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Centre at the LSHTM, for the quality control of this document. Few problems affect so many in such a profound manner as poor sanitation. It is estimated that 2.5 billion people in the world do not have access to improved sanitation (i.e.: a safe, functioning toilet). The cost of inaction on sanitation is high; from the children’s lives lost to easily preventable causes such as diarrhoea to the macro-effects on developing countries ’ economies. Despite the scale of the crisis, sanitation remains a low priority for governments and recent efforts to address this fall far short of what is required. Progress depends on adequate investment and collaborative action across developing country and donor governments, civil society, multilateral agencies, academia and the private sector. All parties have an urgent role to play in supporting national efforts to improve access to sanitation for all. This paper is a contribution to the efforts to address the sanitation crisis. It summarises the evidence of the scale of the problem, points to the potential benefits of addressing the crisis and gives clear and actionable recommendations for all those who can help find a solution