Urban water management has specific institutional challenges that must be addressed in order to improve freshwater access in developing countries. This paper uses case studies from the Philippines to address the political and regulatory barriers that hinder improvements to water services. The central aim is to move past the typical public versus private debate that has dominated international discussions about investment and management of water utilities over the last two decades. The paper describes the scope of the water access problems, examines the need to move past ideology in water management decisions, provides case study examples to illustrate relevant issues, suggests context-specific factors that must be considered, and develops suggestions for policy approaches to reform. The main conclusions are that decision makers need to consult with a broader spectrum of stakeholders when undertaking water sector reform, better understand the local context and existing water provision systems before enacting new regulations and structures, draw on theories and experiences of institutional organization to find context-appropriate systems for water resources, and increase transparency, accountability, and flexibility in governance.