Improving sanitation requires the involvement of whole communities, but is dependent on individual decisions to invest time and money into keeping neighbourhoods clean. Billions of dollars would be required for all countries to achieve full water borne sewerage, an investment which would have to keep pace with population and urban growth rates. In the meantime, the sector must move beyond ‘traditional’ development approaches, which view sanitation as a physical asset (a latrine or a toilet) and instead consider sanitation as a service, bringing in entrepreneurial and private sector approaches.