The continuous growth in the demand for water supply and sanitation services has posed decision makers with the challenge to discover new, and to adapt existing, institutions. Since the last two decades, the most prominent institutional change for the water and sanitation sector is neo-liberalism. Neo-liberalism manifests itself in the water sector through privatization, private sector involvement and liberalisation. This book analyses whether neo-liberalism has had an effect on the institutions, the strategies, and the performances of water providers. Strategies are interpreted through what a water provider can do (strategic context), wants to do (strategic plans), and actually does (strategic actions). On the basis of studies in the Netherlands, the Netherlands Antilles, the United Kingdom and Italy, the book concludes that neo-liberal institutional changes matter for the strategies of water providers. However, it also finds that the inherent problems with performance interpretation, measurement and comparison obscure any accurate insight in the effect of neo-liberal institutional changes on performance. In this regard the book opens a window for research both on the relation between institutions and conduct, and between conduct and performance of water and sanitation providers.