August 2012 — Partners in Madagascar are implementing four U.S. Agency for International Development (USAID)-supported approaches, innovative in this country’s context, to improve water and sanitation without major subsidies: community-led total sanitation, public WASH blocks, village savings and loan associations, and sanitation marketing. The review highlights how these approaches are operating cost-effectively and sustainably. Presented are the findings from an independent review in May 2012 in which a review team assessed approaches applied by USAID partner projects to improve water and sanitation. The team identified and documented factors contributing to and hindering program success and sustainability, as well as key lessons learned.