The management of healthcare waste requires a sustained and holistic approach involving a range of parties. This is challenging for governments, especially in developing countries, where waste management systems have limited capacities for addressing the issue. Using Saudi Arabia as a case study, this paper followed a multi-method approach, including policy analysis, observation, semi-structured interviews, and a focus group, to explore the country’s healthcare waste management system. The study estimated that Saudi government hospitals across the country, every year, throw away in landfills paper (27,000 tons), plastic (15,000 tons), food (10,000 tons), glass (8000 tons), and metal (7000 tons). Regrettably, all these tons of materials end up in landfills without any form of recycling. A number of challenges were identified, reflecting mainly the lack of a legal framework, waste training, coordination among stakeholders, and social responsibility. This study generated new knowledge about waste management systems by exploring how their performance is shaped by the processes occurring at the policy, organization, and individual levels.