The research underpinning this work took place in the context of two rural water and sanitation projects carried out in the Eastern Region of Ghana. The focus of study was on the way engineers can make water and sanitation projects more sustainable. In particular, emphasis was placed on the broad range of non-technical factors engineers need to incorporate into the design of water and sanitation systems and the processes they need to follow in order to achieve this, looking specifically at the implications of community participation for design process, project management and health and safety management.