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Environmental sanitation is a major public health issue in India. Recent interventional studies on environmental sanitation in India highlighted the importance of prioritizing control strategies. Environmental sanitation envisages promotion of health of the community by providing clean environment and breaking the cycle of disease. It depends on various factors that include hygiene status of the people, types of resources available, innovative and appropriate technologies according to the requirement of the community, socioeconomic development of the country, cultural factors related to environmental sanitation, political commitment, capacity building of the concerned sectors, social factors including behavioral pattern of the community, legislative measures adopted, and others. India is still lagging far behind many countries in the field of environmental sanitation.The unsanitary conditions are appalling in India and need a great sanitary awakening similar to what took place in London in the mid-19th century. Improvement in sanitation requires newer strategies and targeted interventions with follow-up evaluation. The need of the hour is to identify the existing system of environmental sanitation with respect to its structure and functioning and to prioritize the control strategies according to the need of the country. These priorities are particularly important because of issue of water constraints, environment-related health problems, rapid population growth, inequitable distribution of water resources, issues related to administrative problems, urbanization and industrialization, migration of population, and rapid economic growth. Challenges 1. Prevention of contamination of water in distribution systems, 2. Growing water scarcity and the potential for water reuse and conservation, 3. Implementing innovative low-cost sanitation system 4. Providing sustainable water supplies and sanitation for urban and semiurban areas 5. Reducing disparities within the regions in the country 6. Sustainability of water and sanitation services. Requirements Implementation of low-cost sanitation system with lower subsidies, greater household involvement, range of technology choices, options for sanitary complexes for women, rural drainage systems, awareness building, involvement of NGOs and local groups, availability of finance, human resource development, and emphasis on school sanitation are the important areas to be considered. Also appropriate forms of private participation and public private partnerships, evolution of a sound sector policy in Indian context, and emphasis on sustainability with political commitment are prerequisites to bring the change.