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The report evaluates four sanitation configurations in Montero, Bolivia, finding that while the city's utility cooperative COSMOL successfully manages a mix of centralized and decentralized systems, significant gaps in governance, technical optimization, and public awareness persist. It highlights that urine-diverting dry toilets (UDDTs) offer the highest environmental potential and that local farmers are open to using treated sanitation by-products as fertilizers, provided quality and price are managed. However, household adoption of non-sewered systems is hindered by perceptions of odors and a view of such technologies as merely transitional.

The report evaluates four sanitation system configurations in Montero, Bolivia, finding that while the utility COSMOL has successfully implemented mixed services, significant gaps remain in environmental sustainability and governance. It highlights that minor technical optimizations can reduce health and environmental risks across all systems, with urine-diverting dry toilets (UDDTs) offering the highest potential for impact reduction. While local farmers show interest in sanitation-derived fertilizers, household acceptance of on-site systems is hindered by concerns over odors and vectors. The report concludes that upscaling sustainable sanitation requires stronger collaboration between local authorities and COSMOL, new policy instruments, and a long-term strategic vision.