As the World Bank and partners aim to support governments in the Middle East and North Africa address the challenges that confront the water and sanitation sector, the development of an effective regulatory framework is seen as increasingly salient. In order to have impact in this space, some basic information is needed. The objective of this study is to collect information through a regulatory lens and present it to serve as part of the foundation for sector reviews and operations. It is not the objective of this study to analyze or critique the performance of water and sanitation services or the effectiveness of regulation in each country or to make recommendations. Thus the approach is positive rather than normative. The report is part of a wider World Bank initiative to provide government officials and other stakeholders including civil society, service providers, potential financiers, and development practitioners with the resources to better understand current conditions and consider approaches to policies, institutions and regulation that can best incentivize the delivery of sustainable services. The report discusses the different approaches in implementing regulatory functions specific to economic regulation and highlights aspects of the operating environment particular to each country context including sector institutional roles and responsibilities, tariff formulation processes, private sector participation and public-private partnerships, and the role of citizen engagement in sector regulation. This desk study is a first step intended to provide some basic information on selected countries that will serve as a foundation for determining where further support in the area of regulatory reform might be best concentrated. The authors review the status of regulatory institutions and practices in five MENA countries which were chosen to include different historic and legal frameworks and fragile/conflict states as well as those that are attempting broader sector reform.