Poor medical waste management (MWM), which is a serious problem in developing countries, is reported to have direct health and environmental consequences. Therefore, this study investigated the mode of medical waste collection, segregation, pre-treatment, storage and disposal of ten randomly-selected health facilities in Akure, the capital city of Ondo State, Nigeria. A total of 32 questionnaires and 17 oral interviews were conducted. There are numerous factors impeding proper MWM in the city; however, the following are the most significant: inappropriate waste storage structures sited in public places and held in unhygienic conditions; general lack of medical waste pre-treatment; establishment of internal regulations that are generally not followed; provision of PPE by only 40% of the hospitals; and scavengers gaining access to the state approved permanent dump site. There is, therefore, an urgent need for the legal regulation of MWM practices in the state to reduce health/environmental risks posed by medical waste.