This study identifies 11 issues that have inhibited the spread of a comprehensive sanitation programme. It emphasises the complexity of issues and helps avoid the facile targeting of the poor as deficient citizens, whose latrine practices are viewed as a "primitive" source of social disorder and disease. Recognition that many factors are involved and interrelated might also serve as a warning against patchwork policies that disregard local context in their haste to proclaim another district an "open defecation free zone".
