This paper analyzes water services in relation to trust in government, with insights for broader state–society relations. The work is based on a multi-year and multi-sited case study of underserved areas of Cape Town, South Africa and Accra, Ghana. The analysis reveals that water quality and satisfaction are statistically linked to trust in government in South Africa, but not in Ghana. As well, while indicators of water access and quality appear to be very good in South Africa, there is nonetheless deep contestation and ongoing dis-enfranchisement. For Ghana, water access and quality are important for people’s daily lives, but are less strongly connected to senses of governmental responsibility—although for both countries there is a strong sense that government should be “doing more.” Features of history and context are emphasized in the Discussion and Conclusion sections to understand key differences between the sites and other results.