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Nepal is one of the poorest countries in Asia. Nevertheless, Nepal government established health policy for improvement of public health and free basic medical service all over the country and trying to fulfill its promise. Among the health problems, drinking water and toilet sanitation are the basic necessity to secure public health in Nepal. Contamination of drinking water by heavy metals and microorganisms is the leading cause of diarrheal disease and skin diseases. Several sites of drinking water confirmed high level of arsenic and microorganism in Nepal. The geographic condition hampers the improvement of sanitation especially in far- western Nepal. Many people live without toilets and consider open defecation as their habit. These conditions have been affected by their culture, ethnicity and regional characteristics. To facilitate Nepal’s government policy to improve public health, KOICA joined work together in Tikapur, Kailali, Nepal. First, baseline survey was conducted to examine general condition and health state in this area. Among these, we summarized regarding drinking water and sanitation related. Among the 4204 households, 97.3 % households used tube well. Of them 97.6% households revealed drink tub well without any treatment or boiling and 49.1% of the people didn’t have toilet in their house. Sixty-percent (60%) of the people have the concept that contaminated drinking water is the cause of illness but rarely act to prevent drinking water related diseases. Our sampling for the tube well quality showed that all the 4 water samples from the tube wells revealed a high concentration of Manganese. To secure hygiene and sanitation, education program on hygiene and sanitation, portable water facility, installation of toilet and further research regarding water safety are needed.