This study follows current approaches topolitical economy-interdisciplinary inquiry drawing uponsocial and political theory and economic principles-tounderstand how political actors, institutions, and economicprocesses influence each other. The 'political economyof sanitation,' therefore, refers to the social,political, and economic processes and factors that determinethe extent and nature of sanitation investment and serviceprovision. This study's conceptual framework combines adiagnostic component with a typology of actions to helptranslate analytical findings into more effective support tooperations and investments. The diagnostic framework aims toidentify political economy constraints as well asopportunities that are entry points for subsequentoperational actions. The study was conducted through aqualitative analysis of stakeholders, institutions, impacts,risks, and opportunities that was linked to processes andpolicy debate. This synthesis report is based on thefindings from the secondary literature review and theresults of primary research in the four case studycountries, which examined how each had identified andmanaged political economy risks and opportunities in itssanitation interventions. Overall, the study confirms theimportance of assessing stakeholder interests, identifyingpotential winners and losers, identifying incentives, andexamining formal and informal institutions.