The ‘Network for the development of sustainable approaches for large scale implementation of sanitation in Africa’ (Netssaf) project was initiated to develop collaboration among stakeholders to identify and implement sustainable sanitation approaches integrating low-cost technologies with community-based management. The investigators focused on West African countries and first identified settlements with no sanitation access. They then selected several case study sites based on a variety of factors and assessed seven sanitation systems along with sustainable alternatives. The researchers identified potential sanitation providers by region, creating a database of small and medium-sized enterprises (SMEs) operating in West Africa. The final project outcome was development of a sanitation decision support or management tool (Sanitation Management Support Tool) and a guide for its use to help stakeholders apply large-scale sustainable sanitation concepts to the varying conditions in West Africa. Implementation of the Netssaf project outcomes should help Europe and Africa to meet the MDGs for global sanitation access and thus enhance the lives of the millions of people in West Africa living without access to clean water.