role of artists in raising awareness about waste management issues
• The impact of waste management on social inequality
• The benefits of implementing pay-as-you-throw waste pricing schemes
• The challenges of managing agricultural waste
• The potential for using blockchain technology to create a transparent waste management system
• The role of citizen science in monitoring waste pollution
• The impact of waste management on tourism
• The benefits of using drones to collect and transport waste
• The challenges of managing industrial waste
• The potential for using gene editing technologies to break down plastic waste
• The role of policymakers in promoting sustainable waste management practices
• The impact of waste management on public perception of cities
• The benefits of using algae to clean up wastewater
• The challenges of managing construction and demolition waste in urban areas
• The potential for using artificial intelligence to optimize waste management processes
• The role of community gardens in reducing food waste
• The impact of waste management on mental health
• The benefits of using green roofs to reduce stormwater runoff
• The challenges of managing asbestos waste
• The potential for using drones to monitor landfill sites
• The role of youth groups in promoting waste management education
• The impact of waste management on renewable energy production
• The benefits of implementing waste audits in businesses
• The challenges of managing wastewater treatment sludge
• The potential for using geospatial technologies to map waste hotspots
• The role of religious organizations in promoting waste reduction
• The impact of waste management on indigenous rights
• The benefits of using blockchain technology to create a circular economy
• The challenges of managing pharmaceutical waste
• The potential for using robots to clean up ocean plastic pollution
• The role of community activists in advocating for waste management reform
• The impact of waste management on green jobs creation
• The benefits of using drones to monitor illegal waste dumping
• The challenges of managing construction and demolition waste in rural areas
• The potential for using satellite imagery to track waste flows
• The role of citizen science in monitoring air quality near waste facilities
• The impact of waste management on water scarcity
• The benefits of using biopesticides to control pests in waste management facilities
• The challenges of managing medical waste in conflict zones
• The potential for using machine learning algorithms to predict waste generation patterns
• The role of grassroots organizations in promoting waste reduction
• The impact of waste management on mental well-being
• The benefits of using drones to monitor illegal waste dumping in remote areas
• The challenges of managing electronic waste in rural communities
• The potential for using blockchain technology to create a decentralized waste management system
• The role of community gardens in promoting sustainable waste management practices
• The impact of waste management on social cohesion
• The benefits of using drones to monitor waste collection routes
• The challenges of managing hazardous waste in developing countries
• The potential for using machine learning algorithms to optimize waste sorting processes
• The role of social entrepreneurs in developing innovative waste management solutions
• The benefits of using blockchain technology to create a transparent waste management system

These waste management essay topic ideas and examples cover a wide range of issues and perspectives, giving you plenty of options to explore in your writing. Whether you're interested in the environmental, social, economic, or technological aspects of waste management, there's sure to be a topic that piques your interest. Good luck with your essay, and happy writing!

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Waste management, waste indicators and the relationship with sustainable development goals (sdgs): a systematic literature review.

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Ram, M.; Bracci, E. Waste Management, Waste Indicators and the Relationship with Sustainable Development Goals (SDGs): A Systematic Literature Review. Sustainability 2024 , 16 , 8486. https://doi.org/10.3390/su16198486

Ram M, Bracci E. Waste Management, Waste Indicators and the Relationship with Sustainable Development Goals (SDGs): A Systematic Literature Review. Sustainability . 2024; 16(19):8486. https://doi.org/10.3390/su16198486

Ram, Meetha, and Enrico Bracci. 2024. "Waste Management, Waste Indicators and the Relationship with Sustainable Development Goals (SDGs): A Systematic Literature Review" Sustainability 16, no. 19: 8486. https://doi.org/10.3390/su16198486

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Waste Management Dissertation Topic Ideas

Published by Owen Ingram at January 2nd, 2023 , Revised On August 11, 2023

Choosing an ideal waste management dissertation topic can be challenging. In order to ensure a healthy environment, we must learn to manage waste in a responsible manner. Contribute to the body of knowledge in the field, capture the reader’s attention in an important area that is usually overlooked, and maintain an academic tone by choosing a relevant and unique waste management thesis topic from the list below.

For you to avoid the headache and have a pleasant dissertation writing experience, our subject matter experts have compiled a free list of the top custom waste management dissertation topic ideas.

You can quickly select one that appeals to you and conduct your research on it by reviewing the following list of possible waste management dissertation topics:

List of Waste Management Dissertation Ideas

• Investigating how decision-making affects waste management optimization.
• Determining the elements that might reduce risk in situations involving the handling of hazardous waste.
• An examination of the impact of environmental legislation on garbage from building
• Identifying the potential environmental risks associated with solid waste management and greenhouse emissions.
• An original investigation of the influence of gender on attitudes and perceptions of trash management in the UK.
• Should we mine landfills for their valuable metals as part of the waste-to-resources process? Weighing the risks and the profits
• Examine the population’s compliance with trash management in urban vs Rural parts of the UK.
• A study of the significance of managing nuclear waste.
• An evaluation of the impact of industrial waste metals in the UK on agricultural output and soil fertility and the harmful consequences of these items on consumers’ health.
• Impact of oil spills on coastal waters: a comprehensive analysis. A thorough examination of each oil leak incident between 2000 and 2020, including an environmental impact assessment.
• High-level versus low-level radioactivity wastes are compared regarding safety regulations for managing radioactive waste.
• An innovative study on recycling garbage into usable, ecological building materials. How will it affect the UK’s building industry, and is it practical?
• A comparison of textile waste from pre- and post-consumer sources.
• Focus on developing nations for the effects of toxic animal manure on human health and the environment.
• An investigation into the UK’s regulations for treating industrial wastewater from companies near rivers, lakes, and the sea.
• A comparison and analysis of the ongoing argument between waste minimization and waste management. Weighing the benefits and drawbacks.
• Economic benefits of better treatment plant construction for sustainable solid waste management.
• Implementation and policy of solid waste management in emerging and rich economies are compared.
• Waste management techniques in the fashion industry: possible difficulties and necessary solutions.
• How virtual and visual aids can be used to teach waste management at the university level?
• Focusing on X countries, local government involvement in municipal solid waste management policy.
• Comparative examination of e-waste management practices in the world’s poorer nations.
• Descriptive research looks into waste management methods’ effects on human health.
• Using a descriptive method, we investigate polymer waste’s biodegradation, incineration, and recycling.
• Creation of a hypothetical waste management strategy for a project in a developing nation during construction.

For your convenience, our senior industry professionals have also compiled a list of fantastic waste management dissertation topic ideas that you can use to create your own topic. However, if you still need further help in dissertation writing, our expert writers are available to help you out.

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• How will you meet your standards for waste diversion during public/private events?
• How will you use assessments to monitor and adapt your waste management program?

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...you continue to fall short of the threshold for waste diversion?

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The wicked problem of waste management: An attention-based analysis of stakeholder behaviours

Giuseppe salvia.

a The Bartlett Faculty of the Built Environment, University College London, 14 Upper Woburn Place, WC1H 0NN, London, UK

Nici Zimmermann

Catherine willan.

b UCL Institute for Sustainable Resources. Central House, 14 Upper Woburn Place, WC1H 0NN, London, UK

Joanna Hale

c UCL Centre for Behaviour Change, 1-19 Torrington Place, WC1E 7HB, London, UK

Hellen Gitau

d African Population and Health Research Center (APHRC), P.O. Box 10787-00100, APHRC Campus, Kitisuru, Nairobi, Kenya

Kanyiva Muindi

Evans gichana.

e County Government of Kisumu, P.O. Box 2738-40100, Kisumu, Kenya

Mike Davies

Surging amounts of waste are reported globally and especially in lower-income countries, with negative consequences for health and the environment. Increasing concern has been raised for the limited progress achieved in practice by diverse sets of policies and programmes. Waste management is a wicked problem characterised by multilayered interdependencies, complex social dynamics and webs of stakeholders. Interactions among these generate unpredictable outcomes that can be missed by decision makers through their understanding and framing of their context. This article aims to identify possible sources of persistent problems by focussing on what captures, shapes and limits the attention of stakeholders and decision-makers, drawing on the attention-based view from organisation theory. The theory describes the process through which issues and opportunities are noticed and how these are translated into actions, by focussing on the influencers at the individual, organisational and context scale. Views on issues and opportunities for waste management were collected in a series of fieldwork activities from 60 participants representing seven main types of stakeholders in the typical lower-middle income Kenyan city of Kisumu. Through a thematic analysis guided by the attention-based view, we identified patterns and misalignment of views, especially between government, community-based organisations and residents, which may contribute to persistent waste problems in Kisumu. Some point to detrimental waste handling practices, from separation to collection and treatment, as the main cause of issues. For others, these practices are due to a poor control of such practices and enforcement of the law. This study's major theoretical contribution is extending the application of attention theory to multi-stakeholder problems and to non-formalized organisations, namely residents and to the new field of waste management. This novel lens contributes a greater understanding of waste issues and their management in Africa that is relevant to policy and future research. By revealing the “wickedness” of the waste problem, we point to the need for a holistic and systems-based policy approach to limit further unintended consequences.

Graphical abstract

• • Attention-based view helps understand multi-stakeholder waste management problems.
• • Our analysis highlighted individual, social and contextual factors driving attention.
• • Household behaviour and government control are pointed as main source of the issues.
• • Misaligned scales in issues and moves across stakeholders must be tackled.
• • We rapport waste management wicked problem to multiple actors and agendas.

1. Introduction

Waste management is a global challenge ( Wilson and Velis, 2015 ) because of the significant fraction of greenhouse gas emissions generated by waste treatment and disposal ( Kaza et al., 2018 ), and a priority to be addressed to ensure sustainable production and consumption ( United Nations, 2020 ). The pressure is acute in low and lower-middle income countries, where growing amounts of waste caused by increased population ( Wilson and Velis, 2015 ), urbanization trends and economic development ( Modak et al., 2016 ) have produced alarming negative impacts, primarily on human health and the environment ( Ferronato and Torretta, 2019 ; Hyman, 2013 ). Lower-middle income countries account for about a third of the waste generated globally, with sub-Saharan African countries in particular projected to triple the amount of generated waste by 2050 ( Kaza et al., 2018 ). These countries are most affected by ineffective waste management, especially because of a lack of infrastructure, proper management planning as well as insufficient financial resources, technical expertise and public attitude ( Srivastava et al., 2015 ).

Kenya is one of the many countries in sub-Saharan Africa affected by the problem of waste ( Kaza et al., 2018 ). This study focusses on Kisumu, a typical example of a growing city in Kenya, which has experienced significant challenges in relation to insufficient waste management systems ( Gutberlet et al., 2017 ). In Kisumu, and Kenya more broadly, diverse policies have been developed and implemented to address the reduction and optimization of waste management ( World Health Organization, 2018 ). The Kenyan Solid Waste Management Strategy ( NEMA, 2015 ) intends to foster the uptake of efficient technology, yet technological solutions alone are likely to be insufficient to the problems of increased waste, as waste management is driven by multi-dimensional factors ( Guerrero et al., 2013 ).

A recent bill on waste management by the County Government emphasizes the importance of public participation and the collaboration with relevant stakeholders ( County Government of Kisumu, 2020 ); this resonates with the recommendation of previous research indicating that the multidimensional nature of waste management in Kisumu “requires the active participation of all relevant stakeholders including the City Board Management, civil society, NGOs, CBOs, waste private collectors and entrepreneurs” ( Sibanda et al., 2017 , p. 399). In other comparable contexts, the engagement of multiple stakeholders has been pursued in the past, especially in informal settlements. Public-private partnerships have also been recurrently explored ( Ma and Hipel, 2016 ), on the grounds that public provision of waste management is inferred to yield worse results in countries with lower GDP ( Simões and Marques, 2012 ); nevertheless the engagement of the private sector does not ensure successful results ( Simões et al., 2012 ). Some projects have also engaged residents and waste pickers in collaborative development of basic services with local governments (e.g. Zapata Campos and Zapata, 2013 ), yet many challenges are faced by these types of projects ( Kain et al., 2016 ).

Previous efforts have attempted to engage a wide set of stakeholders in the development of waste strategies in Kisumu. Nevertheless, both policy and research raise concerns about the limited impact that policies have achieved in practice ( Kain et al., 2016 ). Kain et al. (2016) highlight how a mismatch of views about waste may contribute to the problem. Through analysis of the effects of a plan for waste management in Kisumu, they inferred that policy developers' reframing of waste, from a dirty problem into a resourceful service, was not consistent with the views of other stakeholders, both those directly involved in waste management (such as waste pickers and residents), and those not directly involved (e.g. landlords or residents of some settlements). These other stakeholders did not share the policy developers’ view of change, and some prioritised coping with other difficulties. Ultimately this hindered the anchoring of the Kisumu waste management programme in a fully successful fashion, especially in some informal settlements ( Kain et al., 2016 ).

This study considers how theories of organisational attention could explain mechanisms that drive how stakeholders notice and process changes. Organisations hold understandings of problems, opportunities and the surrounding context which drive their actions towards (sustainable) change. In organisation studies these include collective action frames ( Blomsma, 2018 ) and the institutional logics perspective ( Arena et al., 2018 ; Gregori and Holzmann, 2020 ). Nevertheless, such understandings are not comprehensive and risk failing to capture critical dynamics. By contrast, theories of organisational attention suggest that organisations are problem-solving entities with limited attention; understanding the behaviour of organisations and their ability to adapt to change requires the understanding of how the attention of their decision makers is distributed and regulated ( Ocasio, 2011 ) for making sense of the environment and its changes ( Hoffman and Ocasio, 2011 ). A multitude of factors within an organisation determine if and how crises are identified, interpreted and addressed, as well as the consequences of the actions enacted (or not) to respond to them ( Ocasio, 1997 ).

A comparative and detailed investigation of how diverse local stakeholders understand the management of waste in Kisumu, and what should be changed, is still missing in our knowledge, despite some appreciable contributions (e.g. Kain et al., 2016 ). This study addresses that lack. We aim to identify what drives and shapes the attention of decision makers in order to add further insight about the discrepancies among stakeholder views on local waste management reported by Kain et al. (2016) . The objective is to find whether and how some of the criticalities and unintended consequences in waste management result from what drives the attention of relevant players, and therefore disparities of what they consider salient. In order to test the alignment of understandings, we engaged stakeholders to represent the diverse sectors involved, i.e. government, industry and trading, community-based and non-governmental organisations, academia, and residents’ associations.

The reminder of the article is structured with a preliminary summary of the Attention-Based View of the organiation (ABV), used to analyse the results of the fieldwork activities (section 2 ), followed by the methods for data collection and analysis, including a brief description of the case study (section 3 ). The results (section 4 ) present two main themes resulting from the analysis: stakeholder views on waste handling practices; and assessments of government's role in these. These themes are discussed by expanding on what constitutes an issue for the stakeholders involved, and the limits in the ways this is addressed, from which we argue that waste management is a ‘wicked problem’ (section 5 ). The key insights and contributions of the article are summarized in the conclusion (section 6 ).

2. Attention based view (ABV): theory and applications

This study draws on organisational research addressing “the socially structured pattern of attention by decision makers within an organisation” ( Ocasio, 1997 , p. 188). Diverse elements drive decision makers’ attention, according to a review of the literature ( Suzuki, 2017 ), including organisational goals, strategy and identity; characteristics of decision makers, individual or collective schemas, cognitive models of key decision makers; organisational positions and roles. These elements reflect that “attention is not a unitary concept but a variety of interrelated mechanisms and processes” ( Ocasio, 2011 , p. 1286). ABV is a theory of organisational decision-making and action developed by Ocasio. Drawing on Simon (1947) , Ocasio (2011) provides an explicit treatment of attention to explain organisational behaviour as a situated, variable, multilevel process that combines cognition and structure. Specifically, cognitive processes are engaged at both individual (i.e. the carrier of focussed attention) and social level (i.e. contextually shared understandings and values). Social, economic, and cultural structures operate in the organisation and determine how attention is distributed. For its multilevel approach, ABV is considered a cornerstone breaking engrained assumptions in the field ( Kaplan et al., 2001 ) and it has been used successfully to explain organisational decision-making processes, organisational change and management innovation, amongst others ( Ferreira, 2017 ). However, its application to understanding waste management has been limited to date.

Ocasio (1997 , p. 189, emphasis in original) defines organisational attention as the process of “noticing, encoding, interpreting, and focussing of time and effort by organisational decision-makers on both (a) issues (…) and (b) answers ”. Issues indicate the available repertoire of categories for making sense of the environment, which include problems and threats, as well as opportunities; whereas answers refer to the available repertoire of action alternatives, including proposals, routines, projects, programs, and procedures ( Ocasio, 1997 ). According to Ocasio's model ( Fig. 1 ), issues and answers are conveyed and distributed into specific procedures and communication channels, i.e. the formal and informal activities, interactions, and communications set up by the organisation to induce decision makers to action; these include meetings, reports and protocols. Attention is situated in these channels and therefore managers' attention is conditioned by the interactions between them ( Joseph and Ocasio, 2012 ).

ABV model; simplified version of the original one by Ocasio (1997) representing the process according to which (from left to right) issues and answers in the decision environment are shaped by attention structure and progressively elaborated through procedural and communication channels in order to guide decision makers towards the enactment of organisational moves. The arrows indicate the direction of the influences between the elements of the model.

The distribution of issues and answers into the channels is catalysed by attention structures, i.e. the social, economic, and cultural rules that govern the allocation of time, effort, and attentional focus of organisational actors in their decision-making activities (March and Olsen, cited in Ocasio, 1997 ). Attention structures include contextual rules about how to interpret and operate in reality; players with their skills, beliefs and values; roles and relations within and outside the organisations; and resources necessary for the organisation to perform activities.

Procedural and communication channels as well as attention structures determine the salience of the issues and answers to be attended to; although potentially confusing in their naming, they introduce concrete actions and context respectively in the decision-making process ( Barnett, 2008 ).

These mechanisms guide decision makers towards the definition of organisational moves , i.e. “the myriad of actions undertaken by the firm and its decision-makers in response to or in anticipation of changes in its external and internal environment” ( Ocasio, 1997 , p. 201).

In this study, we apply Ocasio's theory to explore issues , answers and moves as the focus of our investigation. Issues and answers are of paramount importance, because these two “together constitute the corporation's agenda and are central to adaptation and change” ( Joseph and Ocasio, 2012 , p. 637). Therefore, they are envisaged here as principal proxies for the identification of critical elements. The exploration of moves is likewise relevant in progressing towards issues and answers as well, because, once enacted, the organisational move becomes part of the environment of decision making, and in turn inputs to the construction of subsequent organisational moves ( Ocasio, 1997 ). Also known as ‘automorphism’, such use of past strategies may institutionalize solutions and therefore gain legitimacy not only within the actant organisation but also in the wider field ( Schwartz, 2009 ).

3. Materials and methods

3.1. the case study of solid waste management in kisumu.

This study addresses the issues and solutions envisaged by the stakeholders of waste management in the Kenyan county of Kisumu ( Fig. 2 ), where poor health and the degraded environment are associated with improper disposal of municipal solid waste ( County Government of Kisumu, 2019 ). Population growth, urbanization and lifestyle change, accessibility and illegal dumping are some of the socio-economic and geographical conditions putting pressure on the management of waste for the county, as well as for the wider country ( Henry et al., 2006 ).

Map of Kisumu county.

The county of Kisumu is inhabited by 1.1 million ca. people ( Kenya National Bureau of Statistics, 2019 ), with an overall population growth trend projected for the next decades ( United Nations, 2019 ). About half of the population resides in urban areas, especially in Kisumu city, which is the third largest city in Kenya ( Kenya National Bureau of Statistics, 2019 ). About 60% of the urban population is estimated to live in slums and peri-urban settlements ( United Nations Human Settlements Programme (UN-HABITAT), 2005 ), which are densely populated areas with limited access to basic services, including piped water ( Frediani, 2015 ), electricity, sanitation, and solid waste management services ( Onyango et al., 2013 ). In the slums, most household waste remains uncollected, mostly because of accessibility and financial constraints ( Munala and Moirongo, 2011 ), and is dumped along roads, alleyways or in vacant lots, leading to appalling conditions ( Gutberlet et al., 2017 ).

Kisumu County generates about 200–450t of solid waste per day, mostly composed of organic material, e.g. food waste ( County Government of Kisumu, 2019 ), in line with other low- and middle-income countries ( Modak et al., 2016 ). Trends of increased waste generation are associated with lifestyles changes ( Munala and Moirongo, 2011 ), possibly in conjunction with urbanization.

The generated waste is handled by both public and private stakeholders. The Kisumu Integrated Solid Waste Management Plan (KISWaMP) combines centralized modes of service provision with grassroots initiatives for expanding the coverage of waste management services to informal settlements where open pits are widely used to manage solid waste ( County Government of Kisumu, 2017 ). Waste is either collected, disposed of in collection stations, dumped or burned. The door-to-door collection is operated by private collectors in affluent neighbourhoods, whereas community-based organisations (CBOs) and non-governmental organisations (NGOs), as well as individual waste scavengers, are mostly operative in the informal settlements. CBOs are groups of individuals who organise themselves to provide waste services in their (usually poor) neighbourhoods; this represents for many an opportunity for both income and a clean environment for the community ( Aparcana, 2017 ).

Waste in the small city centre and the markets is collected by the county government. Only about 20%–40% of the total generated waste is collected for disposal at the city's open landfill ( Dianati et al., 2021 ). Open burning of waste for more than 50 years, only two km from the capital centre ( Awuor et al., 2019 ), at the so-called Kachok dumpsite has raised concerns around insecurity, public health, and environmental degradation ( Sibanda et al., 2017 ). Efforts towards relocating this overflowing dumpsite to a larger site farther away from the city centre have so far not been very successful, mainly because of residents' resistance.

The majority of waste remains uncollected and mostly illegally-disposed, namely openly burnt or dispersed in the environment in garbage heaps and litter everywhere ( Munala and Moirongo, 2011 ), such as alongside roads or on vacant land ( Sibanda et al., 2017 ). Improper waste disposal and management in Kisumu are associated with scarce human and financial resources, poor organisational structures, inadequate legislation and weak enforcement, poor public attitude and low awareness of waste management ( County Government of Kisumu, 2017 ).

3.2. Engaging stakeholders across multiple sectors

The study is informed by a set of nine fieldwork activities, including workshops, focus groups and interviews, held in Kisumu in July 2019 with stakeholders of local waste management. Two workshops were held for a variety of stakeholder participants to agree first on a local challenge to be addressed in a bid for funding; the challenge agreed upon was municipal solid waste management. Subsequent focus groups and interviews aimed to collect the views and experiences of stakeholders on this challenge. The participants represented different sectors, specifically civil servants in the county government, academic lecturers, industry and trading associations, CBOs and NGOs, and representatives of the local resident community.

Purposive sampling was used for the invitation of the participants, based on their knowledge of the waste management and sector. Participants were gathered in groups according to their sector (except for the first workshop which covered multiple sectors), with the aim to elicit ‘group thinking’ (Brown, 1999; cited in Robson, 2002 ) needed to identify patterns of attention distribution and organisational structures within sectors and clusters of organisations. The local government sector was represented by civil servants from departments addressing topics overlapping with waste management, including environment, climate change, energy and urban development. Academics invited were knowledgeable about waste management either through their teaching or research work. A further group of participant mobilizers were individuals from CBOs or NGOs, who reside in Kisumu. A participant from the sugarcane industry – a main industry for the local economy ( County Government of Kisumu, 2017 ) – and two from trading associations attended the focus groups; although limited in number their views complemented the wider picture of waste management. Finally, there were resident association representatives from underserved residential areas, mostly informal settlements in the city. All the participants are operative in the Kisumu county area. With a totalling 60 attendees, the number of participants in each research activity and their sector are summarized in Table 1 ; abbreviations for fieldwork activities are used to attribute quotes in the Results section, alongside an abbreviation to indicate the specific (male or female) respondent consistently with the transcripts of the activities (e.g. Resident, FR1).

Number and represented sectors of the participants of each research activity.

Each activity started with the participants being invited to introduce themselves and to provide an example of a relevant project on waste management, in which they have been involved. The set of questions for each focus group and interview was designed to inform different streams of the research and including: the goals of the stakeholder groups; barriers and enablers for the achievement of the goals; tensions between organisations and procedures to solve these; decision making processes; evidence use and types; and indicators of success. The number and type of questions were adapted according to the responses and the flow of the conversation in each activity.

The language of all fieldwork activities was English, except for Activity 9 with residents, in which both English and Swahili were used, with local staff members interpreting for the non-Swahili speaking researchers. All the activities were audio recorded with the approval of the participants, all of whom agreed with and signed the informed consent describing the purpose of the study and the research activity; anonymized verbatim transcripts (translated from Swahili where applicable) were provided to the researchers for their analysis informing this study.

3.3. Thematic analysis of issues and moves

The transcripts of the fieldwork activities were subjected to the six-phase thematic analysis by Braun and Clarke (2006) , a well-established method for identifying, analysing and reporting patterns within data (schema in Table 2 ). Thematic analysis is widely used in organisational research because it facilitates “the kind of sensitive, nuanced examination of organisational phenomena that qualitative research seeks to achieve” ( King and Brooks, 2018 , p. 233).

The six phases of thematic analysis. Reproduced from Braun and Clarke (2006) .

After having familiarized with the transcripts (Phase 1 in Table 2 ), the researchers associated codes to reflect the main features described by the text, a process known as coding (Phase 2). Coding followed a hybrid inductive and deductive approach; a preliminary codebook provided deductive (or predetermined) categories reflecting the main premises of the ABV theory for subsequent inductive (or bottom-up) coding, according to which codes are generated to reflect the contents of the data. The coding was performed in NVivo by two coders asynchronously, the work of whom was eventually integrated.

The set of codes was eventually analysed and reviewed for identification of themes (Phases 3 to 5). The themes presented in the Results are elaborated predominantly from the codes capturing two main elements of the ABV model, i.e. issues and organisational moves, when participants explicitly address waste management. The codes informing the themes are visualized in the Results section in Fig. 3 and Fig. 4 , for communication purposes (Phase 6) and transparency ( Gioia et al., 2013 ).

Thematic analysis of the theme ‘waste handling issues and their change’ (on the right). The theme is associated to a set of codes identified in the analysis of the transcripts of the research activities (on the left), which are grouped for convenience (in the centre).

Thematic analysis of the theme ‘poor government control and difficult political context’ (on the right). The theme is derived from a set of codes (on the left), which are grouped for convenience (in the centre).

Frequency of references within codes or themes occasionally reported in this article are to be interpreted as a potential beacon of interest for some participants on a specific topic. Reference counts may be affected by multiple conditions and in this qualitative study they are to be considered a potential topic to explore further in data ( King and Brooks, 2018 , p. 227).

Two main themes are identified from the analysis: the practice of managing waste, from its generation and separation to collection and treatment; and the practice of ensuring that waste is managed appropriately. The first theme focusses on what constitutes an issue or an opportunity when waste is handled, and how these issues are addressed by the involved stakeholders, such as households, businesses and service providers. The second theme focusses on the ways in which suboptimal, or illegal, waste handling practices are addressed by the government, including expectations and moves for encouraging or enforcing change. Together, the two themes address reciprocal – and often unmet – expectations of appropriate behaviours and roles between two main groups of players (the producers and mangers of waste on the one side, and the government on the other), revealing the different foci and structures driving their attention.

4.1. Issues and moves in handling waste

Local waste management is complex, and connected to a wider set of challenges, most notably with health and the environment:

“In Africa we've got all our challenges integrated” (CBOs/NGOs, MR7)

The ways in which waste is handled represent the most recurrent topic, and possibly the priority to be addressed in participants’ description of main issues. The following subsections summarise what participants reported about types of detrimental practices, from waste generation to final treatment, as well as the envisaged solutions for their change. The codes generated from the thematic analysis and associated with this theme are visualized in Fig. 3 .

4.1.1. The issues

The most recurrent issues raised across the fieldwork were numerous inadequate or illegal practices of waste handling, and their distribution across many actors. The various stakeholders implicated include: industries with inadequate waste treatment infrastructure (e.g. using burning chambers as incinerators, industry treatment plants); clinics dumping medical waste and even human remains in undesignated areas; waste collectors providing unauthorized services or inappropriately mixing separated waste; and – frequently – households separating their waste improperly, or disposing of it in public spaces (e.g. on roads, in markets). Participants associate significant negative consequences with inadequate waste handling, including both practical limits to the effectiveness of waste management operations, and health implications for operators and the wider population (e.g. because of contaminated water).

The causes of improper waste handling are attributed to multiple reasons and conditions, starting from a lack of the fundamental assets and infrastructure, such as skips, bins and compound facilities in clinics. Likewise, limited financial resources may constrain access to waste management services, namely for clinics or some low-income households, who cannot afford collection fees:

“That is one place skip don't reach there, there are no bins so people just manage their waste the way they think is best for them. So, they burn it.” (Bid2, MR5)

Residents are reported to be uninformed about appropriate ways of handling waste and the consequences of this for health, such as of flooding spreading diseases, because of drainage blocked by dumped waste.

Social norms and routines are also frequently pointed to as significant sources of issues. Improper disposal may hence be rooted in habits. For instance, participants believe that migrants from the countryside to the city are accustomed to disposing of organic waste that is generally biodegradable, and therefore fail to adapt to the need to dispose of non-organic waste in different ways. Moreover, a sense of ownership towards waste management and public spaces plays a role in these behaviours. Shared public understandings of responsibilities have traditionally framed waste as “government's business”, although this is now inconsistent with current regulations:

“if you look at even the waste management regulations it is very clear that it is the responsibility of the generator of that waste to manage it up to the point provided for the government. (…) Anywhere in between here is illegal dumping. So that has been the challenge that for them because also we have very weak infrastructure systems” (Government2, MR1)

In contrast to private houses, which are kept clean, roads and other common spaces are “nobody's land” (CBOs/NGOs, MR4) and waste is often carelessly left there. Traders, for instance, are blamed by those in the government focus group for their attitude to illegal dumping in their areas which may be convenient in the short run, rather than contributing to long-term solutions to the issue. This apparent carelessness provides, and to an extent justifies, jobs to waste collectors:

“<< I will throw this bottle anywhere because the county has employed someone who I assume is supposed to clean the city >>. (…) So, it is more an attitude problem that we are trying to deal with.” (Government2, MR1)

The waste workers are heavily stigmatised (for instance, being referred to as “warthogs”). Some participants want to see this stigma change (Resident MR3). Yet for others, appreciation of these workers' contribution to waste management remains an “impossible attitude” (Resident, MR2):

“[Hotels who refused to pay young task force] think these are just people for ‘takataka’ (Swahili: rubbish collectors)” (Resident, MR1)

Some participants point to meaning and priorities generally attributed to careful ways of handling waste, with a widely shared perception of waste as annoyance rather than a resource – although with notable exceptions reported in the next subsection.

Local policies and regulations as well as initiatives intended to trigger change towards sustainable waste disposal and effective management are in place, and indeed recurrently mentioned especially by the governmental officers, as well as by the industry representatives. Nevertheless, a lack of compliance, and resistance to change, is also frequently reported, notably being more often raised by the governmental sector (Government2 focus group and in the Bid2 workshop session in particular). Residents and representatives of CBOs and NGOs tended to frame these behaviours as disadvantageous (rather than non-compliant) and refer to them to a lesser extent.

4.1.2. The moves

In response to the apparent “illegal” or disadvantageous practices, several possible or enacted moves are reported by the participants, both for a better understanding of the issues, and for triggering change towards more effective waste handling. Local people (e.g. households, landlords, farmers) are often identified, especially by government representatives, as the main sources of issues. This leads to the view that better waste handling should be addressed by discovering the reasons for which they dump, or separate waste improperly, and then by triggering a change in their behaviours.

This behavioural change is proposed through strategies of either encouragement or enforcement. Encouraging strategies include the provision of incentives, e.g. tokens, for reshaping the perceived value of waste and of sorting it. In particular, participants frequently talk of “sensitising” through the provision of information, to raise awareness, and to educate the community and the waste collectors. The suggested means include the engagement of local champions, exhibitions and shows, developing educating platforms, and engaging in practical activities such as clean-ups with the local community. Some of these latter activities have been incentivised and sponsored by governmental organisations, as a proxy for encouraging participation of multiple stakeholders in waste management, and ideally shifting the perception of waste handling away from “the exclusive responsibility of government” (Government2, MR1). Indeed, the governmental sector together with CBOs (and to some extent the residents) mostly advocate sensitization and awareness raising around the importance of a clean environment.

Some participants acknowledge challenges in behavioural change. For instance, they say that extensive time may be required for households to routinise proper waste separation, thus requiring supplementary workforce in separating waste in the meantime, as suggested by a governmental participant. Nevertheless, behavioural change at household level is deemed insufficient by another participant, as the waste management system is not effective:

“(They) are trying to do separation at source and then the same county mixes the waste going to the dumpsite, waste being mixed then again, the waste pickers now do the sorting. You see, it is a bigger challenge.” (CBOs/NGOs, MR3)

This implies that other actors besides households should be encouraged towards better waste handling practices to achieve systemic change. This wider realm of stakeholders to be engaged and connected, most notably waste collectors, is recognized by a participant from the opening workshop:

“(…) you need to look at this holistically, about the issues that are there because you cannot manage waste when you don't have a proper schedule on how you need to collect it, and you cannot have a proper schedule also when you don't have people who are collaborating or cooperating with you to make the environment clean. So, all this boils to one thing that there must be public participation in the entire issue, the government does its role even if they are availing the skips and collection points and whatever, you must also be a co-operator, in terms of from your household, how you are bringing in this waste. The waste collectors, I mean the private, the private waste collectors are very important people, stakeholders in these aspects. Some of them have a proper way of even scheduling their collection either once or twice a week and they know the people, the households where they collect from. So, with time as you try and educate them and talk to them; they will be able to tell you, you can be able to assist us by doing this or that. So, from there you will also be able to learn and get something to know that if this and this is done, we shall succeed from this point of view.” (Bid2, MR1)

Partnerships and collaborations with many stakeholders are often proposed as a move to address the waste once generated, but there is less attention as to what could change behaviours to prevent it arising in the first place.

Networking players is also suggested for maximizing the residual value of waste. For instance, by the collection of organic waste (e.g. from hotels or schools) for use in the production of energy, thereby fostering the local economy. Circular approaches are recommended to supersede landfilling, currently a convenient option which discourages waste separation. Government could make such waste management approaches lucrative and attractive for private entrepreneurs through the incentivizing provision of infrastructure and financial resources, e.g. funding or tax relief for fostering recycling and youth employment, compostable bag production, or a shift to non-burn-technology for medical waste. Incentivizing actions are complemented by discouraging moves, ranging from the removal of services (e.g. skips from where these are abused by waste collectors and clinics), to better regulation, which is favoured by governmental stakeholders, ideally for limiting illegal dumping, inadequate waste separation, or ineffective recycling in industries.

Other types of moves include stronger enforcement, new policies, inspections, and de-registrations (i.e. of private waste collectors from networks or of providers allowed by the public sector when non-compliance is spotted). Inspections are recommended to inform on the misuse of skips and represent an “easier” way to ensure legitimacy in private clinics, with apparently successful results. Similarly, a resident suggests enforcing the principle of shared responsibility within the community, for example, by making citizens surveillant of disposal habits in a circle of close neighbours.

A final area of attention is the enforcement of a ban on the production of some plastic items, which raises conflicting views. The ban is said by an industry representative to have resulted from lobbying pressure on the government by environmental groups and other stakeholders to regulate the market producing waste, especially the high number of water-bottling companies. Banning the production of plastic bottles risks disincentivising recycling, leading to more plastics disposed of in the environment (CBOs/NGOs, MR7). An alternative to the ban is developed by the industry sector in an action plan approved by the government, for the collection of used plastic bottles for remanufacture.

4.2. Poor governmental control and the difficult political context

The inadequate practices of waste handling mainly reveal the view of issues and moves from the government perspective. The role of governmental stakeholders is highly relevant to waste management, for they have the legitimacy and ability to define the trajectories of issue resolution. Nevertheless, certain groups of participants often contested the effectiveness of their actions, seeing unmet expectations and thus representing a source of issues to be addressed in waste management. The codes informing this second theme are visualised in Fig. 4 .

This issue is raised most frequently by resident representatives and CBOs and NGOs as well as in the initial workshop; few or any references are coded across the other stakeholders. Many expect the government to address waste management better and more intensively by ensuring order through the enforcement of the law, and through implementing policies for change. Issues of order are raised with respect to compliance and illegal actions, to clarifications about procedures to be provided to the community, and to effective collection of separated waste. Policies are reported to be generic, with the resulting risk of amplifying the challenges due to lack of infrastructure.

Urban planners are accused of creating inadequate conditions, failing to deliver on or anticipate, for instance, convenient solutions for the local community; the reconfiguration of urban activities deriving from disruptive interventions; increased pressure on service from population growth over time; or missing designated areas for solid waste especially in informal settlements, which may encourage illegal dumping (Bid2, MR4):

“(W)hat is our planning system? Who is planning for us that I am generating waste in my house, what next should I do with it? should I throw it to my neighbors, should I throw it on the roadside or should I take it somewhere that our urban councils or county governments in a big or smaller way, I am trying to dig out that the planning aspect of it is a major issue that we can be able …. help us address this issue. After generating this waste in my house is there any place that is designated closer to where I am living, where I can take my waste then? Or must I go all the way seven kilometers where Kachok dumpsite is located? So, these are the queries.” (Resident, MR1)

Discussions about unmet expectations, contested actions, and perceived failings reveal possible sources of constraints for the government. These reflect the attentional structures and issues faced and reported by their representatives, including contextual political instabilities, rules of the game for politicians, and salience attributed by decision makers to different stakeholders. Politicians and governmental actors’ personal agendas and priorities are held to drive their moves, with respect to ongoing plans and projects:

“So, in the governor's directive now, because in his manifesto he promised Kisumu people that he will do away with Kachok. And he is already getting rid of Kachok with now timelines.” (Government2, MR4)

Our analysis suggests that two main players attract the attention of the local government and politicians: the national government and the local community.

On the one hand, local government is part of a larger structure with a top-level management at a national scale. The relationship and social norms across representatives of the country's two-tier governmental structure is reported to generate conflicts of interest instead of symbiotic working. Policies intended to bring about sustainable change require the approval of political decision makers, which may result in lobbying, and even bribery and corruption (Government1, MR8).

Likewise, some of the major issues and answers regarding waste management, including the creation of a dumpsite, may be envisaged as opportunities for monetary advantage, said to attract the attention of the political class and higher governmental levels, and thus becoming their interest rather than of the wananchi 's (Swahili: citizens'):

“(…) Waste management is not for the poor, it is for the rich.” (Government1, MR3)

On the other hand, the importance for politicians to produce visible and memorable outcomes attracting the attention of the voting local community (e.g. a borehole, a hospital) is a driving force in decision-making processes. This is supported by discussion regarding the allocation of budget to the departments at governmental level. This is observed to be often on the basis of the visibility of the actions (e.g. creating dispensaries or drilling boreholes, rather than cleaning the market), serving as proxies for increasing the chances of re-election for a political candidate.

“Unfortunately, decisions made at this level, a lot of it is driven by politics and politics is about perception. When I build a hospital or dispensary then I stand a chance of people seeing what I have done [… and be re-elected …]. When I clean a market, the traders may have a feeling of that impact. But even then, because it is something recurrent, tomorrow when you come back it is already dirty. So, it doesn't stick in mind. So that dispensary is more long lasting or a road or an ECD center. So, in order of priority they only seem to get the bowl first then whatever remains is given to the rest of us.” (Government2, MR4)

The dynamics of these two poles indicate how the moves operated by government to attract attention of decision makers, or other salient players, may in turn contribute to problems for waste management.

Notably, unlike the set of moves fostering change of practices of waste generators and handlers, there are few actions suggested to address these political issues, constraining rules of the game, procedure and attention structures of local government.

5. Discussion

The results of the study confirm how complex the system of waste management is in Kisumu, engaging a number of different stakeholders who pursue a variety of goals through their moves (summary of issues and corresponding moves in Appendix B ). This general outcome and several of the specific dynamics resonate with previous studies in this context, most notably with the issues of deprivation, financial scarcity, poor planning ( Kain et al., 2016 ), poor government control and enforcement ( County Government of Kisumu, 2019 ), ambiguity in responsibilities, ( County Government of Kisumu, 2019 ; Gutberlet et al., 2017 ), poor public attitude to proper waste management and infrastructural inadequacy ( County Government of Kisumu, 2019 ; Gutberlet et al., 2017 ; Kain et al., 2016 ; Munala and Moirongo, 2011 ; Sibanda et al., 2017 ).

Our thematic analysis identified two contrasting themes, corresponding to an opposite attribution of responsibility and expected actions from other stakeholders ( Guerrero et al., 2013 ); in summary these themes are inadequate waste handling according to the governmental sectors, and ineffective control mostly according to the local community. In our view, these contrasting themes largely emerge through the identification of multi-level drivers of attention enabled by ABV, and which contribute to explaining the discrepancy in views and perceptions of success in policy local implementations.

5.1. What constitutes inadequate practices and the limits of sensitisation?

The non-compliance of households in handling waste and resistance to positive change emerged in our first theme, and, consistently with literature ( Sibanda et al., 2017 ), is more recurrently reported by participants from the governmental sector. In our view, this pattern is possibly associated with the area of competence of our participants, and the way success is measured, i.e. the extent to which one of their main outputs (policies) are abided by.

A multitude of moves are proposed or reported as enacted by the participants to change residents' and other waste generators’ behaviours. Raising awareness and “sensitisation” are dominant reported moves by local government, and intended to trigger change in waste handling practices. Nevertheless, our results suggest that information may actually be available to the waste handling actors.

Behavioural science theory and research highlights that these information-provision based approaches are not necessarily sufficient to change behaviour ( Gatersleben et al., 2002 ; Kollmuss and Agyeman, 2002 ), nor are they the only behaviour change approaches available to policy makers ( Michie et al., 2011 ; West et al., 2019 ). Information and sensitisation typically aim to change people's understanding and attitudes, but it is well-established that there are gaps between forming an attitude, forming an intention to act, and actually acting ( Armitage and Conner, 2000 ).

A multitude of additional factors affect this practice and characterise the environment of the waste handlers, including rooted habits, financial and infrastructural scarcity, convenience and situated circumstances, perceived ownership and diffused responsibility. Although non-compliant with the law, the ways in which waste is disposed represent accessible solutions to other sets of more relevant or pressing issues.

In order to initiate a desired behaviour, such as sorting waste at source, or to stop an undesired behaviour, such as dumping on the roadside, people need to have sufficient capability (physical and psychological ability, e.g. skills and knowledge), opportunity (features of the physical and social environment, e.g. infrastructure and social norms) and motivation (reflective and automatic processes, e.g. beliefs and habits). These factors form the COM-B model of behaviour ( Michie et al., 2011 ). Stakeholders mentioned examples of each factor as a barrier to proper waste management. For example, a lack of knowledge about how to dispose of waste correctly (capability), a lack of resources such as easy-to-reach bins and skips to dispose of waste (opportunity), and beliefs that waste management is someone else's responsibility (motivation). Successfully changing behaviour in complex systems is likely to require a combination of different intervention types, including education, incentivisation, training, environmental restructuring ( Michie et al., 2011 ), and delivered through multiple policy actions, e.g. fiscal measures, legislation, service provision, communications ( Michie et al., 2009 ).

Nevertheless, evidence about if, and how, households’ environment and behaviours are explored by governmental players to make decisions is limited. Furthermore, consensus on how change towards more sustainable patterns of consumption occurs is not reached in scientific literature; the critiques that some dominant behaviour change approaches receive (e.g. Shove, 2010 ) reinforce how challenging such a necessary change in the way people frame and carry normality is, and major efforts are required to envisage and develop more robust, effective moves.

5.2. Structural determinants of government

Participants often attribute substantial if not sole responsibility for addressing waste management to the government. This interpretation may derive from former governmental arrangements, preceding the establishment of Kenyan Environmental Management and Coordination Act in 1999, which reallocated environmental responsibilities ( The Republic of Kenya, 1999 ). Despite the declared intentions and moves of engaging the wider set of stakeholders, the role of government will likely remain central in setting goals and coordinating actions.

Nevertheless, our analysis showed few suggested moves to change the way government acts (see Appendix B ). Possible reasons for this include the potentially more visible nature of issues associated with resident behaviours, and the difficulty of envisaging solutions to possibly perennial problems characterising government attention (e.g. political interests, pleasing voters, two-tier governance and budget constraints). Our results suggest how the capability of county government to trigger change is bounded by structural and procedural determinants across two poles attracting its attention, i.e. the top management and the local community to serve. An issue is salient when it “resonates with and is prioritised by management” ( Bundy et al., 2013 , p. 353). Nevertheless, the goals of the top management may not necessarily capture the changes important to the voting population. Bansal et al. (2018) elaborate on how organisations may fail to identify latent issues (especially for sustainability) because of the lack of procedural or communication structures to notice them, more specifically because of the inconsistency of scale of the processes that generate the issues.

The issue of scale is important, as in Kisumu the longer-term view of government that elaborates extensive plans and programmes appears temporally misaligned with issues for the local community affecting their shorter-term, or even daily, routines. On one side of the spectrum, the county government pursues strategies intended to meet environmental targets scheduled in five or even 35-year plans; whereas, on the other side of the spectrum, residents report on routinised habits of dealing with cooking waste, market shopping, and corporeal needs. Business, CBOs and NGOs fall in between the previous two, while seeking profits and economic sustainability over the following financial years.

Public participation is required by the constitution ( The Republic of Kenya, 1999 ) and results in a driving force in decision-making processes. The conventional procedural and communication channels deployed by the Kenyan government to collect the issues of the community are reportedly consultation in meetings and engagement in activities. Nevertheless, these means of expression and participation may not necessarily enable latent issues to surface ( Sanders, 2000 ) and therefore the community's underlying problems could easily persist.

The scarcity of financial resources, confirmed in literature ( Kain et al., 2016 ), paired with reported conflicts of interest and corruption when monetary opportunities arise, further restricts the possible pathways for change to be undertaken and may increase chances on unmet expectations from other stakeholders. Therefore, the complex and complicated dynamics characterising the whole set of attentional structures (i.e. players’ salience, organisational roles, sector rules, and resources), as well as the potentially underperforming conventional procedures and communication channels, possibly hinders the current capability for local government alone to trigger the transformational change that waste management in Kisumu requires.

Multiple pathways for government to limit issues and generate benefits towards waste management in low- and middle-income countries are suggested in literature. The participants and literature ( Awuor et al., 2019 ; Gutberlet et al., 2017 ) often recommend that the government increase its support to solid waste management; in our view, the ABV approach can help understand which structures need to be changed for this. A more structured participatory approach and involvement of stakeholders across the multiple stages of waste management is key, starting from the development of county integrated development plans, most notably residents and CBOs. We also support the recommendation of other studies about the closer and more sustained engagement of the informal sectors in waste collection especially ( Wilson et al., 2012 ). The main benefit usually envisaged is a capillary collection of scattered waste ( da Silva et al., 2019 ; Velis, 2017 ). The main advantage we foresee in the engagement of this intermediary is the bridging role that the informal sector may play between the narrower scale characterising the local community in waste handling, and the broader one of the government, in ensuring control. Informal waste collectors may inform and interpret between these two players, for their knowledge of both the context (with its social norms and needs) and the policy ambitions and procedures.

Consistent with a wicked problem, this solution necessarily raises new issues, including the increased attentional effort required in relating with more players ( Gutberlet et al., 2017 ), resistance to the formalisation of the engagement, competition with the formal sector ( da Silva et al., 2019 ) and criminal activities ( da Silva et al., 2019 ; Velis, 2017 ). Nevertheless, it remains to be understood if the benefits will offset the negative consequences.

5.3. Systems-thinking for handling the wicked problems of waste management

The results support the view of waste generation and treatment as multidimensional practices ( Sibanda et al., 2017 ), entangled in complex webs of interacting actors ( Gutberlet et al., 2017 ) and situated features, including social norms, political influences, financial availability, let alone infrastructural and technological implementations ( Guerrero et al., 2013 ). Our results indicate how organisational moves and opportunities envisaged by some may result in or be interpreted as issues or threats for others; for instance, convenient disposal in undesignated areas increasing collection pressure, banning of plastics disincentivising recycling, landfilling discouraging separation. The complexity, the social and the endless nature of the causal chains that link stakeholders, and interacting systems contribute to defining waste management as a wicked problem, which is apparently impossible to resolve ( Churchman, 1967 ; Rittel and Webber, 1973 ).

Systems-based approaches, especially participatory ones, may help towards such wicked problems that are characterised by multiple contrasting views ( Vennix, 1999 ), by limiting the risks of unintended consequences. Some studies adopted a system-based approach to tackle waste management in Kisumu and suggested diverse solutions, namely sensitisation, separation at source, and the formalisation of the informal sector ( Gutberlet et al., 2017 ; Munala and Moirongo, 2011 ).

Although approaching a complex system by pointing to its individual elements appears reasonable and convenient, we instead propose focussing the discussion on the source that underpins the multitude of issues, i.e. the multiple and varied views of the system across stakeholders, which may generate inconsistencies between expected and actual dynamics in the environment. A systemic study of waste management based on such multiple views could provide a detailed and more comprehensive understanding of dynamics and causal links that result in problematic issues. A lack of a systemic approach to waste management in Kisumu has been previously reported in literature ( Gutberlet et al., 2017 ; Sibanda et al., 2017 ). Nevertheless, traces of systems thinking emerged evidently in our focus groups, more frequently in governmental representatives, and CBOs and NGOs. This suggests an existing capability to deal with complex systems and linkages. Although the importance of operating holistically is acknowledged by these players, and echoed in the connections across challenges or envisaged solutions, the enacted moves may not necessarily reflect this systemic nature. For instance, whether internal procedures and organisational structure hinders the achievement of intended behavioural change was not raised by the governmental participants. This may be interpreted as inertia, with such structures seen as harder to change than the behaviour of households and other actors. Nevertheless, this interpretation may not reflect the view of the participants and the topic requires additional investigation.

Systems thinking may indeed be hindered by some structures and conditions, such as siloed working within governmental departments, financial constraints limiting the breadth of actions, the political agendas driven by elections; these appear affected by the narrower rather than systemic view of other salient players. In organisational attention literature, specialisation as well as integration of different viewpoints is generally considered important to overcome the limits of individual views and bounded rationality ( Vuori and Huy, 2016 ); this integration should be extended likewise outside the single organisation and across multiple players.

The integration between players faces some challenges. Gutberlet et al. (2017) pointed to weak links between them in Kisumu's informal settings. By drawing on the reflections by Bansal et al. (2018) , we suspect a risk of misalignment of scale occurring at their interfaces between stakeholders, which may result in undesirable effects. For instance, waste handling is a highly routinised activity with a short timescale for the local community (daily, weekly, monthly), yet the main proposed or enacted changes especially by government (e.g. more infrastructure and social norm perception) implies change on a long term. In this respect, issues and solutions between the two timescales could be compromised.

In this view, the main question to be addressed when dealing with waste management in Kisumu, and possibly elsewhere, regards the types of tools, strategies, and in particular organisational procedures and communication channels that could enable the link to be made between the multiple levels and players. We know that such procedural and communication channels play a fundamental role in the strategic adaptation of firms, by generating the decision-making patterns necessary to identify opportunities and respond to competitive threats ( Joseph and Ocasio, 2012 , p. 637). Our analysis suggests that not only intra-organisational, but also inter-stakeholder, procedures and communication channels are important for enacting systemic thinking, attention and moves. How could these channels within the involved organisations be arranged in order to notice, encode and interpret the dynamics occurring at different scales and linking multiple players? How can these surface latent issues across them? These questions require major efforts in future research intending to embrace the ABV approach for systemic change.

Finally, participatory approaches which engage the involved stakeholders in modelling of the system (e.g. Király and Miskolczi, 2019 ), including residents and intermediaries, are recommended for future studies as a proxy to both capturing the multiplicity of understandings of the issues, and identifying possible leverage for positive change in local waste management.

6. Conclusion

We conclude by remarking how waste management in low- and middle-income cities, such as Kisumu, is a wicked problem, for which a solution may not be achieved due to the number and complexity of actors who hold diverse views of the local system. Our study contributed by collecting and analysing the views of a considerable number of stakeholders, representing the variety of sectors engaged across the waste management process and policy making. Our results point to two main issues envisaged by the stakeholders in the persistence of issues: waste handling from separation to treatment in defiance of the law, more frequently pointed to by the government and CBOs; and the poor control over these disadvantageous practices according to others, most notably residents.

The resulting reciprocal blaming, and pointing predominantly to others as the main source of issues, reflects how normality is understood and pursued by the involved actors, who each carry different goals, boundaries of competence and responsibility, ways in which accomplishment is reached and success is measured. In explaining the source of the contrasting views, we infer that the complexity lies not only in the wider waste management system, as acknowledged by the literature, but also in the specific environment of each stakeholder, which is characterised by a multitude of priorities, factors and dynamics attracting their attention.

The research contributes to knowledge in three ways. First, it increases the understanding of waste issues and their management in Africa, where some dynamics, such as costs and efficiency in particular, are under-explored ( Simões and Marques, 2012 ), and specifically in Kisumu, where the perspective and engagement of diverse stakeholders is relevant and urgent ( Sibanda et al., 2017 ). Second, the study explores a novel use of attention theory for complex dynamics with multiple interacting actors towards sustainable change, including non-formalised organisations (e.g. residents); this methodological feature represents the most original contribution in our view, as we are not aware of similar applications of the theory, especially in waste management. Third, the study corroborates the emergent ‘wicked nature’ of waste management ( Laura et al., 2020 ), characterised by problems which are “ill-defined, ambiguous, and contested, and feature multi-layered interdependencies and complex social dynamics” ( Termeer et al., 2015 , p. 680), and demanding a holistic, system-based approach. The combination of these contributions may inform future methodological approaches to policy making in waste management, which elicit understandings and drivers of attention in multi-stakeholder settings.

We recommend future studies and policies to consider the multiple time and spatial scales characterising the attentional processes for the involved players, and to deliver implementations which address the dynamics at each level in order to plan and anticipate change. Systems-thinking approaches could help in this direction.

The validity and relevance of our results are necessarily constrained by some limits both in the use of the model and in the methodology. The attention-based model was developed and mostly applied for the understanding and representation of formalised organisations, typically firms ( Ocasio, 1997 ). In this study, organisations and stakeholder groups with more variable levels of formalisations than Ocasio's firms were explored and involved.

In this respect, decision-making across these organisations may not necessarily reflect all the mechanisms of the original model. Nevertheless, the fundamental contributions of the model in this study lie in some of its premises and multiple level mechanisms determining the salience of attended issues; and the recognition that enacted moves become part of the future environment of decision and affect the scope of issues which will be attended to.

This paper also suggests and exemplifies how stakeholder groups, in our case residents and CBOs, can be viewed as an entity from the perspective of the ABV. Like an organisation, they are not a homogeneous group, but their attention and decision-making are influenced by established procedural and communication channels and structures. The ability to consider organisations at different levels of formalisation and structure is a necessity for applying ABV to multi-stakeholder problems and provides much basis for future studies. Limits are methodical as well. In the fieldwork activities, the sectors are represented by an uneven number of participants, with a dominant presence of governmental representatives and a minority of representatives of the industrial and trading sectors in particular.

In future research, some of these limits may be resolved or addressed. Although it is not the authors’ aim to generalise the insights of this study, these findings may inform possible critical dynamics and elements of waste management to be further addressed in the future, both locally and in comparable contexts.

CRediT authorship contribution statement

Giuseppe Salvia: Conceptualization, Methodology, Formal analysis, Writing – original draft, Visualization. Nici Zimmermann: Conceptualization, Methodology, Investigation, Writing – original draft, Supervision. Catherine Willan: Methodology, Formal analysis, Writing – original draft. Joanna Hale: Methodology, Investigation, Writing – original draft. Hellen Gitau: Investigation, Writing – review & editing, Visualization. Kanyiva Muindi: Investigation, Writing – review & editing. Evans Gichana: Investigation, Writing – review & editing, Supervision. Mike Davies: Investigation, Writing – review & editing, Funding acquisition.

Declaration of competing interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Acknowledgments

We gratefully acknowledge the time and effort of the participants of the fieldwork activities held in Kisumu. The study was funded by the Wellcome Trust (CUSSH project, ref. no. 209387/Z/17/Z) and by the U.K. Natural Environment Research Council (CAMELLIA project, ref. no. NE/S003495/1).

For the purpose of open access, the author has applied a CC BY public copyright licence to any Author Accepted Manuscript version arizing from this submission.

Handling editor: Kathleen Aviso

Appendix A. 

Guide of the activities, including questions posed to the participants.

Appendix B. 

Summary of the results about reported issues, associated moves and new issues to face as either affecting the move or generated by the move. Issues and moves regarding governmental stakeholders are emphasised in light grey.

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• Published: 27 September 2024

A mountain of waste created daily: a thematic analysis of environmental sustainability experiences of postgraduate intensive care nursing students

• Fredrika Sundberg   ORCID: orcid.org/0000-0002-7400-6574 1 , 2 ,
• Heather Baid 3 &
• Åsa Israelsson-Skogsberg 4  

BMC Nursing volume  23 , Article number:  679 ( 2024 ) Cite this article

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Metrics details

The healthcare sector has a negative ecological impact, and intensive care is one of the most resource-consuming areas. Nurses have a duty to contribute to climate change reduction, design climate-resilient healthcare systems, and support individuals and communities in adapting to the effects of the planetary health crisis. It is essential to incorporate environmental sustainability into nursing education so that nurses can advocate for conscientious and ethically sustainable healthcare that benefits both patients and the planet. This study aimed to explore postgraduate intensive care nursing student experiences of environmental sustainability in clinical practice at intensive care units.

Data were collected using a qualitative questionnaire, and the data were analysed using inductive thematic analysis. The participants were 24 registered nurses studying postgraduate, specialist intensive care nursing courses at four universities in the south and west regions of Sweden.

The results describe critical care students’ environmental sustainability experiences in one overarching theme with five subthemes. Intensive care is a challenging context in terms of sustainability, where saving lives is the number one priority. There were good and bad sustainability habits among the staff, and awareness was key to improving. Clinical supplies come in unsustainable packages, and the participants wished for better alternatives and they wanted more knowledge and education on sustainable practices. The findings also emphasized the importance of a holistic perspective throughout each patient’s pathway.

Conclusions

Sustainability in intensive care units is somewhat unrecognised today, although intensive care nurses want that to change. The context where saving lives is prioritized makes implementing ecologically responsible practices a challenge. However, environmental sustainability in intensive care is feasible, with education needed for nurses to take on the responsibility of making improvements. Hospital management prioritizing sustainability is also important to support clinicians in implementing sustainable practices in intensive care units.

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Sustainable healthcare

The World Health Organization (WHO) recognises that worldwide climate change is a public health crisis of paramount significance [ 1 ]. Notably, the healthcare sector’s ecological impact would rank fifth globally among nations if assessed as an entity within the framework of environmental ramifications [ 2 ]. The adverse environmental impact attributable to the healthcare sector primarily emanates from production, consumption, waste management, and energy use requisite for the procurement of commodities and materials employed therein. This encompasses pharmaceuticals, technical apparatus, and other medical-technological equipment [ 3 ]. Numerous countries, Sweden included, have now enacted legislation to advance climate policy efforts, thereby safeguarding the environment, climate, and public health [ 4 , 5 ]. These legal requirements are sanctioned by constraining the adverse environmental impact of businesses and organisations while transitioning towards sustainable practices. The United Nations (UN) formulated 17 Sustainable Development Goals (SDGs), which are interconnected, indivisible, and harmoniously address the three dimensions of sustainable development: the economic, the social, and the environmental [ 6 ]. The United Nations World Commission defined the concept of sustainable development, from which these global goals emanate [ 6 ]:

“Meeting the needs of the present without compromising the ability of future generations to meet their own needs.” [ 7 ].

Intensive care and resource utilization

Intensive care aims to save human lives and admits, treats, and cares for the most critically ill patients in intensive care units (ICUs). To effectively monitor and treat patients with life-threatening conditions such as organ failure, substantial resources are necessary. The greater the consumption of materials in the care of critically ill patients, the more pronounced the environmental impact stemming from intensive care becomes [ 8 ]. A more adept and innovative utilization of the existing resources is necessary compared to the current practices, as the demands of healthcare are escalating and evolving [ 9 ]. Presently, there is a limited volume of research to guide environmentally sustainable healthcare within the context of intensive care nursing [ 10 ]. The COVID-19 pandemic highlighted the significance of intensive care for society while also emphasizing the resource-intensive nature of the operation in terms of equipment utilization and the considerable need for staff possessing the appropriate expertise.

Environmental sustainability and carbon footprint education

The International Council of Nurses (ICN) emphasized the need for incorporating the concept of environmental sustainability in nursing, as well as the integration of knowledge about the health implications of climate change into both education and continuous professional development for nurses [ 11 ]. After graduation, it can be challenging for nurses to reconcile the demanding healthcare environment with a focus on carbon footprint reduction and implementing environmentally sustainable choices in their daily practice [ 12 ]. A carbon footprint is the amount of greenhouse gases released into the atmosphere from the production, use and waste management of an item or activity; therefore, a carbon footprint represents how much the item or activity worsens climate change. Nurses are responsible for upholding and safeguarding the natural environment by reducing climate change and assisting individuals and communities in adapting to the effects of the climate crisis. Nursing leadership is imperative for taking immediate action to design climate-resilient healthcare systems [ 11 ].

Embedding environmental sustainability into nursing education is fundamental if students are to progress in their future profession to advocate for conscientious and ethically sustainable healthcare that benefits the patients without harming the planet [ 13 , 14 ]. Undergraduate nursing students assessed environmental sustainability and carbon footprint as significant aspects of healthcare, underscoring the need for their implementation into the educational curriculum [ 15 , 16 , 17 , 18 ]. Swedish universities vary in their progress in integrating these topics into undergraduate nursing education and postgraduate specialist nursing courses, including those used to educate registered nurses for working in intensive care. Currently, there is no national overview in Sweden. Given the resource-intensive nature of intensive care, an environmental sustainability educational intervention could be highly valuable in reducing the carbon footprint of ICUs. However, an initial assessment of intensive care nursing student experiences with environmental sustainability is required to strategize intensive care nursing curriculum recommendations.

To explore postgraduate intensive care nursing student experiences of environmental sustainability in clinical practice at intensive care units.

Setting and participants

A convenience sample was designed to address the study’s aim. The target population comprised postgraduate intensive care nursing students at four universities in southern and western parts of Sweden between September 2021 and January 2023. Those who voluntarily agreed to participate were included, in total, 24 students. The median amount of time participants worked as an RN before postgraduate intensive care nursing studies was 9.5 years [range 3–23] (Table  1 ), and they had a median age of 37 years [range 26–53] (Table  2 ).

Data collection

The data collection comprised a qualitative questionnaire developed for this study using ten open-ended questions (Table  3 ). The qualitative questionnaire’s face validity [ 19 ] was checked by experts in sustainable healthcare and researchers with experience in interviewing, who examined and discussed the tool and agreed on the final version (group consensus). The qualitative questionnaire was not piloted because the open-ended, exploratory questions sought qualitative, narrative responses about each postgraduate intensive care nursing student’s sustainability experience in the ICU. Using open-ended questions in a qualitative questionnaire was suitable because exploring experiences about sustainability in intensive care was the focus [ 20 ].

Each participating university’s ICU program director was informed, who then authorized the study and posted a notice about it on its digital learning platform with written information about the study and how to access the qualitative questionnaire. The participants were invited to the study at the end of their education when they returned to university from clinical practice at an ICU. The completed questionnaires were returned by email. The data included 75 pages of written narratives from the participants, containing rich and meaningful data.

Data analysis

Inductive thematic analysis according to Braun and Clarke [ 21 ] was used, a process where coding of the qualitative data identifies recurring patterns and collates these into key themes (Table  4 ). For the first step , a common document was created where all questions and answers from the 24 participants were brought together. In the first step, two researchers (F.S. and Å.I-S.) read the text carefully and separately several times to become familiar with the data. The reading was done actively to identify patterns and meaningful units regarding the phenomenon. At this stage, notes were made for what would later form the basis of the next coding process.

The second step initially involved the two researchers independently organizing codes from the data generated manually by using coloured pens to indicate potential patterns. The codes were then discussed together until consensus on key elements of the text and associated codes was reached. The authors did the third step together; all codes were written on a blackboard, and an analysis was made of codes that together formed subthemes and themes. Step four and step five , an overview and review of codes and formulated subthemes and theme, ensured the thematic map was consistent with the dataset as a whole and checked the relationship of individual themes to each other and separately to summarize how the synthesized themes told the overall story about the data. Finally, step six was done by writing the story within and across themes.

The findings describe postgraduate intensive care nursing students’ experiences regarding environmental sustainability in one theme and five subthemes.

ICU - a challenging context for environmental sustainability

The participants narrated their views of the ICU as a caring place where the foundation is to save lives, which created a prerequisite for continuing life when existence is at stake. Saving lives is the number one importance, and a sustainable approach to clinical practice seems to be further down the list of priorities. The ICU setting involves a multitude of technology, equipment, consumable supplies and pharmaceutical products, which consumes a considerable amount of energy and creates substantial waste with environmental and financial implications. “ The entire intensive care system is incredibly resource-intensive in terms of materials , time , finances and social sustainability” (Participant 3). This was seen as a context where a mountain of garbage was created every day. On the other hand, ICUs have large staff numbers compared to other hospital departments, which can be an advantage if they collectively work together to prioritize collaborating on improving sustainability topics.

Acknowledging the need for awareness of good and bad habits regarding sustainability

Being in the ICU environment made the participants aware of the good and sometimes bad habits that the staff had in the ICUs. The good habits were acknowledged as some of the ICU nurses, in some situations, were aware of their actions and deliberately tried to minimize waste and the use of materials. The good and bad habits related to how some staff had awareness regarding sustainable issues and others lacked awareness of their own actions and of the structure of the units. However, the awareness and the good habits were outnumbered by the bad habits and unawareness.

The participants wished for more deliberated actions by the staff. They identified improvements to be made, such as routines where staff could be more mindful of equipment and disposables that each patient needed and then only collect those supplies more likely to be used to prevent throwing away unused items. The participants explicitly stated that it should be mandatory only to get the required supplies for each patient care episode. Currently, staff get supplies that might be needed, and therefore, often thrown away unused. Participants recommended that nurses think one step ahead and plan what specifically should be taken from the storage and taken into the patient room. They also expressed an ignorance of sustainable behaviour among the staff and underlined the importance of thinking before you act and using resources wisely.

Bad habits and unawareness were also noticed regarding pharmaceuticals. It was not unusual that the ICU nurses often prepared too much of the drugs or that pharmaceuticals for acute situations were drawn into syringes instead of being more standby and had them in the original packages. Therefore, the drugs could not be returned to the medicine room and had to be thrown in the waste bin.

“The administration of pharmaceuticals is not well-functioning. I try to do it right , but it depends on time. I try not to mix too much , instead to mix several times , a bit more often instead” (Participant 1).

They also noticed that another reason for increased use of materials was acute situations when the staff focused on saving lives. Sustainability issues were not considered during life-threatening situations when there was no time or space to reflect on sustainable choices, which initiated unreflective actions.

To promote awareness and good habits, it was important that every staff member working in the ICU took responsibility for their actions to minimize unnecessary use of products, especially toxic pharmaceuticals, and, in the long run, also waste. The participants wished that behaviour such as disposing of pharmaceuticals in regular waste could be eliminated: “ Pharmaceuticals are thrown anywhere , in the nearest trash bin” (Participant 19) .

It was also noticed that waste management had a spatial connection. In the patient rooms, there were often only ordinary trash bins. Outside the patient rooms in the designated areas for waste, there were complete recycling stations with designated bins for plastic, paper, and batteries. However, walking the distance from the patient area was not doable. Therefore, recyclable waste was thrown away in the trash bin.

The participants also stated that healthcare personnel should work more digitally, with better systems to improve the structure of the units and increase environmental sustainability in everyday ICU practice. They also noticed that equipment that consumed electricity could be left on without being used, raising concerns about the need for more critical sustainability thinking.

Participants appreciated that responsibility towards proactive sustainability work had several layers, and everyone had to take a step in the right direction to make improvements. They thought it was ultimately the managers’ and the organizations’ responsibility who had the overarching responsibility. The units had thorough clinical guidelines, and following these guidelines in patient care created considerable waste. They followed the guidelines as they should; therefore, vast amounts of waste are routinely created while caring for every patient. The participants identified the need to improve the units’ structure when addressing sustainability, which they viewed as outdated.

When awareness was lacking, staff threw away unused materials while tidying up the patient room. These items could be saved and used when the patient needed the products later. Staff also put on aprons and gloves when not needed, which is merely a reflex for the healthcare staff to do so. Another example of this behaviour was the staff drinking coffee from disposable cups in the break room, despite porcelain mugs being available and other more sustainable choices, such as plates and cutlery. The participants viewed this unsustainable behaviour as coming from being in a hurry and staff just passing by the break rooms and getting a cup of coffee on the go.

Unsustainable packaging of ICU supplies

The participants indicated that ICUs were flooded with materials and equipment, of which many products were disposables. Most of the materials were accredited as being made of plastic, and they also identified much of the packaging as unnecessarily wasteful. Almost every product that came into an ICU was individually packaged and then packaged into a group of ten or twenty pieces before being put in a box wrapped with further plastic. The participants wished for a better procurement process where purchasing was well thought out and existing contracts were reviewed and updated to be more environmentally sustainable. They wanted the packages, both the materials and size, to be discussed with nurses and clinical teams. This was a shared responsibility among the manufacturers, hospital procurers, and the ICU staff. A wish was expressed for a more transparent procurement dialogue between each stakeholder to occur regularly.

Another problem the participants stated about substandard products was that they led to breaking, tearing, or falling apart, and therefore, there was an increase in the use of these clinical supplies due to them not holding what they were supposed to do. Instead of one pair of gloves and apron, the staff used two or three pairs of gloves and two aprons.

Innovative solutions were also wanted. Recycling was recognized as one way to improve sustainability, but it was acknowledged as not being the answer to everything. Instead of recycling, they wanted modern and groundbreaking ways of increasing the sustainable practice in the units. Better materials were one aspect they suggested as improving sustainability, as they knew that decreasing the use of products and supplies is better than recycling. They also suggested reusing more products than what was done at that moment.

“Away with all the unnecessary printers and copying papers that negatively impact the environment with deforestation and forest degradation. It is time to use modern electronics such as Tablets with automatic transfer into patients’ medical records. To reduce the use of paper would also reduce our workload. As of today , when we print an electronic referral and then use the fax machine to send to another unit in the hospital.” (Participant 21).

They suggested some products they had identified as possible to reuse. The participants identified that there were several improvements that needed to be made in the ICU to improve and increase the sustainability practice.

Knowledge and education on sustainable practice

The participants experienced that environmental sustainability issues were not at all or not enough in the curriculum for postgraduate specialist nursing education. Although challenges with finding space in the curriculum were recognized, they wanted and needed to learn about sustainability in an educational program with limited teaching hours:

“We haven’t discussed sustainability much in the education , the focus is more on how we should prioritize our tasks in a technical way” (Participant 16) .

Some participants expressed a need for more knowledge about ecologically responsible healthcare practices, and they called for an increased theoretical understanding of why sustainability matters:

“When I undertook my nursing degree , nobody mentioned sustainability. This has gained ground lately , and I have now got an eye-opener during my course in critical care for sustainability” (Participant 20).

The participants identified a knowledge gap for themselves and newly hired staff in the ICU. It was also clear that it was difficult being newly graduated as a critical care nurse and having high standards regarding sustainability since it was not on the top of the agenda for the clinical practice. They clearly expressed the shared responsibility among the university, the clinical unit, and themselves. Environmental sustainability was also seen as a way of being; if one practised it in private life, one also intended to be more sustainable in professional life. The habit of recycling was intertwined with the person as a personal characteristic regarding sustainability should be more appreciated and acknowledged than what it was. The discourse was clear that knowledge and critical thinking were required for sustainable intensive care nursing.

The importance of a holistic perspective throughout each patient’s pathway

The participants emphasized that sustainability in the ICU was a multidimensional issue, including diverse aspects from modern, reflective waste sorting to caring activities with a patient perspective that included good, committed, and holistic care with the patient and relatives. In the ICU context, there were opportunities to assist patients and their families in reaching sustainable life and living conditions post-ICU.

“If you have time to complete your tasks and take care of the patient in the best possible way , you will feel more satisfied that you have done a good job. This requires that you have good staffing and , above all , that you have good skills in general with the opportunity for skills development at work”. (Participant 20)

Intensive care was described as a costly, resource-intensive service where care should be provided equitably, with the appropriate patients receiving the right level of care. It was important to ensure that there were reasonable chances that patients could leave the ICU within the shortest possible care time. Equitable care was also about catching those who needed support after discharge, where post-ICU clinics were an example mentioned as important for a holistic perspective. Knowing that patients were offered follow-up was important for finding meaning and motivation in work. To provide equitable care that was perceived as sustainable, the importance of having a critical approach throughout the different parts of the care chain was emphasized.

“Through the education , I have gained a picture of what a good work environment can look like and how I want to care to feel good as a nurse and a human being” (Participant 10) .

Prerequisite for a sustainable work life

Due to all the challenges in the ICU context, participants perceived that the conditions for a sustainable way of working existed in the ICU, where a high staff density allowed for the prioritization of sustainability issues. The ICU had better conditions regarding sustainability issues compared to many general wards, where the staff-to-patient ratio was significantly lower. The participants felt that effective workforce management was a prerequisite for long-term sustainability, including environmental, financial, and social dimensions, to ensure ‘sustainable thinking’ (cognitive attention to sustainability) is maintained.

“I believe in a dense staffing to ensure that the sustainability of healthcare will last in the long run and not be thinned out because it will mean that sustainable thinking will be the first thing that flies out the window “ (Participant 22) .

The participants felt that staff working in the ICU were passionate about their work, critical, and not afraid to raise questions about treatment strategies, which was perceived as a good starting point for increased sustainability thinking. Several participants had experience working during the COVID-19 pandemic when they witnessed many nurses in the hospital resigning. “ The work environment during the pandemic has been demanding and many in the work group have needed sick leave due to high workload , this is of course not sustainable” (Participant 18) .

Questions were raised about prerequisites for having a sustainable working life in ICU. A sustainable working life in the ICU was exemplified by feeling safe and trustful in collegial support, having reasonable working hours with a reasonable workload, having the possibility to leave work on time, and not having to think about work issues in my spare time. Having time allocated for ongoing discussions and reflections among colleagues was important. Continuing development opportunities and support for new employees safeguarded job satisfaction and united the staff group. Working in safe interprofessional teams created feelings of coping with more challenges. Feeling secure in their professional role awoke a sense of choosing sustainable employment/work.

“I want them to invest in the staff , to make them feel safe with training and to create a safe team. This can help them cope with more things that happen at work” (Participant 4) .

Another aspect of concern about sustainability from the participant’s point of view was worries about the future. Concerns over the low application rate for the specialist postgraduate nursing course in intensive care and other vacancies in the ICU create an unsecured future with an even greater shortage of ICU nurses and worries about who will choose to work in the ICU in the future. “ There are too few staff in relation to the number of patients we have. There are no ICU nurses applying for the advertised positions” (Participant 8) .

The findings in this study revealed that environmental sustainability in intensive care settings is a complex phenomenon. Intensive care is a resource-consuming practice where critical illness and saving lives must be prioritised. However, striving for intensive care practice that is less damaging to the planet must be addressed. There is no contradiction between quality of care and environmental sustainability; quite the opposite, they are intertwined and extensively linked [ 22 ]. Quality and environmental sustainability both aim to improve public health [ 23 ]. Climate change profoundly threatens human health and well-being, and the nursing profession must decrease vulnerability to harmful consequences [ 11 ]. This requires prioritising environmental sustainability by all stakeholders, including researchers, educators, politicians, managers, nurses, and other healthcare staff. Individuals have a responsibility to practice healthcare in an environmentally sustainable manner, and employers, at an organizational level, need to be accountable for endorsing and providing resources for sustainability throughout estates and facilities, procurement, waste management and clinical practice systems.

The findings revealed that the participating students identified different hierarchical layers in waste management, which are supported in the literature [ 25 , 26 ], expressed as 5Rs (Refuse, Reduce, Reuse, Repurpose and Recycle). In this study, the nurses expressed that reducing waste is more important than recycling, although recycling was considered important when the product had turned into waste. However, there were some barriers to sustainable waste management, with space being an issue. The ICUs had recycling stations but not near where the patients’ care took place. Instead, they were located far away; therefore, the waste was seldom disposed of in the incorrect bin. More innovative solutions should be implemented in the ICUs to facilitate sustainable waste management. It was also acknowledged that the hospital had outdated regimes that did not simplify sustainability. It is a common misperception that sustainable interventions are costly due to a lack of knowledge regarding this area. Instead, it is quite the opposite: saving resources and reducing wasteful consumption reduces financial costs and environmental impact [ 24 ], which was evident for the participating nurses.

Unfortunately, environmental sustainability is considered a bonus, an add-on activity rather than a priority, since staff shortages, budget deficits, and supply chain interruptions overshadow sustainability [ 24 ]. When acute situations appear in the ICU, sustainability guidelines must be present—otherwise, nothing will change. The participants in this study felt they were responsible for environmental sustainability and wished that their present and future colleagues also share this vision. They expressed a need for more education on sustainability. To make that feasible, it is crucial to create awareness of this subject early in the nursing profession, and integrating sustainability in all levels of nursing education is necessary. As the findings revealed, this differs today; some universities have embedded sustainability in postgraduate intensive care nursing education, and some have not. Sustainability needs to be contextualized and can be integrated into every lecture and seminar if educators adopt a sustainability lens while teaching any ICU nursing topic. For example, educating nurses about an ICU investigation or intervention can consider opportunities to address the 5 R’s (refuse, reduce, reuse, repurpose and recycle) while teaching about this clinical activity. Environmental sustainability must also be on the agenda when curricula are revised to align with the ICN’s statement of incorporating it in nursing [ 11 ]. If we do not start early in nursing, the necessary widespread change to stop damaging the planet through healthcare practice may never happen.

Strengths, limitations and final conclusions

The consolidated criteria for reporting qualitative research (COREQ checklist) [ 27 ] was used to ensure a rigorous approach while designing and implementing the study’s data collection and data analysis. Lincoln and Guba’s [ 28 ] trustworthiness model informed the delivery and reporting of this qualitative questionnaire project to ensure credibility, transferability, dependability and confirmability of the findings and conclusions. To enhance credibility, the thematic analysis was performed individually before discussing the findings together until consensus was obtained. This to enhance the credibility. When the themes emerged, the third researcher read the whole analytical interpretation, followed by all researchers discussing the findings as a whole until there were no further questions aiming to faciliate a critical stance to ensure rigor [ 29 ] and to minimize preconceptions. A limitation of the study is that it reflects the views of postgraduate intensive care nursing students in Sweden, which may not be transferrable to other nations with different procurement, waste management and sustainability opportunities. However, strengths included that the questionnaire responses provided a range of perspectives across four universities with insightful reflections that led to themes and recommendations that helped to fill a gap in the literature about environmentally sustainable intensive care nursing practice.

Data availability

No datasets were generated or analysed during the current study.

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Acknowledgements

The authors are grateful to Sigmar Gericke at Skaraborg Hospital Skövde, Sweden, and to Lars Berko at Region Västra Götaland, Sweden for valuable time and input on environmental sustainability.

Open access funding provided by University of Skövde. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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F.S. and Å.I-S. collected data and did the initial data analysis. All authors wrote the main manuscript text and H.B. prepared Tables. 1, 2, 3 and 4. All authors reviewed the manuscript.

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This study obtained approval from each ICU program director at the participating universities (University of Skövde, University of Borås, Lund University and Gothenburg University). They received information about the study and authorized the distribution of the qualitative questionnaire to the students. This study followed the guidelines of the Declaration of Helsinki [ 30 ], as the students were informed about the study’s aim, confidentiality and voluntariness to participate. The participants received information and signed an informed consent form before being included in the study. All methods followed the research ethics guidelines and regulations of the universities. Completed questionnaires were returned to an email address belonging to the researcher with whom the student had not had contact during their education to avoid any form of identification. The answers were confidential and anonymous, and no sensitive personal data was requested or collected; therefore, no further ethical approvals were needed according to Swedish legislation, SFS 2003:460 [ 31 ].

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Sundberg, F., Baid, H. & Israelsson-Skogsberg, Å. A mountain of waste created daily: a thematic analysis of environmental sustainability experiences of postgraduate intensive care nursing students. BMC Nurs 23 , 679 (2024). https://doi.org/10.1186/s12912-024-02347-4

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Breaking barriers: enhancing construction and demolition waste management in Egyptian residential projects

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• Ahmed Osama Daoud 4  

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Integrating sustainability principles in all stages of construction decision-making is crucial for achieving optimal benefits while maintaining the functionality of residential projects. However, limited research has focused on identifying and analyzing primary barriers to effective construction and demolition waste management (C&DWM) in Egypt’s residential construction projects and their impact on sustainable waste management practices. This study aimed to address the question: “What barriers impede the implementation of C&DWM in Egyptian residential projects?” Previous research highlighted general barriers to C&DWM, which were contextualized using a questionnaire survey in the Egyptian building sector. The survey targeted industry practitioners in Egypt, specifically those working in various construction companies with expertise in construction management or civil engineering. The survey received responses from 90 out of 120 participants, resulting in a high response rate of 75%. The exploratory factor analysis (EFA) reveals that barriers to C&DWM can be classified into four distinct constructs: culture, resources, efficiency, and procurement. These constructs were integrated into a model using partial least squares structural equation modeling (PLS-SEM). The findings underscore that cultural barriers emerge as the primary hindrance to effective C&DWM implementation, whereas procurement barriers were found to have the least impact. This study makes a substantial academic contribution by providing empirical evidence on the classification and impact of various barriers to C&DWM in a developing country context, specifically Egypt. It introduces a novel application of PLS-SEM to model the relationships between cultural, resource, efficiency, and procurement barriers and their effect on C&DWM implementation. Furthermore, the study offers practical insights and actionable recommendations for policymakers and industry practitioners in developing nations, emphasizing the need for targeted strategies to address these identified barriers. The methodological approach and findings of this study fill a significant gap in the existing literature and can serve as a reference for future research in similar contexts, contributing to the broader discourse on sustainable construction management.

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The data that support the findings of this study are available from the corresponding author, Ahmed Osama Daoud, upon reasonable request.

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Kineber, A.F., Mostafa, S., Ali, A.H. et al. Breaking barriers: enhancing construction and demolition waste management in Egyptian residential projects. Clean Techn Environ Policy (2024). https://doi.org/10.1007/s10098-024-02999-5

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What we can learn from Lebanese waste management

On September 16, the Council on Middle Eastern Studies (CMES) hosted Salma Mousa , assistant professor of political science at Yale and a scholar of migration, conflict, and social cohesion, for a lecture on her most recent research on the problem of waste management in Lebanon. Mousa’s lecture, titled “Co-producing public goods: Experimental evidence from a Lebanese recycling program,” was sponsored by CMES and moderated by its chair, Professor Marcia Inhorn. (view lecture)

Mousa began her talk by laying out the problem. In the summer of 2015, Lebanese landfills had reached capacity, leading to piles of trash accumulating on the streets of Beirut, the country’s capital, as well as being mass-dumped into the Mediterranean. “All of this mismanagement is despite the fact that Lebanon, which is a country the size of Connecticut, spends more than ten times on its waste sector than Jordan or Tunisia,” Mousa said. “So, this is not a question of there being no government funds or capacity. The money is there, it’s just that the system is incredibly inefficient.” Mousa added that the problem is not just confined to Lebanon. “The vast majority of extracted materials globally are not recycled,” she said, noting that over 90% of waste in low- and middle-income countries is disposed of in unregulated dumps or openly burned, causing significant environmental harms.

The root cause of the current inefficiency, Mousa argued, is that Lebanese citizens fail to sort their waste—trash, recyclables, and organics—at home, and the country lacks expensive machines at sorting facilities to do the sorting for them. To investigate a possible solution to the problem, Mousa and her co-researcher, Kristen Kao, partnered with a local waste management NGO called Nadeera and a launched a sorting program in Bickfaya, a small municipality in northern Lebanon. The sorting program gave residents QR codes which they could affix to their trash bags to be scanned and evaluated by investigators at the municipal waste management facility. The residents’ sorting quality was rated on a scale of 1 to 5, and the residents could elect to receive feedback on their sorting via a mobile app.

The experiment, Mousa said, “speaks to a really fundamental question in political science and social science, which is how we can encourage citizens to become co-producers of public goods.” In order to foster that encouragement, Mousa explained that communities require active citizen participation, strong formal and informal institutions, and, like other compliance challenges, a trustworthy government, social norm enforcement, and the ability to make private behavior publicly visible.

In Bickfaya, Mousa and her co-workers confronted what she described as a “gap between perceived and actual sorting quality,” as most Bickfaya residents claimed to care about proper waste management—97% believed sorting was a civic duty—yet often failed to properly sort their waste. “The average residents say the quality of their sorting is 4.1 out of 5, but in reality, when we actually inspected the bags, it’s 2.8 out of 5,” she said. “There’s a strong culture, but the actual implementation and knowledge is very low.”

Examining the residents’ sorting quality two months after the researchers’ intervention, Mousa said that the “average effect of inviting someone to join is a 0.3 out of 5 stars increase in sorting quality,” with the increase largely driven by better treatment of organic waste. In terms of compliance, Mousa said that half of the residents did not use the program, while a quarter used the combination of QR codes and the app, and a quarter just used the QR codes.

The economic and environmental benefits of such an increase, Mousa argued, are numerous. In particular, the rise of more attentive treatment of organic waste results in less compost in landfills, fewer pollutants in the air and soil, more clean organics to feed hogs and create fertilizer, and lower sorting plant operating costs. “This evidence shows that making norm-compliant behaviors visible by removing anonymity and at the same time giving people knowledge on how to comply increases citizen cooperation,” Mousa concluded. “Hopefully this shows a promising path forward for encouraging citizens in the Arab world and other developing, low-trust societies for how to become co-producers of public goods.”

Written by Jack McCordick, a senior in Yale College majoring in humanities.