The accelerated expansion of cities is imposing enormous economic, environmental, social and political challenges for Latin America and the Caribbean and demands for integrated planning and management approaches. Although, the countries of the region have made progress in terms of coverage of water and sanitation services, water resources are managed in an unsustainable manner and many utilities in the region are managed inefficiently and lack transparency. They also encounter great difficulties in meeting operational and expansion demands, particularly in peri-urban areas, which puts in danger the sustainability of the progress made in coverage. Therefore it is paramount for governments, donor organisations and stakeholders to design and implement programs that stimulate reforms and capacity building.