This WHO paper provides an overview of the impacts of climate variability and change on sanitation and the implications for health. It outlines potential adaptation options for strengthening climate resilience of sanitation governance, policies, systems and services, and highlights further research needs and imperatives for policy and programming. It has a global focus, noting that the specific issues may differ across countries with varying levels of onsite and sewerage sanitation systems. This paper is not intended to be a comprehensive review but is designed to serve as a starting point to identify challenges, needs and future actions. It builds on input provided by countries and development partners at a meeting on climate resilience and sanitation hosted by WHO in March 2018, as well as on recent research. This paper includes consideration of sanitation at national and local levels. The scope includes all aspects of excreta management, including wastewater. The paper provides input on national vulnerability assessments as well as local level risk assessment and management approaches, building on Sanitation Safety Planning (SSP) (WHO, 2016). The focus of the paper is dominantly on climate adaptation rather than mitigation.