There are four main targets for sanitation programmes: rural development, urban upgrading, periurban shanty and squatter upgrading, and new urban development. Programmes for these areas may be similar in content or approach. For example, both rural and shanty town development may have a high level of community contribution in labour, yet they may be very different in the input of health education, introduction or enhancing awareness of new technologies, development of managerial structure, and provision of finance.
Questions have arisen concerning the kinds of technology that are most appropriate to the communities to be served and how this technology can best be introduced. The need for technical specialists to be aware of the social and cultural context of engineering interventions has been emphasized together with the need for popular participation in project design and implementation. Concepts such as grass-roots development, based on an approach that builds from below, have offered a challenge to the top-down approach based on decisions made at high managerial levels. The former is critical in sanitation programmes, since the effectiveness of these programmes depends not merely on community support but, more particularly, on the consent and commitment of households and individual users. Further, in sanitation programmes, technical and social decisions are closely interrelated.