The document discusses global sanitation issues and innovative solutions being piloted by USAID's Hygiene Improvement Project in various countries. 2.6 billion people lack basic sanitation and 1.1 billion still practice open defecation. New approaches are needed beyond subsidized latrines. Projects in Ethiopia, Madagascar, Peru, and Uganda aim to create demand, strengthen local markets and entrepreneurs, and link sanitation to hygiene. Monitoring tools also developed to measure access and behaviors. Handwashing promotion highlighted as a way to reduce diarrhea by 50%.