This chapter focused on the challenges that Sub-Saharan Africa (SSA) region faces in its efforts to manage wastewater (WW). Findings showed that WW management in most of the region is flawed due to infrastructural limitations that make effective operations and management of effluents difficult to realize. Treatment plants are not fully functional; they are not able to collect generated effluents effectively; they suffer from power shortages, they have no competent operators and techniques applied cannot remediate effluent pollutants with high removal efficacy. The situation is made worse by the use of conventional treatment technologies, the lack of equipment to assay for effluents prior to and after treatment, corruption during the hiring of plant operators and the non-adherence to predefined standards of WW treatment. Apparent political unwillingness to fund the WW sector and the low social acceptance to the use of treated WW also crippled efforts to manage the resource sustainably. To reverse the current situation, there is a need to revise the existent institutional, legal and governance frameworks for WW management in specific SSA countries in order to infuse more resources, community awareness and desirable attitudes for sustainable management and valorization of effluents.