The Government of India has requested ADB to assist in development of an Operations Plan to strengthen execution of rural sanitation agenda in India. The Ministry of Drinking Water and Sanitation (MDWS) recently promulgated the Ten Year Rural Sanitation and Hygiene Strategy (2012-2022). Aligning with the Government Planning Commission’s next 12th Five Year Plan (2012-2017), the MDWS plans to incrementally shift from the present project-based approach of Total Sanitation Campaign (TSC) to a more comprehensive National Total Sanitation Mission (NTSM). However, the operational modality, supporting structures, and other practical implementation aspects of NTSM need to be further developed and refined. Effective operational tools and models in rural sanitation, especially for lagging states, need to be further sought based on TSC implementation experience, as well as global and regional best practices.