There is increasing pressure on water and sanitation systems in South African human settlements. Droughts have reduced water availability in many areas. Ageing infrastructure and a lack of maintenance have contributed to water supplies being unreliable in some regions. Water and sewage disposal costs have also escalated over the last 5 years particularly in water scarce areas such as Cape Town. Scarce, expensive and unreliable water supplies make waterborne sanitation problematic. There are also problems associated other widely applied sanitation types such as pit toilets which can contaminate groundwater and cause diseases like cholera.

It is therefore important to re-evaluate water and sanitation systems in human settlements to ascertain whether these are responsive to changing local conditions related to water supply, climate change and social and economic dynamics.

The Sanitation Options for Sustainable Housing (SOSH) is a tool that assesses alignment between local environmental, economic and social characteristics of a human settlement and sanitation options. The paper presents the SOSH and applies it in case studies in order to critically evaluate the tool. The study concludes that the SOSH shows potential as a support tool for making decisions about sanitation options in human settlements and recommends further development.