In 2008, 59% of the population in Africa lacked access to improved sanitation facilities with only 9 of the 54 African countries on track to meet the Millennium Development Goals (MDG) Sanitation target. The collaborative process of desk review, consultations and analysis behind this paper reinforces what we already know- that the ‖excluded‖, are not only people who suffer from ‖asset poverty, but also those who are shut out for social reasons. The key question: Is it possible at scale? – to enable all people across the region to practise safe sanitation and hygiene? Mere commitment to action will not work, unless policies, investments and actions are based on the principle of equity which is essentially the principle of fairness. Equity involves recognizing that people are different and require specific support and measures to overcome the specific impediments that stand in the way of their being able to access and use services sustainably, in this case safe sanitation and hygiene practices.