Investments for basic rural sanitation programs should not only focus on the construction of new installations, but also on the necessity of implementing proper management models that guarantee the operational and financial sustainability of the investments. The integrated rural sanitation system (SISAR) is based on the idea of creating a confederation of local user groups which come together on a regional basis, and through an adequate institutional setup, are responsible for managing SISAR and assuring the adequate provision of water supply and in some cases, wastewater services. Financial sustainability is achieved by the implementation of tariffs for water consumption and provision of wastewater services generating revenue which is redistributed among all systems in order to cover all operational, maintenance and administration costs. Important stakeholders in the model include, besides the users, local and state government and international financing institutions responsible for financing the investments in the construction of rural water supply and wastewater systems. This document focuses on the experience and results achieved by SISAR in the Brazilian state of Ceará. In 2001 eight SISARs began providing improved water supply services in 66 settlements. Today, more than 560 settlements (more than 330,000 inhabitants) are supplied by SISARs.