This paper characterizes municipal solid waste (MSW) management practices in developing Asia, with a focus on low and middle-income countries. The analysis that is conducted supports a proposed framework that maps out the trends observed in the region in relation to two parameters, waste compositions and urban dimension, which was prepared based on a set of national and urban case studies. The management of MSW in developing Asian countries is driven, first and foremost, by a public health imperative: the collection and disposal of waste in order to avoid the spread of disease vectors from uncollected waste. This comes, however, at a high cost, with local government authorities in these countries spending up to 50% of their budgets in the provision of these services. Little or no value is derived from waste, which is typically seen as a liability and not as a resource that can be harnessed. On the other hand, in many cities in developing Asia there is an informal sector that ekes out a living from the recovery of recyclable materials found in waste. Members of this “informal waste sector” are especially active in areas that are not served by formal waste collection systems, such as slums or squatter areas. A distinctive element shared among many cities in developing Asian countries concerns the composition of the municipal solid waste. MSW in those countries tends to be richer in biodegradable organic matter, which usually accounts for more than 50% of the total waste composition, suggesting that biological methods are more appropriate for treating this organic fraction. Conversely, thermal combustion technologies, which are extensively applied in high-income countries, are technically and economically challenging to deploy in light of the lower calorific value of waste streams which are rich in organics and moisture. Specific approaches and methods are therefore required for designing adequate waste management systems in developing Asian countries. In addition, despite some common characteristics shared among cities in developing Asia, their specific circumstances can significantly vary, even within the same country, calling for the need for context-specific waste management approaches. Set against this background, this paper proposes a guiding framework in the form of a matrix that maps out approaches observed in the management of municipal solid waste in cities of developing Asian countries as a function of the city dimension, share of organics on waste streams, and wealth generated by the city. The cities of Surabaya (Indonesia), Bangalore (India), Quy Nhon (Viet Nam), and Matale (Sri Lanka) are showcased as good practices in the region in the management of solid waste, with their experiences used to illustrate the framework laid out in the matrix.