An important milestone for the sanitation sector was the adoption by the UN of Sustainable Development Goal (SDG) targets 6.2 (safely managed sanitation and hygiene services) and 6.3 (reducing the portion  of untreated wastewater), which focus on managing the entire sanitation service chain. Tajikistan has been at the forefront of promoting these at global level. Meanwhile, the fourth initiative of the President of Tajikistan on the International Decade for Action on Water for Sustainable Development, 2018–20281 is being implemented at national level.

Over the past decade, sanitation has been given low priority within the focus areas of water sector reform. For example, not all aspects of regulations have been duly revised to adopt new technologies. In addition, many regulations for wastewater treatment remain outdated and pose legal constraints for testing new approaches in the country. 
The Tajikistan Water Supply and Sanitation (TajWSS) (Phase III) project piloted a decentralised wastewater treatment system (DEWATS) in the peri-urban Rudaki district in Tajikistan with two hospitals with the aim of scaling up to national level. This learning paper showcases the project findings, assessments and lessons learned in application of the DEWATS.