The Water and Sanitation Program (WSP) has provided technical assistance to support government efforts to scale up rural sanitation since 2007 through Scaling Up Rural Sanitation (TSSM). One of the central objectives of this initiative is to learn how to improve rural sanitation at a scale sufficient to meet the 2015 Millennium Development Goal for sanitation in Indonesia, Tanzania, and the states of Himachal Pradesh (HP) and Madhya Pradesh (MP) in India, and to then use the lessons learned to help replicate policy, programmatic, and service delivery approaches in other countries. The purpose of this document is to synthesize key findings, conclusions, and recommendations from the country specific endline assessment reports to provide guidance and insight to other countries seeking to create large-scale sustainable rural development programs.