The acceleration of improved sanitation access in specific urban areas can reduce water-borne diseases and the degradation of water resources. In this paper, the development of technology of wastewater infrastructure in some specific urban regions with an ecosystem approach will be analyzed based on some practical research. The ecosystem approach is analyzed with integrated biophysical and social factors for improved wastewater system; it includes the tidal area, coastal area, and urban water sensitive area. The system of wastewater treatment has certain design criteria to be adapted for specific areas and upgrading the treatment process based on the ecosystem characteristic, community awareness of sanitation and some best practices. The design criteria of wastewater treatment consider the process of environment approach, pollutant transformation target, and the configuration of the processing unit. The option of treatment technology at an individual, communal or settlement scale depends on biophysical factors in each area. This condition can achieve 80-95 % organic removal, 30-70 % nutrient removal by biofilm absorption or phytofiltration. Challenges and social constraints at each selected technology development have an influence on the sustainability of infrastructure in achieving health requirements and the standard of effluent for watercourse or water reuse.