This chapter addresses the import of systemic conditions on the development, organization and functioning of water and sanitation services (WSS), with particular emphasis on the social conditions and constraints that are mostly neglected or even ignored in traditional public policy and management practices in this sector of activity. The analysis of the influence of systemic conditions has a long tradition in the social sciences, particularly in relation to the intertwining of structural and agent-driven factors in almost all spheres of social interaction. It has also been deployed in a number of fields, from the analysis of the barriers and constraints facing the introduction of preventive health public policies (Berkeley and Springett, 2006) to business studies examining the constraints posed by market systems on economic agents who have to make choices between the pursuit of profit maximization or ‘more morally preferable alternatives’ such as environmental sustainability (Alexander, 2007).