A multitude of transitional water supply and distribution interventions are continually piloted in Kenya’s fast-growing urban settlements to meet national and global MDG targets, yet visible problems persist regardless of the investments made. This research evaluates the performance of four interventions led by public utilities and non- governmental organisations in the low-income settlements of Nairobi, Kisumu and Nakuru counties. To understand the service improvement received by the residents, this study used qualitative data from interviews and focus group discussions and quantitative data from 1,168 household surveys. Service level analysis results showed making water more affordable using pre-paid technology reduced the effective price by 75% and increased consumption per household by 20 litres per day, resulting in the highest service progress. Improving water accessibility for the very poor via hosepipe door-step delivery reduced the burden on women carrying water by 43% although efforts failed to reduce the pricing structure, limiting the progress. Subsidised ‘first-time’ metered plot connections to increase the utility customer base experienced shortages in water supply and reluctance from landlords, restricting development. Despite showing no positive change, 81% of residents continued to rely on expensive self-supplied boreholes which were all contaminated. Although the utilities have made positive strides in service improvement, in the context of universal service this study has shown that the very poor remain the most difficult to access, forming the target of discrete interventions that experience difficulties in influencing a reliable supply, sustained price reduction and/or good water quality – essentially what is needed most. In investigating the longer term supply and demand shortfall, this study concludes that the equitable supply and innovative distribution of point source groundwater, with a bias for the poorest, could be the most resilient transitional solution for the utility to promote in the foreseeable future, out of necessity rather than desire.