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Past research by one of the authors of this paper has identified four key institutional challenges that community-driven initiatives to improve sanitation in deprived urban settlements face: the collective action challenge of improving community sanitation; the coproduction challenge of working with formal service providers to dispose of the sanitary waste safely; the affordability challenge of reconciling the affordable with what is acceptable to both users and local authorities; and the tenure challenge of preventing housing insecurity from undermining residents’ willingness to commit to sanitary improvement.

In this article we examine how two well-documented, relatively successful and longstanding initiatives, the Orangi Pilot Project and an Alliance of Indian partners, met these challenges. They were met through social innovation, but also through the choice and development of sanitation technologies (simplified sewers …