Few reliable figures on the share of the wastewater collected in sewers that is being treated in the world exist. In many developing countries the bulk of domestic and industrial wastewater is discharged without any treatment or after primary treatment only. In Latin America about 15% of collected wastewater passes through treatment plants (with varying levels of actual treatment). In Venezuela, a below average country in South America with respect to wastewater treatment, 97 percent of the country’s sewage is discharged raw into the environment. In a relatively developed Middle Eastern country such as Iran, Tehran's majority of population has totally untreated sewage injected to the city’s groundwater.

In Israel, about 50 percent of agricultural water usage (total use was 1 billion cubic metres in 2008) is provided through reclaimed sewer water. Future plans call for increased use of treated sewer water as well as more desalination plants.

Most of sub-Saharan Africa is without wastewater treatment.

Water utilities in developing countries are chronically underfunded because of low water tariffs, the inexistence of sanitation tariffs in many cases, low billing efficiency (i.e. many users that are billed do not pay) and low quality operational efficiency (i.e. there are overly high levels of staff, there are high physical losses, and many users have illegal connections and are thus not being billed). In addition, wastewater treatment typically is the process within the utility that receives the least attention, partly because enforcement of environmental standards is poor. As a result of all these factors, operation and maintenance of many wastewater treatment plants is poor. This is evidenced by the frequent breakdown of equipment, shutdown of electrically operated equipment due to power outages or to reduce costs, and sedimentation due to lack of sludge removal.