Universal access to safe water remains elusive in Africa, and the continent is unlikely to meet the Millennium Development Goal (MDG) for access to improved sources of water. What is the price tag for moving closer to universal access? To meet the MDGs, Africa would have to spend $15 billion annually, far more than the current spending of $3.6 billion. Underpricing of water and the operating inefficiencies of utilities deprive the region of about $3.7 billion in revenues each year and prevent water from being made available to the poor. But even with improvements in efficiency and cost recovery, the water sector will still confront a sizable funding gap. That gap could be narrowed through the use of simpler forms of water supply and by reallocating subsidies so that they benefit only the neediest households.