Political interference and low tariff policies have led to inefficiency and chronic financial weakness of public utilities. The inability of water supply and sanitation (WSS) utilities to maintain and extend services has led typically to situations where in fact subsidized services are denied to the poor who have to rely on more costly and lower quality alternatives. A well-performing utility is a necessary condition for enhancing the economic efficiency of cities and for accelerating the provision of services to low-income areas. However, water utilities in Africa have limited prospects for improving their performance unless they undergo structural reform. Service delivery is not keeping pace with demand, especially for the fast growing number of low-income households living in informal settlements.