In the Global South, where urban and rural waste challenges are becoming more pressing and centralized capital-intensive waste management has proven to be difficult to achieve environmental sustainability and social equity, decentralized solid waste management has become a key strategy to tackle these issues. Haritha Karma Sena (HKS), a women-led, community-based waste collection, segregation, and resource recovery network, is one of the most ambitious and ambitious initiatives in India to decentralise at scale in Kerala. This review paper collates literature and project studies and government documents on the topic of HKS and other similar decentralized waste management practices in Kerala, highlighting the challenges and opportunities in scaling up such systems beyond the pilot stage. The paper builds a conceptual framework that maps institutional, socio-cultural, economic, infrastructural and gender-differentiated factors influencing the expansion and consolidation of HKS, drawing from the empirical studies from Ernakulam and other districts, policy documents of the Haritha Keralam Mission, and recent analyses of gender equity, climate governance and participatory waste management. The review identifies that needs of the policy support, the user fee and the scrap-based revenue streams, the integration with women's SHGs of Kudumbashree as well as investments in material collection centres have facilitated the rapid scale up of the HKS units in over a thousand local governments, allowing for effective removal of non-biodegradable waste and improved segregation practices at the household level. Weak infrastructure in some regions, low and inconsistent remuneration, lack of adequate social recognition, occupational health risks, reliance on public collaboration and lack of equal institutional capacities are all factors limiting a long-term sustainable and equitable model. The presented conceptual approach focusing on scaling up decentralized waste management emphazises the need for good governance, equitable employment conditions, gender-responsive recognition, secure funding and flexible participatory approaches. The paper ends by summarizing implications for state and local governments and providing further research directions, such as comparative analyses between districts, longitudinal analyses of livelihoods and more in-depth intersectional analyses of gender and environmental justice in decentralized waste governance.