In low- and middle-income countries, people need water for drinking, personal hygiene and other domestic use. But they also use it for livestock, horticulture, irrigation, fisheries, brickmaking, and other small-scale enterprises. Multiple-use water services (MUS) are best suited to meeting people’s needs. However, most water services are designed only for domestic water or only for agriculture, and fail to reflect its real-life use. The action research project ‘Models for implementing multiple-use water supply systems for enhanced land and water productivity, rural livelihoods and gender equity’ developed case studies in eight countries (Bolivia, Colombia, Ethiopia, India, Nepal, South Africa, Thailand and Zimbabwe) involving 150 institutions. The project analysed two models: homestead-scale and community-scale MUS and developed a ‘multiple-use water ladder' to show how better livelihoods flow from increased access to water. This book shows how livelihoods act as the main driver for water services and how access to water is determined by sustainable water resources, appropriate technologies and equitable ways of managing communal systems. Climbing the water ladder requires a small fraction of total water resources, yet has the potential to help people climb out of poverty. Local government can be the pivot to make this happen. But, it needs support to implement its mandate to meet multiple-use demand and to become more accountable to people in communities.