For 10 years, I had been promising Joe Madiath I would come to Gram Vikas in Orissa. This year, I finally made it. And what a treat it was.

They achieved this by sticking to two principles: Understanding the importance of time and patience and leveraging assets.

The behavioural and social changes that Gram Vikas triggered in the 700-plus communities, where it is present today, did not happen overnight. Social enterprises working at the community level must rely on a trial and error approach, and that takes time. This approach has been essential, given that the communities where Gram Vikas works are the most forgotten groups in the subcontinent.

Gram Vikas’ greatest success has been using sanitation and water as an entry point to start a series of behavioural, social and economic changes at the community level which have had a huge impact on people’s lives. But before it found the winning strategy, there was a failed attempt at setting up a dairy farm, followed by a biogas initiative which, while successful, was limited in its impact because it did not improve the lives of the poorest.

As a result of its work in the villages, Gram Vikas was acutely aware of the high disease incidence and knew that there was one major factor at fault—the lack of proper sanitation. Open defecation was the norm, contaminating water supply and creating a never-ending cycle of diarrhoeal diseases and skin disorders.

In addition, lack of access to water forced women and girls to walk long distances to fetch enough for household consumption—and kept girls out of school. Malaria, endemic to the region, was exacerbated because of unprotected water sources.

The only way to ensure every single man, woman and child in the village was reached and their lives improved was through water and sanitation and so in 1992, Gram Vikas initiated what was to become its winning strategy, focusing on these two basic needs. Today, those communities that have engaged in joint efforts with the organization have reduced overall illness by 85% with an 88-90% reduction in incidence of diarrhoea, jaundice and malaria. As importantly, 80% of the girls are enrolled in school and at least 16,000 women have organized into self-help groups with access to microfinance.

Illustration: Jayachandran / Mint

• Every household has to agree to join the programme, ensuring participation of the entire community. A 100% consensus is vital to totally end the practice of open defecation. Even one family left out would mean that diseases would be transmitted through polluted water or unsanitary habits.

• The water supply is not connected until all households have a latrine—water being the carrot to stop open defecation.

• Every family is required to contribute to a community endowment fund that is held in a deposit account and funds future expansion to new families—who also contribute—so that no family in the village is without a toilet or a bathing room.

• Each household contributes to the costs of construction, either in cash or kind, and pays a monthly fee for the operation and management of water supply.

There are other transformational spin-offs under way. The water and sanitation programme has given the community an opportunity to manage its own resources through village committees. As a result of the organization’s all or nothing approach, every family, including those of Dalits, has been required to come together to contribute financially and with labour to the effort. Centuries-old class, religious and gender divisions are eroding rapidly as a result.

One of the most moving points in my trip took place in a village where Gram Vikas and the village had come together to install toilets and pump water. The village leaders were there; so were women who had not dared join such a gathering before. And then the head of the village shared with me that he was a Dalit—but thanks to the collective work the organization had catalyzed, two years ago, he had been elected village president.

Madiath and his colleagues have ensured that others take the credit for the transformational changes—giving centre stage to the government of India and the state and municipal governments, as well as to the communities. It has had an uphill struggle to leverage government monies under the total sanitation campaign.

Madiath’s main tactic has been what he calls grovelling—and it has worked. Today, the campaign contributes 80% of the costs of the water and sanitation programme facilitated by Gram Vikas.

The organization has a staff of 500 spread throughout India, primarily Orissa, and it has huge ambitions. By 2010, it aims to double the number of families with access to water and sanitation facilities from 50,000 today to 100,000, improving living conditions and helping communities to emerge from the orbit of poverty to a spiral of sustained growth. Never underestimate the power of a toilet.

Pamela Hartigan is director of the Skoll Centre for Social Entrepreneurship at Saïd Business School, University of Oxford