Nepal’s management of health care waste involves several ministries, government departments, local authorities, health institutions and regulatory bodies because health care waste has implications for public health, environmental protection, occupational safety and municipal sanitation. The Ministry of Health and Population (MoHP) has the principal responsibility for establishing health-sector policies, standards and programmes relating to health care waste management. However, effective implementation requires coordination with environmental authorities, provincial governments, municipalities and individual health-care institutions. The Ministry of Health and Population is the central ministry responsible for the health sector and therefore plays the leading role in health care waste management. It develops policies, strategies, standards and guidelines for safe handling, segregation, storage, transportation and treatment of health care waste. The ministry is also responsible for incorporating waste management into health service planning and strengthening infection prevention and control systems. Through its relevant divisions and departments, it provides technical direction to hospitals and other health facilities. It also promotes training and awareness among health workers concerning segregation at source, use of protective equipment, safe sharps management and prevention of exposure to infectious materials. The Department of Health Services (DoHS), under the Ministry of Health and Population, is an important implementation body. It supports the delivery of national health programmes and provides technical and operational guidance to health facilities. Health care waste management is closely associated with infection prevention and control, hospital sanitation and occupational health, all of which fall within the wider responsibilities of the health service system. The department can facilitate monitoring, training, technical supervision and implementation of national guidelines through government hospitals and health programmes. Provincial governments have become increasingly important following Nepal’s transition to a federal system. Provincial ministries responsible for health and population affairs implement federal health policies within their respective provinces. Provincial health directorates and other provincial health offices provide supervision and technical support to provincial hospitals and other health institutions. They can coordinate training, monitoring and reporting and can help ensure that waste management practices are incorporated into provincial health programmes. The federal structure therefore distributes implementation responsibilities while retaining national standards and policy direction. Local governments are particularly important for the practical management of health care waste because municipalities and rural municipalities are responsible for many local sanitation and waste-management functions. The Local Government Operation Act, 2017 provides a legal basis for local responsibilities relating to sanitation, environmental management and local services. Municipal authorities can regulate and support collection, transportation and disposal systems and coordinate with hospitals, clinics and other health facilities. They are also important in preventing the mixing of hazardous health care waste with ordinary municipal solid waste. In areas where health facilities lack adequate treatment infrastructure, local governments can facilitate common treatment or disposal arrangements. The Ministry of Forests and Environment (MoFE) has an important regulatory role because health care waste