Although the number of urban dwellers in the Global South with access to improved sanitation increased significantly over the last three decades, progress has been outpaced by rapid urban growth. The number of people in urban areas lacking improved sanitation has steadily increased and today over 1.8 billion urban dwellers do not use safely managed services. Progress has not only been slow, but also uneven between different segments of the population. The focus of ministries, urban authorities and financing agencies has been mostly on incremental expansion of sewers, benefitting non-poor segments of the population, and in most places, utilities have failed to provide citywide services mainly because they have stayed within the sewer paradigm. [...]