India, a country with one of the oldest civilisations of the world had the concept of sanitation from Indus valley days. Excavations at Harappa and Mohenjadaro sites show evidence that even in ancient India, the practice of using toilets was prevalent and even community toilets and proper drainage systems were present. Yet so many centuries later, it is a paradoxical reality that the country is grappling with the problems of open defecation and access to sanitation facilities. Sanitation, in today’s parlance, is a comprehensive concept which includes waste disposal, environmental, domestic, personal and food hygiene. It is one of the basic determinants of quality of life and human development index. Good sanitary measures and proper utilisation of the facilities is an important component of healthy living including reduction of morbidity and mortality and prevention of water and soil pollution. Lack of clean drinking water, improper disposal of waste and human excreta, improper environmental sanitation and lack of personal and food hygiene - all of this has direct adverse impact on health, quality of life and economic and social well being. A number of innovative and successful approaches have increased access to sanitation. However, much more needs to be done to scale-up and sustain these efforts.