**4.1 Institutional development for HCW management**

In designing a system for HCW management, it is important to consider three layers institutions levels; namely, global, national, and local levels. The institution at the global level is given by the internationally-accepted guidelines published by WHO [1] and other international organizations.

In any country, a national policy is the first step in creating a successful and sustainable HCW management system. The policy should be the blueprint to drive decision-making at a political level, for the allocation of resources, and mobilize government efforts to create the conditions to implement an HCW management system [28]. Based on the international guidelines, national-level legal systems and institutions for conducting proper HCW management will be formulated according to the given conditions of the country. Specific and comprehensive legislation and policy documents on HCW management with a clear designation of responsibilities to various stakeholders are required [18].

The following five basic principles are important in formulating an effective HCW management system, which was originally specified by the Global Healthcare Waste Project conducted by the United Nations Development Programme (UNDP) in cooperation with the Global Environment Facility (GEF) and WHO [29]:

