This chapter explored on the treatment technologies applied to manage wastewater (WW) in Sub-Saharan Africa (SSA). Both conventional and advanced technologies of WW treatment were applied in specific countries of the region. The efficacy of conventional approaches to remove nutrient loads from WW was high though for other pollutants, it was low and effluents required further treatment. The techniques including septic systems and waste stabilization ponds required large space for operation and were prone to producing sludge. Greener approaches such as the use of biodigesters and composting toilets were effective in managing WW especially Blackwater and converted it to useful energy and bio-fertilizer sources. However, their implementation in SSA was at small-scale due to their high cost and maintenance needs. The need to optimize these treatment techniques to treat more WW was emphasized as generation rates increased in the region and concerns on effluent management and its negative implications were growing despite the apparent low treatment capacity of the region. Such initiatives need to be supported with the right financial, technological, human and infrastructural resources.