This case is the first of a three-part series that follows the managerial, strategic, and communications decisions of the Swachh Bharat Mission (SBM) or Clean India Mission, the flagship programme of the Government of India to eliminate the practice of open defecation (i.e., not using a toilet) from 2014 to 2019. As of 2014, 550 million people in India practiced open defecation. This problem posed a massive public health hazard and economic drag for the country as well as a threat to global health. Written from an insider’s perspective, the cases centre on the decisions made by a new Secretary of the India’s Ministry of Drinking Water and Sanitation, who was hired to manage SBM, and the team he assembled. Case A sets the stage for addressing open defecation in rural India and discusses the human resources and strategic challenges to implementing SBM from the vantage point of the new Secretary. It ends with strategic dilemmas related to what the new SBM team should do once they had sized up the challenges to eliminating open defecation by 2019. The case provides an opportunity to deliberate the managerial and strategic decisions of a globally relevant public behaviour change and rural infrastructure development program as well as different forms of public sector implementation in the Indian context.