Haritha Karma Sena (HKS) is a women-led network of enterprises in Kerala's decentralized solid waste management, across over 1000 local bodies and involving tens of thousands of members of Kudumbashree (SHG) groups. Although HKS is well known for its work in changing the way waste is managed in cities – including door-to-door collection, resource recovery, and digital monitoring – the implications for gender equity and community health have garnered comparatively less systematic attention. This review aims to consolidate the government documents and mission reports, along with the latest empirical studies to understand the nature of HKS as a gender responsive participatory waste management model and how it influences the environmental and health situation in Kerala. The paper first makes the case for the importance of understanding the context of the sanitation and decentralization reforms in Kerala and then presents the following theoretical perspectives on participatory governance, gender and environment justice, and social determinants of health. It then follows the development of the “green army” of HKS, an institutionalized force for waste services and green entrepreneurship, born from the campaigns. Later chapters examine evidence of socio-economic empowerment of female workers, behaviour change and environmental improvement in communities, and the rise of digital innovations like Harithamithram that will enable real-time tracking of waste flows. The risks to the health of the HKS workers, for example to mixed waste, to physical strain and social stigma, and the lack of health metrics in waste planning and evaluation are given particular attention. The review finds that the work of HKS on environmental hygiene and livelihoods has been significant, and has great potential to catalyse community health transformation, though gaps exist in epidemiological data, studies on occupational health and cross-sectoral collaboration between waste and health. It ends by outlining a research agenda and policy options that conceptualize women-led participatory waste management as a key element of a preventive public health and genderjust urban and rural governance in Kerala.