Access to potable water, sanitation and water for irrigation is already a serious problem in the developing world, especially in the vast semi-arid regions of Central Asia and Africa, and is expected to become even more serious as population growth and climate change exacerbates existing inadequate delivery systems and dysfunctional management institutions. The Millennium Development Goals (MDGs) have set very ambitious targets. The principles and practices of contemporary water management are well known and have adapted reasonably well to technological advances, institutional prerogatives and public preferences in the developed world. Yet the gap between water resources availability and needs grows inexorably in the developing world. Is it the failure of water managers, or the lack of adequate investment or failure to adopt new technologies, or is it a failure at a more elemental level; the failure of institutions and the technical capacity to implement solutions and to manage those investments wisely? There is a consistent storyline in the recent literature, such as the reports of the Intergovernmental Panel on Climate Change (IPCC; Bates et al, 2009) that: