This report evaluates how well EECCA countries have done in ensuring people’s access to adequate water supply and sanitation services since their Economic, Finance, and Environment Ministers adopted the Almaty Guiding Principles to support such efforts in 2000. Besides looking at trends in the technical and financial performance of the water sector, the report analyses the results of institutional reforms at different levels of governance, as well as financing arrangements. Analysis focuses mainly on urban areas, but some of the challenges in rural areas are also examined. The report draws policy recommendations to help countries stem the decline in the sector’s performance that has occurred over the last decade, despite opportunities provided by rapid economic growth in many EECCA countries in this period.