Many believe that by simply providing sanitation facilities, there would be reduced cases of water-borne diseases. However, not everyone is aware of the fact that good hygiene practices and access to quality sanitation services are key in combating health threats, especially to children, particularly those under the age of five years. Approximately 88 per cent of all diarrhoea infections worldwide are attributed to unsafe water supply, the lack of safe hygiene practices and basic sanitation infrastructure. The challenge is enormous as the number of people who lack access to sanitation is higher compared to those who access water supply especially in the informal settlements Discussions on sanitation access on the international policy agenda have greatly improved. A major step is the inclusion of sanitation in the Millennium Development Goals (MDGs) in 2001 within MDG 7, Target 10, which sets the aim of halving by 2015, the proportion of people without sustainable access to safe drinking water and basic sanitation. Despite serious health implications, hygiene and sanitation have not received adequate consideration at the local and national level The above situation is evident in Nakuru like in other informal settlements in Kenya. To address this gap, Practical Action and Umande Trust with the support from Comic Relief have designed the Realizing the Right to Total Sanitation (RRTS) project targeting low income settlements in Nakuru. The initial focus is on the sprawling settlements of Kaptembwo and Rhoda. The Nakuru programme has adopted the Community Led Total Sanitation, Technology and Empowerment of small scale sanitation services providers as approaches to improve sanitation in the target areas.