This paper presents the findings from a research project titled ‘WatSan and PRSPs: strengthening the design, finance and delivery of water supply and sanitation programmes under PRSPs in sub-Saharan Africa’. The research deals with issues in relation to policies and practices when implementing Poverty Reduction Strategy Papers (PRSPs). It provides the current context of sub-Saharan Africa and the factors that result in poor integration and also deals with the themes and issues that may emerge during preparation and implementation. Under this section, arenas such as resource allocation, sustainability, accountability and evaluation are discussed in great detail. The second phase of this research looks at PRSP implementation in Zambia, Malawi and Uganda and the case studies presented in the study explores reforms that have been implemented. The recommendations highlight factors behind the poor integration of water supply sanitation within PRSPs and how the performance can be improved by monitoring equity and sustainability.