Today, 2.6 billion people in the world have nowhere safely to defecate on a daily basis or to follow hygienic practices that are important for their health and wellbeing. People are different and require support to overcome the specific impediments that stand in the way of their being able to use services sustainably. There is a greater likelihood of success if we focus on the forgotten millions, first . When pastoralists, ethnic or religious minorities, the disabled, the chronically ill, children, the aged, adolescent girls, women, or anyone without voice or agency are centre stage, their needs are reflected in design and investment decisions, with gains for all, including the larger community. To make this happen for all those without sustainable sanitation and hygiene, we will need to redefine policy and practise so that equity is woven into the fabric of every investment, every supervisory mission, every reward and every audit .