Objective: To understand rural communities’ perception and attitudes on safe water and sanitation facilities. Additionally, provide evidence to showcase the impact access to safe water and improved sanitation facilities can have on rural communities. Design: A case study with mix-method data collection through household surveys and focus group discussions (FGDs). Setting: Two villages in Agam district, West Sumatera province, Indonesia, with contrasted performance on access to water and sanitation. Participants: 227 household respondents, 7 FGDs and 15 in-depth interview informants. Main outcome measures: To gain insight on respondents’ perception and attitudes toward safe water and improved sanitation, to design stages of behavioral change. Results: Access to safe water and improved sanitation is not yet needed by rural communities due to insufficient information, nature condition, limited options for facilities, lack of reliable health workers and unclear policy. Behavioral change amongst community members requires more than awareness raising, it also needs planned activities, supplies and policy support with shared ownership between community and government. Conclusions: Sanitarians are key stakeholders in rural water and sanitation. They hold important leadership in gradually changing rural people’s behavior towards safe water and improved sanitation. © 2018, Indian Journal of Public Health Research and Development. All rights reserved.