Sanitation, water supply, and their governance remain major challenges in many Pacific Island countries. National sustainable development strategies (NSDSs) are promoted throughout the Pacific as overarching improved governance instruments to identify priorities, plan solutions, and fulfill commitments to sustainable development. Their relevance to local village-level development priorities is uncertain. In this work we compare national priorities for sanitation in NSDSs with those in village community development plans (CDPs) and with metrics in censuses from the Kingdom of Tonga. Tonga’s Strategic Development Frameworks (TSDFI 2011–2014 and TSDFII 2015–2025) were developed to focus government and its agencies on national outcomes. From 2007 to 2016, 136 villages throughout Tonga’s five Island Divisions (IDs) formulated CDPs involving separately 80% of women, youth, and men in each village. It is shown that censuses in 2006 and 2016 reveal linked improvements in water supply and sanitation systems but identify IDs with continuing challenges. It is found that sanitation and water are a national priority in TSDFI but are absent from the current TSDFII. In contrast, analysis of CDPs, published just after TSDFII, show in one ID, 53% of villages ranked sanitation as a priority and marked differences were found between IDs and between women, youth, and men. CDPs’ sanitation priorities in IDs are shown to mostly correspond to sanitation and water metrics in the censuses, but some reflect impacts of natural disasters. Explanations for differences in sanitation priorities between the national and local development plans, as well as suggestions for improving NSDS processes in island countries, are advanced.