Responsible, effective wastewater management is needed to address global water crises. This requires careful balance of the often-competing interests of stakeholders, as what poses a risk to the environment and public health may be a valuable resource to farmers and industry. How do we manage these different interests from a policy and practical perspective? At World Water Week 2017, Stockholm Environment Institute, GIZ, the UNDP-SIWI Water Governance Facility, CEPT University, the Water Research Commission of South Africa, and the Sustainable Sanitation Alliance organized a session to explore these questions through a series of case studies from regions facing different wastewater challenges. This policy brief provides an overview of these cases and key messages that emerged from the session.