The efficient management of water resources and services continues to be a concern in many of the small island states of the Caribbean. There are growing concerns over the ability of governments in the region to ensure the good management and provision of water without jeopardizing economic growth and the maintenance of social well-being. This paper provides an overview of the major factors influencing the water security facing the Caribbean Region and how the emerging concerns are being addressed. The key challenges and vulnerabilities may be summarized as lack of data and barriers to making available what information there is. Forward planning has been largely neglected and is symptomatic of a lack of appreciation of the need for having national water policies. In this respect Jamaica’s development of a national master water plan serves as a good example of what is needed. Water service providers have to be efficient, well managed and allowed to do their job. This means that they have to be on a sound financial footing. The challenge is to find the balance between appropriate political and regulatory oversight and the autonomy of water managers and service providers.