Major challenges attributed to dysfunctional wastewater treatment facilities in developing countries include lack of commitment and poor informed decision making by the higher municipal administration. This paper presents how process monitoring and control during full scale operation ensures sustainability of civic infrastructures like Al-Bireh wastewater treatment plant (AWWTP). It is written from the perspective of practical process selection to evaluate the performance of AWWTP, a single-sludge nitrification–denitrification process with aerobic sludge stabilization. Process monitoring data (July 2000–April 2007) from available monthly operating reports were analyzed and evaluated. Additional data on microbiological analysis and information about facility unit operations were gathered through review of published local literature and interviews with AWWTP personnel. Influent and effluent data evaluated were the chemical oxygen demand (COD), biological oxygen demand (BOD), total nitrogen (TN), and total phosphorus (TP). Despite annual and seasonal variations in AWWTP influent for COD, BOD, TN, and TP, the Palestinian wastewater reuse requirements for restricted irrigation were met. Process design and proper facility operation have direct impacts on effluent quality. The study concludes that regardless of the design capacity and process type, adequate administrative and operational management dictate the sustainability of AWWTP and reuse schemes.