Unplanned, high-density settlements in low-middle income countries often lack functional wastewater management systems. Nature-based solutions, such as constructed wetlands, are an option for the treatment of greywater, provided they are used by and useful to the community. We explored the effectiveness of iterative design for two pilot constructed wetlands in an informal settlement in Johannesburg, South Africa. Using ergonomics and human factors (E/HF) design approaches, this study evaluated the usability and postural risks associated with interactions with the constructed wetlands to motivate (and evaluate) design changes to increase use and reduce the risk of musculoskeletal pain. An elevated work area reduced musculoskeletal risks and a larger work area allowed more users at one time. The raised work areas provided other benefits such as stormwater and sewerage protection. The value of E/HF as part of a broader transdisciplinary team was demonstrated by embedding the design in the activities of the community.