Poor access to safe drinking water and sanitation is a severe health risk and a fundamental development constraint for Pacific nations, which have among the world’s lowest access to basic water supply and sanitation. To improve public health and hygiene in the Pacific, this study aims to increase knowledge and awareness among policymakers and designers of sanitation options, programs, and projects. The study covers the feasibility, risks, and opportunities of the various technological options for improving on-site sanitation and targets peri-urban and remote locations. It also investigates peri-urban and remote communities of Vanuatu and the remote communities of the Republic of Marshall Islands in-depth.