Excreta and wastewater contain highconcentrations of pathogens. Poor excreta and wastewaterhandling and disposal leads to excreted pathogens enteringthe environment. This coupled with lack of adequate personaland domestic hygiene; in-sanitary conditions at communitylevel and discharge of untreated wastewater pose high riskto human health. The World Health Organization (WHO)estimates that 2.2 million people die annually fromdiarrheal diseases and that 10 percent of the population ofthe developing world are severely infected with intestinalworms related to improper waste and excreta management (WHO2000). Improving access to sanitation facilities andmanagement of liquid waste continues to be a major challengefor all ULBs in India. According to census 2001, about 285million people (54.79 million households) lived in urbanareas. Nearly 26 percent of these households lacked accessto sanitation facilities (and most were forced to defecatein the open). In the same year, 32 percent of 2.79 millionurban households in Madhya Pradesh lacked access tosanitation facilities.Madhya Pradesh, popularly referredas the heartland of lndia, has 338 urban centers (GOMP,2007). In 2001, the level of urbanization (at about 27percent) in the state was comparable with the nationalurbanization level (28 percent). More than a third of thestate's urban population lives in 9 major cities of thestate. According to GOMP (2007), in 1991, only about 45percent urban households had access to all three facilitiesof water, sanitation and electricity. By 2001, thisproportion went up to about 62 percent. Though this is asignificant progress, there is still a long way to achieveuniversal access. Nearly 12 percent urban households lackaccess to safe drinking water. The status of urbansanitation is abysmal with only about 53 percent householdsreporting access to improved sanitation facilities. Amongthe rest, 15 percent access 'other' latrines and alarge proportion of households (32 percent) lacked access tosanitation facilities. Thus, improving access to improvedsanitation facilities continues to be a major challengedespite more than two decades of focus and attention to the sector.