There is a direct relationship between water, sanitation and health. Inadequate water and sanitation infrastructure and unhygienic practices facilitate the transmission of pathogens that cause diarrhoea, which accounts for 2 million child deaths annually in the world, about half of them in India. Globally 1.1 billion people, including an estimated 638 million in India alone, practice open defecation (OD). This is inextricably linked to the very low availability and use of toilets. In India, the 2011 census indicated that less than half (46.9%) of households (HH) have latrines within their premises. Disappointing results from incentive driven government schemes for toilet construction and increased political commitment to sanitation led the Government of India (GoI) to elevate achievement of Open Defecation Free (ODF) status to a national mission in 2014. India aims to achieve ODF status by 2019 through a mix of strategies that include financial incentives for HH toilet construction, recognition and rewards for villages that become ODF, and community led initiatives to mobilise behaviour change. Community Led Total Sanitation (CLTS) is one such community empowerment approach. CLTS seeks to raise awareness of the faecal-oral contamination route, by capitalising on human emotions of disgust and shame to bring about community-wide change in defecation practices, with the ultimate goal of triggering entire villages to become ODF. [86 pages]