The focus of attention of the MDG targets on improved sanitation have focused resources on increasing service coverage in terms of access to improved toilet facilities,  but with far less attention paid towards ensuring that waste streams are adequately collected and treated prior to discharge into the environment.  Worldwide wastewater treatment is failing. In Asia 90 % of the waste water is allowed to pass untreated into open water bodies or leach into soil. This is caused by lack of wastewater treatment systems, but moreover the lack of maintenance of systems there. Africa also illustrates high percentages (55% South Africa, 85% Ghana) of none functioning wastewater treatment plants. In Latin America only 6% of the generated wastewater receives secondary treatment before it is being discharged into surface waters.

As a result, the majority of wastewaters, septage and fecal sludges are discharged without any form of treatment into the environment; an estimated two million tons of waste, estimated to equal two or more billion tons of wastewater is discharged daily into rivers and seas spreading disease to humans and damaging key ecosystems such as coral reefs and fisheries. Dirty water is a key factor in the rise of de-oxygenated dead zones that have been emerging in seas and oceans across the globe. This is becoming increasingly a global problem as urban populations are projected to nearly double in 40 years, from current 3.4 billion to over six billion people - but already most cities lack adequate wastewater management due to aging, absent or inadequate sewage infrastructure. (UNEP/UN-Habitat 2010).