Water resources management faces challenges that affect water availability and long-term freshwater security. An example is the increasing threat to streamflows caused when catchments are converted for development and agriculture. Overall water security is an emerging challenge, which the present institutional frameworks and enabling environments are increasingly ill-equipped to deal with. Although many governments acknowledge the need for change and to develop plans, existing efforts to put these plans into practice have not proved sufficient. Regional interventions have failed to get off the ground and national-level interventions have fared little better. The main challenge facing regional approaches is diversity, and so water resources management should focus on developing common frameworks and standards. Over the past decade, most of the many interventions designed to improve integration have been initiated or promoted by international or regional actors. But a 'project approach' preferred by such agencies, and the associated implications for funding activities, does not fit well with the protracted process of transitioning and reforming national water sectors. Despite the fact that the Caribbean region shows considerable understanding of and sensitivity to the need for integration, so far efforts to embed integrated thinking have yielded few tangible benefits, particularly when these efforts have focused on institutional frameworks. The administrative and professional classes in the water sector are very well acquainted with an integrated approach and actively include it, as far as they can, in the working environment. This is due in large part to ongoing training, capacity building, and networking of various advocacy organisations. However, the professionals have failed to capitalise on this, even when opportunities, such as the impact of natural hazards (e.g. droughts and hurricanes), have drawn attention to the need for change. It may have been the case that the urgent need for short-term crisis management obscured the longer-term commitment required for more far-reaching reforms. Projects that address specific stakeholder concerns or issues at national and community levels were the most successful and visible aspects of interventions. The greatest impact can be seen in specific 'demonstration' projects, usually at the community or watershed level. These results reinforce the message that an integrated approach works best when it addresses real issues that resonate with people's everyday experiences with water and their environment. In spite of failings in water service delivery, consumers and the public have shown very little appetite for change, and there is implicit support for continuing with existing arrangements. Customers have little influence over service providers and are unable to hold them to account. This lack of public interest in change is compounded by perceived political risks of change, such as raising water rates, improving collection of unpaid bills, and depoliticising investment decisions by which potential influence is reduced. The cabinet-based approach to political decision-making could potentially provide a mechanism for mobilising political support if ministers were to become champions of change. But this has seldom been the case. Given the level of consensus among the various actors in the water sector and their commonly held beliefs about what constitutes good water governance, the necessary conditions for improving water management are in place. However, the slow pace of change suggests that these conditions and the presence of champions alone are not sufficient; that something else is necessary. Recent research suggests that advocacy needs to be complemented by so-called 'brokering' actions, which call for different approaches for different countries. Brokering is about recognising and reconciling the needs and aspirations of different stakeholders, particularly the politicians. This is achieved by ensuring a 'fit' between the problem perceived by politicians and decision-makers and the proposed solution. This suggests that approaches that seek wholesale water management reform will seldom 'fit'. What are required are more incremental approaches,peculiar to each country, coupled with international financial contributions. Such approaches may be more successful, particularly if they have support at the very highest political level. The challenge for the Caribbean is how to secure that level of support, which to date is missing.