Systems interventions for the transition from basic to safely managed water and sanitation services

Most countries remain off track to meet global water and sanitation targets. Basic service levels are no longer sufficient to protect public health or support national development ambitions. Safely managed water and sanitation services, ensuring on‑premises access, continuity, quality of water services and the safe containment, transport, treatment and disposal of faecal waste, require system‑wide transformation. But many countries lack clear guidance on how to achieve this. This learning paper addresses that gap. It identifies a set of transition pathways reflecting how systems evolve from basic access to meeting safely managed criteria. These pathways are organised across three types of settings: low‑density rural areas, villages and small towns, and urban areas, each with predominant service delivery models. The paper shows how multiple pathways often coexist within the same area and analyses their implications for households, service providers and governments. The report also examines key drivers of transition, including household demand, provider incentives, and the roles of regulation, financing and institutional arrangements. Based on this analysis, it proposes three guiding principles to accelerate progress: strong leadership with a clear vision and strategy; data‑driven identification of binding service constraints; and area‑wide planning that coordinates multiple technologies and providers. Together, the pathways and principles offer practical guidance for designing and sustaining transitions to safely managed, equitable water and sanitation services. About this publication This report was developed under the WASH Systems for Health Facility, financially supported by the FCDO (Foreign, Commonwealth & Development Office) of the UK government. We also thank the partners under the WASH Systems for Health programme who provided insights through various learning sessions. Acknowledgements This report has been written by Paul Hutchings (University of Leeds), Stef Smits and Marieke Adank (IRC). The data analysis of trends in service levels was done by Arjen Naafs of IRC. In the original conceptualisation of the settings and transition pathways, we were supported by Barbara Evans of the University of Leeds. We especially thank the peer reviewers, Barbara Evans (University of Leeds) and Fiona Gore (World Health Organization), for their valuable feedback.