The issue of ensuring that growing communities in small island countries have access to safe water and adequate sanitation is examined in Kiribati, whose islands are spread over three million square kilometres in the central Pacific. Its coral island communities have water supply and sanitation problems among the most difficult in the world. Formulaic developed-world approaches, models, techniques and toolboxes that do not consider the social and cultural context have had little success. Changes in approach at the international, national and local levels are called for, and the resourcing of village-level water and sanitation committees would return ownership and control in rural communities to its traditional base.