In 1970s most rural water systems suffered systemic failures. In the bid to correct these failures, development organisations and some Non Governmental Organisations (NGOs) in the 1980s advocated a decentralised, community-based approach to water delivery. As a result Ghana reformed its rural water and sanitation delivery approach, making a complete paradigm shift from a supply to demand-driven approach. This approach is underpinned by community participation at all levels of the project cycle, ownership, operation and maintenance, promoting water as an economic good, private sector participation, adoption of a participatory approach involving other stakeholders and the change in role of the state as a provider of service to a facilitator and regulator. Irrespective of these reforms, there are evidences of partial or complete failure of technology, issues of social inclusion, partial or complete breakdown of the community management system, lack of support from the District Assemblies, elite capturing the water system and disputes over ownership of facilities.