This brief summarizes the constraints and opportunities of water governance and resource management to understand the root causes of water insecurity and how they relate to adverse nutrition outcomes in Samburu and Turkana. Using group discussions, desk review of existing literature, and an adapted version of UNICEF’s Water, Sanitation, and Hygiene Bottleneck Analysis Tool, USAID Nawiri explored systemic constraints and promising solutions to improve water, sanitation, and hygiene service delivery in urban and rural contexts in these counties. Findings confirmed that women’s time burden for collecting water contributes directly and indirectly to malnutrition in rural and urban households, requiring approaches that include improving governance and management of water services and resources. Improving county governance and management capacity for water service delivery requires both the creation of policy, legal, and regulatory arrangements and strengthening technical and management capacity for planning and operationalizing these services. Rural water system functionality and coverage can be improved through borehole rehabilitation, increased county management capabilities to build strategic boreholes, and the institution of a private sector maintenance and repair business model. The under-performance of utilities has increased urban/peri-urban water insecurity, emphasizing the need for transformed and accelerated water service provider performance. Finally, poor and limited outcomes from prior productive water schemes can be improved through farmer-led natural regenerative practices and small-scale, climate-smart irrigation technologies.