The Water Board in Lilongwe, Malawi is facing enormous challenges in providing access to urban citizens to safe and affordable drinking water. These challenges includes; keeping production levels up with drinking water demand, reducing the amount of physical and commercial water losses and collecting sufficient revenue to cover operational cost, repayments on loans and investments. This study analysis the incentives and disincentives that contributes to improve accessibility by reducing water losses and safeguarding continuity of drinking water supply to citizens of Lilongwe, Malawi. This study undertakes a qualitative in-depth analysis. First a conceptual framework is made by using the IAD framework distinguishing exogenous variables and action situations. Second, exogenous variables are described by highlighting incentives and disincentives from two data sets of two different countries; Lilongwe Water Board, Malawi and Vitens NV, the Netherlands. Third, by using game theory five action situations have been analyzed in depth to extract institutional lessons. The analyses suggest that the presence of an external donor organization which provides funds to make necessary investment displaces local efforts to contribute to maintenance efforts. To ameliorate donor disturbances a more effective allocation of institutional capacity is needed. This study concludes that first, better information gathering and information management will reduce uncertainty and improves decisions making by management and planners. In addition, an increase in transparency through bi-directional communication and ownership of information management will provide an incentive to commit to decisions of participants involved. Second, the frequency of encounters between a government institutions and a drinking water supply company will provide a government institution with more credible institutional instruments to withhold funds or conversely reward funds for new investments. Third, given limited institutional capacity of government offices, creating transparency on maintenance outcomes of different urban regions will create competition among maintenance teams, managers and planners. Consequently, this will provide an incentives to improve maintenance efforts to achieve better outcomes.