Improved sanitation facilitates improvements in human health, it enhances prospects for education and work, as well as personal security and dignity and has a positive impact on the environment. In this way, sanitation has a pivotal role in achieving all eight Millennium Development Goals. Human excreta can be viewed as waste or a resource. Traditional sanitation treats excreta as waste, whereas productive sanitation (also referred to as Eco-sanitation or EcoSan) treats human excreta as a resource, with natural fertilizer as an end-product. If done right, productive sanitation can improve agricultural productivity, enhance food security and contribute to sustainable economic development. Innovative mechanisms, including smart subsidies, should be put in place to ensure sanitation provision for the very poor. National decision-makers and the development community need to show leadership and innovation in order to secure sanitation for all.