**Salomey Gyamfri Afrifa is a PhD candidate at the International Institute of Social Studies (ISS) of Erasmus University Rotterdam.** My research is on understanding the institutional change which has occurred in the implementation of the National Water and Sanitation Programme. Specifically, the study explores processes of institutional change and how that has impacted on users’ access to water and also, the sustainability of small town water systems using six cases represented in three regions of Ghana.