Environmental cleanliness is a key indicator of urban quality of life, yet Medan City continues to face challenges due to rapid urbanization, increasing waste volume, and limited waste management infrastructure. This study aims to describe the implementation of Medan Mayor Regulation No. 18 of 2021 concerning Environmental Cleanliness Management in Medan Helvetia District, analyze the supporting and inhibiting factors, and examine its impacts on environmental conditions. The research employed a qualitative descriptive approach, with data collected through in-depth interviews, field observations, and document analysis. Data were analyzed using the interactive model of Miles, Huberman, and Saldana. The findings reveal that the policy implementation has been carried out but remains suboptimal. Based on Edward III’s framework, communication among actors is still partial, resources are limited, implementors’ disposition is relatively strong at the leadership level but weaker among field staff, and the bureaucratic structure is not yet fully effective in cross-level coordination. Supporting factors include clear regulations, leadership commitment, community participation, and collaboration with stakeholders. In contrast, major obstacles involve insufficient personnel and budget, low awareness among certain community groups, weak inter-agency coordination, and diverse geographical and demographic challenges. The impacts identified include increased community awareness, improved cleanliness in priority areas, institutional strengthening, and multi-stakeholder cooperation, though uneven outcomes, weak monitoring, and limited facilities remain. This study recommends strengthening institutional capacity, increasing resource allocation, diversifying community-based education programs, and developing an integrated monitoring system to enhance policy effectiveness and sustainability