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Community-based safe drinking water programmes are being promoted as cost-effective interventions that will help reduce this illness burden. However, the effectiveness of these programmes remains under-investigated. The primary argument of this paper is that the biological exposure reductions underlying safe water interventions vary tremendously over space and time, and studies that only report results of intent-to-treat analyses cannot reveal why such programmes succeed or fail. The paper develops a stepwise evaluation framework to characterize, and so analyse, the technical, financial, social and behavioural factors that underlie exposure and mediate the impact of safe water investments. Relevant factors include physical performance of the water system, community capacity to maintain and manage the systems, and the time and budget constraints of households participating in the programme. 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