The use of wastewater in agriculture is receiving renewed attention as a result of increasing global water scarcity. Wastewater use potentially poses a risk to public health if not properly managed. In Pakistan the use of wastewater in agriculture is already common, though in most cases its use is unregulated and wastewater untreated. In a four year study in Faisalabad, Pakistan, the risks and benefits of the use of untreated wastewater in agriculture were assessed. The study found an increased risk of intestinal disease in wastewater farmers but also found major financial and nutritional benefits for farmers and consumers in the city of Faisalabad. This paper presents a policy approach for the implementation of the WHO guidelines for the safe use of wastewater in agriculture in Pakistan.