The gap between policy, implementation and outcome is neither new nor specific to the sphere of sanitation. This article attempts to apply policy implementation literature in the context of developing countries, when much of the scholarly work on implementation and policy process and empirical research has been in the context of developed countries. It explores the gap between sanitation policy intentions and outcomes in a comparative study in Rwanda and Uganda with “good” and “limited or no” reported progress respectively towards the former Millennium Development Goals (MDGs).

The authors find that, whereas the policy climate and prioritization of sanitation has been favourable in much of sub‐Saharan Africa (SSA), resources and capacity constraints, especially at the local level, negatively affect sector performance in an increasingly decentralized governance landscape. Progress in Rwanda is explained by stronger political leadership and support for sanitation, stringent performance monitoring and oversight, an institutionalized community‐based approach, and investment in rural sanitation.

This article shows that the management of sanitation depends on a changing governance landscape; leadership is important for overall sector improvement; networks present co‐ordination challenges; approaching sanitation as a public concern requires strong government intervention; the move towards markets necessitates government oversight; approaches that foster inclusion and legitimacy at the local level need to be considered.