Simulating Sanitation and Waste Flows and their Environmental Impacts in East African Urban Centres Abstract If improperly managed, urban waste flows can pose a significant threat to the quality of both the natural environment and public health. Just as many urban authorities in other developing countries, most cities in the vicinity of Lake Victoria (East Africa) have been unsuccessful in providing adequate solid waste and sanitation services to their residents. To effectively manage urban waste flows, the current and future trends for the solid waste and sanitation flows and their environmental impact need to be assessed. A model was developed that represents waste flows management through the social and natural systems of East African cities. This simulation tool was designed to enable the projection of future waste flow trends and their environmental impacts under different management regimes. The results for the model simulations indicate that the annual organic load to the inshore of Lake Victoria increased twofold between 2001 and 2011. The model projections also show that a lack of optimal measures to mitigate various waste flows would further deepen the current environmental crisis in the near future. The executed multi-criteria analysis reveals that mixtures of diverse waste technologies and management regimes matching with local socio-economic and environmental conditions have a positive impact on East African cities’ environmental quality. The integration of resource recovery into the formal waste management sector is found to improve the environmental performance of waste sector in East African cities. These results contribute to the development of an integrated policy support approach, which aims at strengthening the sustainable management of urban waste flows in East African cities. This could then form the basis for improving the urban environmental quality in these cities. Also, in agreement with the modernised mixture approach, this study can conclude that applying a mix of diverse waste technologies and management regimes, and matching these with the local conditions in each city will have positive impacts on East African cities’ environmental quality. This diversity in waste technologies and management strategies for waste flows should be driven by modernised mixture principles. This would safeguard the water quality for Lake Victoria from pollution by waste, and improve the well-being of humans depending on the lake.</p