This paper reviews the urban water and sanitation scenario in metropolitan cities. Section 1 focuses on the institutional and organizational structure of the service providers by looking at the level of technical and managerial decentralization reached in the four cities (Calcutta, Chennai, Delhi, Mumbai) Section 2 focuses on the question of property rights and the debate on usage conflicts in order to fill the gap for the future demand. Section 3 revisits the question of reforms that were launched in the 1990s for all infrastructure sectors. Section 4 and 5 concentrate on two directions the sector could look at for changes: the development of conservation based strategy and the need for a more participative approach by involving the civil society. This would mean a paradigm shift for the sector. Indeed, demand side solutions are rarely considered and the problem of water supply is mostly addressed by the supply angle.