This thesis investigated the sustainability of community water management in small towns of developing countries by using case studies from Ghana. Sustainability is investigated as a multi-faceted concept encompassing technical, managerial, institutional and organisational issues. The study is particularly relevant because over one billion of the world's population lacks access to safe drinking water with resultant poverty, morbidity and mortality among the World's most vulnerable, a significant proportion of who live in small towns of developing countries. Small town dwellers are likely to increase thus exacerbating the existing situation of poor sustainable water services. Efforts at providing solutions, largely through the public sector, were found to be ineffective and inefficient. Consequently, many governments have adopted community management a key paradigm for rural water supply and sanitation for small towns. The thesis however, hypothesises that community management is limited in achieving sustainable water supply solutions in small towns; hence modifications are needed in approach to the issues of small-town water supply.