Based on studies of water, poverty and livelihoods in nine river basins, this article reviews the role of institutions and organizations, focusing on their strengths and weaknesses, and to generalize as to why they fail to address the basin-wide issues of water, poverty and livelihoods. The authors show how a more comprehensive, integrated approach might change them to be more broadly relevant to basin-wide needs as well as to address the mismatch between development and the need to provide ecosystem services relevant to food, poverty, livelihoods and sustainable ecosystems. Keywords: water resource management, governance, ecosystem services, basin focal projects, sustainable development.