Sanitation is a political and institutional orphan, an under-funded sector with no voice at the policy or service delivery 'high table'. Establishing one national coordinating body, formulating a single, country-wide sanitation plan, and putting into place a transparent monitoring framework could spur and drive progress.

Health-oriented information campaigns have been less successful at driving demand than using commercial techniques and appealing to consumer preferences for convenience, comfort, safety, cleanliness and prestige. Building community consensus that open defecation and other environmental hazards are actually serious health problems - that can be solved by toilets - has proved successful in a number of countries. Supporting health departments and community health workers to focus on long-term behaviour changes and educating children through school-based programs are both necessary for sustaining demand and helping new behaviours stick.

Significant professional business development support for small-scale sanitation providers is required, as is greater training of sanitary engineers, to meet the demands of the massive scaling up of efforts required for universal coverage. It needs to be made easy for lower income families to build and maintain toilets, washrooms and wastewater disposal systems whose benefits they understand, and whose domestic convenience they actively seek.