The current environmental challenges that most middle-and low-income countries have been experiencing has led to new environmentally sustainable and economically viable sanitation solutions, such as waterless systems with source separation of human waste. We conducted a cross-sectional study in eThekwini municipality to explore the post-implementation challenges of urine diversion dehydration toilets (UDDTs) after a decade of installation and the adaptive processes necessary to increase the sustained use of the toilets. A structured questionnaire was administered to 17 499 households in 65 rural and per-urban areas of eThekwini using mobile phone technology. Results report low levels of satisfaction with the facilities as well as an association between perceived smell in the toilets and malfunctioning of the pedestal, and low use of UDDTs when a pit latrine is present in the dwelling perimeter. Conclusions relate to the importance of educational and promotional activities that stress the economic return derived from reusing urine and excreta in agricultural activities.