Gram Vikas is a development organization working with tribal and other poor and marginalized rural communities in Orissa, the poorest state of India, since 1979. A study we conducted revealed that 80% of common diseases, particularly among infants and children, were traceable to contaminated drinking water and bad hygiene practices. Waterborne diseases are a major cause of death among children under 5 and loss of productivity among rural communities and hence constitute one of the root causes of poverty. MANTRA is a rural health initiative in nearly 300 villages across Orissa, which facilitates poor communities to come together to establish, operate and manage their own water supply and sanitation systems. The facilities are created with their own efforts and resources, with some assistance from external agencies. Community managed water supply and sanitation is the entry-point and core-rallying element for all families in a village to come together, cutting through social barriers. MANTRA directly targets waterborne diseases such as diarrhoea, worms, gynaecological problems, skin diseases and other infections due to contaminated drinking water and lack of sanitation. MANTRA informs and mobilizes communities to construct toilets and bathing rooms for every household in the village. Once completed, the community builds an overhead water tank with the assistance of Gram Vikas. Every household gains piped water directly to its toilet, bathroom and kitchen. Soak pits, dug adjacent to toilets hygienically absorb waste. The hardware is complemented by an ongoing awareness and education campaign that promotes the importance of toilets, hygiene and overall cleanliness of the village environment. A village committee is set up to manage the system and enforce a system of fines for unclean toilets or open defecation near the village. We have seen an 85% reduction in the incidence of water-borne diseases in villages where MANTRA has been implemented.