As part of A.I.D.'s response to the El Tor cholera epidemic which arrived in Ecuador in 1991, a multidisciplinary team from the Water and Sanitation for Health (WASH) Project conducted a cholera assessment of the country. The team reviewed conditions at both the national level and in three hard-hit coastal cities (Guayaquil, Machala, and Esmeraldas), examining factors directly affecting disease transmission (water quality and quantity, excreta and solid waste disposal, and health practices) as well as indirect influences (community participation, institutional and human resource development, financial planning, and the legal and regulatory environment). Problems found included: water contamination due to interrupted water supply and loss of pressure; loss of chlorine residual in water stored overnight in 55-gallon tanks; poor hygienic practices in managing excreta; use of contaminated water for bathing and washing clothes; lack of cholera prevention programs; failure to base health education messages on the knowledge, attitudes, and practices of populations at risk; limited attempts to engage communities in program planning and implementation; inadequate excreta disposal facilities; lack of a national or regional cholera strategy; weak inter-institutional cooperation; and poor management and service provision on the part of the Ecuadorian Institute of Sanitary Works. Includes short- and long-term recommendations at both the national and site-specific levels. The key recommendation for USAID is to increase assistance for patronization in urban areas.