This working paper reviews the first decade (2001-11) of Uganda's pioneering private sector participation (PSP) model for small town water supply. The number of towns under the PSP model has steadily risen from only 15 in 2001-02 to over 90 in 2010-11 with a combined population of over 1.5 million. In evaluating the impact of this development, this working paper aims to guide further reform within Uganda, and to inform other countries considering similar PSP approaches. The core idea behind PSP centered reform in Uganda was to improve sustainability and efficiency of piped networks in small towns by hiring private operators (POs) for their commercial management. Driven by a profit motive, POs were expected to maximize revenue, minimize waste and maintain and expand networks in a sustainable manner. To guard social objectives, infrastructure remained under government ownership and the introduction of POs was accompanied by a complex regulation, as well as support, framework.