Pagar Alam City is one of the cities in South Sumatera province which has a high number of people who are quite and fluctuating diarrhea caused by poor environmental sanitation. The research aims to produce a direction for the arrangement of a sanitary-based environment for diarrhea prevention in Pagar Alam City. This research is a qualitative study with an analysis of Analytical Hierarchy Process (AHP) which emphasizes comparative judgment based on data and literature study. From interviews and literature studies, there are three important criteria for structuring a sanitation-based environment, namely society, environment, and infrastructure. From these criteria, there are eight alternative policies related to the arrangement of sanitation based environment for diarrhea prevention, with priority as follows: Environment sanitation Program based on a case study, strengthening community empowerment facilitator, improving coordination and cooperation among related agencies, rescue environment through local wisdom, improvement of infrastructure access and sanitation facilities, forming sanitation clinics incorporated in Public health center, institutional strengthening and drafting strict rules, and Monitoring and evaluation of sanitation programs.