The Sustainable Development Goals promulgate access to sanitation and hygiene for all and the end to open defecation in the framework of the human right to sanitation. Tanzania has one of the lowest levels of access to sanitation, with increasing open defecation. Ending open defecation has been identified as a top priority for reducing global inequalities in WASH (water, sanitation and hygiene). In this context, the coordinated work of NGOs, universities and governments developed a hygiene and sanitation programme (UMATA), whose methodologies and lessons learnt are ready to be scaled up. This research analyses the information collected from more than 21,000 households and discusses the challenges of monitoring and tracking the degree of achievement of the Sustainable Development Goals and the human right to sanitation. A characterisation of the hygiene and sanitation situation and the degree of adoption of different latrine types was assessed before (baseline) and after (follow-up) the implementation of the UMATA programme using the WHO/UNICEF JMP (Joint Monitoring Programme for Water Supply, Sanitation and Hygiene) metrics and approach. This allowed evaluating the efficacy of the strategy implemented in Tanzania to reduce open defecation that led to a decrease from 40.7% to 9.70% in the monitored period. Finally, we discuss the critical economic factors affecting the adoption and sustainability of improved sanitation systems.