Perhaps the greatest challenge in improving the environmental health conditions of more than 2 billion people globally is the safe management of human [and animal] excreta. We all know that human excreta is unsafe, and that ending open defecation is an important step in reducing our exposure to harmful pathogens. But containment is only the first step. How do we “safely manage” human excreta? What do safe disposal and management systems look like and can we ensure that they are resilient and sustainable? How do we measure success? Every step within the human excreta management chain (containment, emptying, transport, transfer, treatment, and reuse/disposal) is a potential opportunity for pathogens to be released into the environment and represents a complex set of technical, engineering, financial, social/cultural challenges. This section will explore what we know and don’t know about how to manage shit to prevent the release of pathogens release into the environment.