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Does formal recognition of a right to sanitation (RTS) increase levels of availability and access to quality, affordable and adaptable sanitation services? This study finds that progress towards these goals seems to be faster in countries that have recognised an RTS. It is highly probable that sanitation services in countries seeking to fulfil an RTS will be more equitable and inclusive than elsewhere. However, attributing successes to a rights approach will require better monitoring and evaluation that includes rights-sensitive indicators. A further finding is that what makes formal recognition meaningful is a participatory approach to working to fulfil rights: citizen-state engagement is crucial.

Internationally accepted rights standards require sanitation to be available, accessible and affordable, of acceptable quality and adaptable. When these rights standards are fulfilled, sanitation services will be fully inclusive and equitable, and will be more likely to be sustainable.

There are trade-offs between reaching the largest number of people (working at scale), and making sure services are inclusive (working towards full scale). Front-loaded, heavy investment is required to work for equitable and inclusive sanitation for all people, including the poorest and most marginalised. However, the economic, social and political benefits of equity approach are beginning to be demonstrated. Other findings include the following:

• There is a gap between the implementation of successful models, and whether/how these models are brought to scale.
• Claim and redress mechanisms set up by government or quasi-government institutions or by large-scale businesses are usually not well-understood or used by poor and marginalised people.
• Data collection, monitoring and evaluation on sanitation are weak. Indicators are almost always quantitative, and do not capture the processes and achievements of voice, accountability and citizen-state engagement mechanisms that are crucial to rights fulfilment.

Formal recognition of an RTS can be an important accelerator if it is combined with political drivers that build an enabling environment and support inclusive implementation. Strong legal and regulatory structures and systems are also needed. These include laws and bye-laws, at all levels, on both technical and social issues (such as inclusion and participation), and systems of redress. Further recommendations include the following:

• Claim and redress mechanisms need to operate at all levels. Considerable resources will be needed to ensure that people know about them, use them and grow to trust them.
• Citizens need to be full participants in monitoring accountability in service provision and improvement. A formalised mechanism such as a 'Standards Board' could be established through which stakeholders could decide which models/systems or technical adaptations to adopt.
• Mechanisms for taking successful models to scale need to be developed and implemented. To facilitate scaling-up, government, service providers and the private sector need to establish and institutionalise effective networks and coalitions.
• Greater investment in innovation is needed, and country-specific standards need to be established and implemented.
• Transparent and enacted rewards are required for the inclusion of un- and under-served people, together with sanctions for lack of compliance.
• Information needs to be open and accessible to all: effective communication channels with excluded and disadvantaged groups are needed.
• Indicators are needed on all aspects of the rights principles (participation, inclusion and non-discrimination, accountability and fulfilment of obligation) and on the rights standards. M&E systems need to be based on disaggregated data so that outcomes and impacts towards equity and inclusion can be tracked.