Water is a critical resource necessary to support social and economic development. Economic growth and, in particular, the growth of urban and peri-urban areas, however results in declining water quality which threatens water-dependent industries. In developing countries this is a particular concern due to the rapid rate of urbanisation and the limited financial resources and technical capabilities to adequately maintain and upgrade wastewater treatment works. This is particularly relevant in catchments with a high dependence on export-orientated agriculture. This study considered water quality risks in the Breede River catchment as an area which experiences significant urban and peri-urban growth, focusing on economic risks associated with declining water quality, estimates of the costs needed to rehabilitate existing wastewater treatment works, and alternative strategies such as the use of artificial wetlands, the rehabilitation and protection of natural wetlands, as well as the clearing of invasive alien plants. A major conclusion is that the financial risk associated with a declining economy and social instability outweighs the costs that will be needed for rehabilitation of existing treatment plants. Together with more pronounced fluctuations in precipitation anticipated with climate change, these risks due to declining water quality are likely to increase in future with continued urban and peri-urban growth.