This book, published by Practical Action publishing in 2013, is a synthesis of 13 country studies, carried out between late 2009 and mid-2010 to review and better understand trends in rural water supply and to identify factors that contribute to or constrain the delivery of sustainable rural water services at scale. It offers valuable insights into ways countries and individual organisations can move towards a service delivery approach step by step and can be used by professionals in government departments, NGOs, development banks, and donor agencies to improve the design and implementation of rural water supply programmes. The Multi-country synthesis report brings together the insights from the 13 Triple-S country studies to: identify trends in rural water supply; analyse factors that contribute to or constrain the delivery of sustainable rural water services at scale, and Highlight innovative models and good ideas from actual practice. Triple-S (Sustainable Services at Scale) is an initiative to promote water services that last by encouraging a shift in approach to rural water supply from one that focuses on implementing water systems to one that aims at delivering a reliable and indefinite service. The initiative is managed by IRC International Water and Sanitation Centre in the Netherlands, with funding from the Bill and Melinda Gates Foundation.