In many LMICs, fecal sludge is still not properly managed. This may be due to a lack of mandated institutions and low awareness of the impact of poor sanitation; a lack of technical expertise and experience; an inability to source funds for to purchase of vacuum trucks and treatment, as well as a lack of knowledge necessary to initiate and implement successful FSM programs.  Another factor is that the transporting fecal sludge has a real cost to vacuum truck operators and there is thus an incentive to dispose of the untreated waste into the environment (primarily into waterways, but also directly onto the land.) Failure to properly manage fecal sludge can result in the poor performance of onsite sanitation facilities (OSSFs), fecal sludge overflowing from containments, and the unsafe emptying and dumping of untreated fecal sludge into the environment.
Fecal sludge contains pathogens, can generate odors and cause surface water pollution, as well as groundwater pollution.