In many low and middle-income countries, solid waste management (SWM) systems remain weak and lack standardization. Moreover, these systems fail to account for citizen’s insight on the proposed solid waste initiatives. This study aims to identify the main determinants of SWM practices in a low-middle income country while accounting for citizens’ perceived knowledge, attitudes, structural barriers, and willingness to pay for different services. Three communities were thus selected with varying socioeconomic factors and where different SWM practices were adopted. A cross-sectional study based on an interviewer-administered questionnaire was conducted across the three areas. Our results showed that increased knowledge and awareness of proper SWM did not correlate with people’s attitudes nor with their adoption of positive waste management practices, such as reusing, reducing, recycling, and sorting of waste. Nevertheless, the results showed that the presence of an effective SWM system in a community positively influenced people’s attitudes. Structural determinants, including the lack of appropriate facilities and adequate infrastructure, weak public knowledge on sorting, recycling, and composting, as well as the absence of guiding policies, appeared to be core barriers hindering the adoption of sustainable waste management practices across the three communities. The results of this study highlight the importance of establishing integrated SWM systems in developing countries, as they appear to trigger positive behaviors by the serviced citizens.