<p>Municipal solid waste (MSW) management remains a critical challenge in developing countries, yet comprehensive national level analyses that integrate policy, infrastructure, and socioeconomic dimensions are limited. This study aims to provide the first holistic diagnosis of the municipal solid waste management system in Rwanda by conducting a systematic review that integrates peer reviewed literature, government documents, environmental laws, and census data from 2000 to 2024. By synthesizing these sources, the PRISMA 2020 guidelines along with analytical classification, specifically the 3I’s, which examine Irregularity in collection services, Inadequacy of infrastructure, and Inefficiency in regulatory enforcement, were applied to identify the root causes of systemic governance failures. The synthesis reveals that per capita waste generation in Rwandan cities ranges from 0.57 to 0.7&#xa0;kg/day with a 5.95% annual growth rate, while the waste stream comprises 75% organic material. Collection coverage is highly irregular, reaching 52.9% in Kigali but only 2–3% elsewhere. Infrastructure remains fundamentally inadequate, with all four national landfills lacking environmental control. Regulatory enforcement is profoundly inefficient, as evidenced by a stark disconnect between the policy target of 40% recycling by 2024 and the actual performance of 10% recycling achieved informally. The informal sector, comprising thousands of waste pickers responsible for current recycling, remains excluded from formal systems. This study suggests that achieving sustainable waste management in Rwanda requires synergistic interventions that target policy reform, decentralized infrastructure investment, and the formal integration of informal actors, while systematically addressing the identified governance gaps of Irregularity, Inadequacy, and Inefficiency.</p>