As of 2009, at the time of Kenya’s last census, roughly half the population lacked access to clean water. The shortage was more pronounced in the nation’s northern, arid counties. This case looks at the challenges and choices facing one northern county, Garissa County, where Issa Oyow, County Executive Committee Member (CECM) for Water and Sanitation, tried to meet citizen demands for increased water access in the face of a complex and incomplete decentralization process. Garissa County leaders, like other local leaders in Kenya, had to decide how to reform existing water companies and water user associations inherited from the previous regime, while confronting the failure of the national government to fully devolve power and resources, and engaging effectively a mobilized public in water policy reform. The case is relevant for those with an interest in the decentralization of key services, looking at both political and legal aspects of water sector reform in a lower middle income country.