This report aims to highlight some existing sanitation system alternatives (e.g. ecological sanitation) to conventional (centralised) sewer based sanitation systems; but also to point out the necessity to consider (international) water quality guidelines, environmental and health protection, as well as human rights-based legislation and policies when addressing domestic water and sanitation issues. The objective of this report is therefore to stress the multi-faceted aspects of what is needed for achieving sustainable development in water and sanitation. In fact, providing affordable and sustainable water and sanitation services in large cities (including informal settlements) and remote rural areas of low and middle income countries is a massive challenge that does not only require technical skills and financing investments in new activities or technologies; but also strong national and local governance institutions. The present report highlights that there are several factors that need to be appropriately addressed when setting up a model of sustainable sanitation; such as (i) the capacity of local communities, individuals and institutions to manage sanitation systems and services, and (ii) the coordination between the different sectors (health, environment, land planning), partners (public, ministers and private companies) and stakeholders.