Municipal solid waste management (MWSM) systems have been evolving across most of the developing world. However, despite decades of refinement, they are still underperforming in many cities, leading to negative sustainability impacts in rapidly urbanizing cities of the global South. Despite similarities in the observed transitions between developed and developing countries, there are important differences in their characteristics and underlying drivers. This study aims to unravel the sustainability transitions of the MSWM systems in the two major cities of Bolivia, La Paz and Santa Cruz de la Sierra, illustrating the role of various actors, and specifically local governments. This is achieved through the analysis of secondary data and expert interviews with stakeholders involved in different aspects of the MSWM system at the national and local level. We identify three partially overlapping sustainability transitions in the two cities, namely “Collection and centralized disposal”, “Environmentally controlled disposal”, and “Integrated solid waste management”. However, timelines, speed and elements of these transitions are somewhat different between cities, largely due to their inherent characteristics, institutions and stakeholder dynamics. Many technological, socioeconomic, and institutional factors converge to facilitate and hinder these transitions, including interactions of government and private sector actors, and the country’s broader political context.