Environmental sanitation management in port areas has become increasingly important amid the growing intensity of global logistics activities. Perawang Container Terminal (PCT), one of the major ports in Riau Province, continues to face several unresolved sanitation issues, including the absence of a waste segregation system, temporary waste storage facilities that do not meet technical standards, irregular monitoring of clean water quality, management of hazardous and toxic waste (Bahan Berbahaya dan Beracun [B3]) without the required permits, and the absence of a disease vector control program. These conditions indicate a gap between current practices and healthy port standards as stipulated in Indonesian Ministry of Health Regulation No. 44 of 2014. This study aimed to assess the existing condition of environmental sanitation management at PCT, identify supporting and inhibiting factors, and formulate optimization strategies to achieve a sustainable healthy port. A qualitative case study approach was employed, involving 10 key informants selected through purposive sampling from PCT management, the Class I Health Quarantine Office of Pekanbaru, and the surrounding port community. Primary data were collected through observations using the Healthy Port Self-Assessment Form, semi-structured interviews, and document review, while secondary data were obtained from relevant institutional records. Existing conditions were analyzed descriptively, followed by SWOT analysis and the Analytic Hierarchy Process (AHP) to determine priority optimization strategies. These strategies were integrated with the Triple Bottom Line framework, encompassing environmental, social, and economic dimensions, to support the development of a sustainable healthy port.