For the ADB Gangtok Urban Water Supply project, CURE designed Knowledge Attitude and Practice (KAP) studies with a stakeholder analysis and mapping of low income settlements in Gangtok city. Gangtok WATSAN service delivery mechanisms were found to be affected by a combination of inadequate sanitation facilities and poor hygiene practices. Key areas of concern were the long /open /overhead /ad hoc water pipe lines easily damaged and capable of contamination as they moved through the storm water drainage system and resulted in high incidence of gastro intestinal infections. Poor people living in tenanted accommodations were the worst affected by poor quality services. Complex institutional arrangements were leading to numerous gaps and overlaps in service delivery.