The study aimed at exploring the situation of municipal Human Excreta Management (HEM) in Northeast Thailand. Both qualitative and quantitative methods were used for data collection. The findings indicated that nearly all municipalities (98%) had their own legislation regarding HEM. However, the HEM policies were not clear (89%). Regarding collection and transportation services, 78% were serviced by private licensed companies, 13.04% by unlicensed private companies and 9% by the municipalities. Municipalities had only 26% appropriate disposal sites. Only 4% of these disposal sites could be used in practice because of long transfer distances, lack of maintenance, or inappropriate treatment system or model. Municipalities that had no disposal system took them into public land, grassland, or orchard and rice fields, with or without permission from the landowner. Thus, having no disposal system and untreated human excreta is the principal cause in the transmission of pathogens leading to human illnesses. Therefore, for effective management of sanitation, it is necessary for related organizations to balance the sometimes-competing requirements for planning, design and construction of facilities, as well as to monitor the safe operation of their HEM.