Wastewater management in Latin America faces great challenges to reach a sustainable state. Although enough infrastructure has been built to treat around 40% of wastewater, only between 15–20% is effectively treated, and abandoned or defective infrastructure is a common sight. Data about current conditions at specific sites is quite fragmented, when existing. This leads to challenges in management, decision making and planning for sustainable options. We argue that a main obstacle is the lack of a regionally relevant sustainability assessment framework that allows for a holistic understanding of wastewater management as a nexus problem. We therefore developed a comprehensive framework to (1) understand current conditions (2) involve stakeholders and (3) point to pathways to improve wastewater management in the Americas. Building on literature review and stakeholder involvement, we constructed a multi-scalar extended dataset framework that is adaptable to different study sites using specific criteria. Sustainability was assessed through a “distance-to-target” approach. Social and economic variables were the lowest ranking in both cases, with technical variables generally performing better. Although some dimensions of sustainability are performing acceptably, others, such as social and economic, are general low to very low performing. This means, when looked at in an integrated manner, neither of the wastewater management systems analysed can be considered sustainable. Here we present the approach itself, the results of its application in two pilot sites in Latin America, and our recommendation to shift waste water management into sustainability.
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