There is a wealth of literature indicating that socio-cultural understanding is crucial in the implementation of sanitation programmes. However, in Indonesia, the exploration and response to this understanding in regard to sanitation uptake and sustainability remain weak. This study aims to gain an understanding of the cultural determinants underpinning sanitation issues across all sanitation stages in one part of Indonesia in order to address both uptake and sustainability. A qualitative exploratory study in two rural communities in Bali identified some cultural values and traditional roles that can affect sanitation uptake and sustainability. A set of values relating to harmony and purity, and community and individual roles defined by culture appears to modify the perception of risks and barriers, and sets priorities for resources and commitment. The paper also discusses how to translate the understanding of local values and roles into action strategies in order to improve sanitation uptake and sustainability.