The world is not on track to reach the sanitation target of the Millennium Development Goals: a halving of the proportion of people without access to improved sanitation by the year 2015. Sanitation and Hygiene (S&H) policies, backed by sound epidemiological evidence, and supported by solid socio-economic arguments for increased investment, are still being overlooked by many governments. Technical solutions exist, as well as broad agreement that they should be used to support demand. Recent research suggests that the problem lies in failures in sanitation policy-making. An example from Ethiopia shows what can be achieved when a sound sanitation strategy is backed by strong political positioning and good communication.