In developing countries, sewer system problems are frequently encountered with wide variation of severity. Usually, the real cost of losses due to these problems is neither calculated with the consideration of all losses neither declared. Frequently, it is easy to observe that the initial cost of project plus the real and comprehensive cost of the damages caused by the frequently encountered malfunctions is likely to add up to a number that may be even higher than the cost of similar projects executed of the highest standards. This insight should motivate developing nations to enhance the execution quality of sewer system projects by allocating a more generous budget. It is advisable to promote the incorporation of advanced technology in construction, operation, and maintenance. The research delves into the prevalent issues and root causes associated with sewer systems in developing countries, alongside the introduction of relatively more cost-effective advanced technologies. Then, the difficulties encountered in adapting such technologies are presented and discussed with proposed solutions.