In a series of four case studies, researchers examined how local cooperative waste management, city governance and more affect the sustainable optimization and uptake of sanitation technologies.

They found that technical improvements are still needed in wastewater and excreta management and treatment, to reduce health and environmental impacts. However, optimizing the existing sanitation systems could increase environmental, health and hygiene sustainability. Urine-diverting dry toilets (UDDTs) have the potential to reduce environmental impact the
most, once optimized and if urine and faeces are collected and treated for reuse.

Local farmers have expressed demand for sanitation reuse products, as long as low price and quality can be guaranteed. From a household perspective, demand exists for high levels of service and maintenance by providers, no matter the type of system, to ensure simple maintenance by users. But the sanitation system still needs to be affordable, match cleanliness expectations, and remain free of odours, mosquitos and rodents.

Upscaling on-site sanitation systems depends strongly on the support of the public institutions and resources available, including legal, economic and technical resources, as well as having a long-term vision.