The document discusses hygiene and sanitation improvement efforts in the Amhara region of Ethiopia using community-led total sanitation approaches. A mix of community-led and household innovations were applied to improve WASH practices and reduce diarrheal disease while strengthening health systems. The program was embedded in Ethiopia's national hygiene and sanitation strategy and health extension program and emphasized community participation, behavior change techniques like shame walks, and capacity building of local cadres. Evaluation found improvements in sanitation access and handwashing knowledge from baseline to endline surveys.