Water management institutions and arrangements in many Caribbean states have not, until recently, altered substantially for some sixty years with the current arrangements reflecting the predominant governance paradigm of a transitional colonial era. This is most obvious in the continuance of a sectoral approach to what might be referred to as the business of government. This, however, is beginning to change such that the water sector in the Caribbean region exhibits varying stages of institutional re-ordering as it seeks to respond to challenges of increasing demand on and for water. This paper reviews the institutional status of water management and water policy developments in the Caribbean through examples from fifteen English-speaking Caribbean states. The trends and influences that are contributing to policy change and governance responses are examined and critiqued, in order to explore where and what potential tensions the re-ordering might give rise to.