Within the last 15 years 34 waste stabilization pond systems have been built in Central America in the countries of El Salvador (6 systems), Honduras (12 systems), Guatemala (9 systems), and Nicaragua (8 systems); these systems were built for municipalities with populations ranging from 5,000 to 80,000 persons. There are 14 additional systems in the final design phase or under construction in the region, including the first designs for large cities: a 162 hectare facultative system for Managua, Nicaragua (population (1,000,000); and a 168 hectare system for San Pedro Sula, Honduras (population (640,000). Monitoring data from Honduras and Nicaragua show that treatment efficiency is generally comparable to tropical pond systems cited in the literature in other parts of the world, although fecal coliform removal has not been as good as theoretically predicted and the desludging of facultative ponds has been a significant operational cost. While waste stabilization ponds are generally considered the technology of choice for municipal wastewater treatment within Central America, there are, nevertheless, problem areas that need to be addressed if waste stabilization pond use is to have continued acceptance and long-term sustainability. These areas of concern at the regional level are: i) design guidelines using parameters from data developed in Central America; ii) effluent guidelines that are realistic for pond effluents for reuse or surface water discharge; iii) monitoring programs focusing specifically on pathogen removal; iv) cost-effective grit removal and sludge removal from facultative ponds; v) improving designs for pathogen removal; vi) the need for centralized (El Salvador and Nicaragua) versus decentralized (Guatemala and Honduras) mechanisms for financing and operation and maintenance; vii) the development of comparative cost data for construction, operation and maintenance, pond desludging, and microbiological monitoring; and viii) the development of training programs for design, operation and maintenance, and monitoring.