Over the decades, and especially during the UN International Drinking Water and Sanitation Decade (1981-1990), many projects were built in developing countries. Most were initiated and implemented by governments, donor agencies and NGOs with little or no involvement of beneficiary communities (supply-driven approach). Further, most of these organizations preferred to implement without involving the government, or other NGOs, for implementation efficiency. The operation and maintenance of these projects was undertaken by governments. With time, poor management structures and diminishing resources made it difficult for governments to maintain and sustain them, which led to the collapse of 20 to 40% of the projects. The effects of this was a marked decline in water and sanitation coverage, access, loss of investments and user benefits. Water sector reforms driven by policy changes have resulted in a shift from centralized systems to community managed services. Scaling up is a process of accelerating coverage from “islands of success” to entire populations. The overall objective of scaling up water supply is to secure long term sustainability of community managed water supply and sanitation services; and to rapidly serve more people with sustainable water supply and sanitation services and reach 100% coverage within a geographic area. Scaling up requires different approaches to implementation, especially a move away from projects towards a service delivery approach. Communities need to be empowered to take over the operation, maintenance and management of water supply, sanitation and hygiene projects and to work in partnership with governments and other partners. According to the World Bank, scaling up should meet two critical criteria; namely that of inclusion and institutionalization.