Water scarcity is a global challenge faced by millions of people, and it has a negative impact on the ecosystem, public health, and financial stability. Water demand and supply management becomes critical, especially in areas with limited access to clean, safe water. Wastewater and water treatment infrastructure is essential for maintaining environmental integrity and protecting human health. However, water treatment plants in South Africa face various complex obstacles brought on by institutional setups, practical limitations, and environmental concerns, including water quality. This study investigated the institutional arrangements, operational challenges, and environmental concerns that water and wastewater treatment plants face in the Vhembe District Municipality, South Africa. A qualitative study was conducted in Limpopo province, where employees from 12 water and wastewater treatment plants were interviewed, and the data were analyzed thematically. The data were arranged into five major themes using thematic analysis: understanding water and wastewater treatment systems, educational and demographic profile, water quality assessment, operational performance and regulatory compliance, and water volume in waterworks plants. Staff attitudes, institutional and operational challenges, and the current condition of treatment plants were all comprehensively portrayed using Ostrom’s IAD Framework. It was found that workers generally understand water treatment processes, but inconsistencies and a lack of transparency in monitoring water quality were noted, with many parameters from SANS 241 not being tested consistently. A significant educational gap among workers was also observed. Insufficient capacity, load-shedding, limited resources, and inadequate infrastructure prevented treatment plants from meeting daily water needs, worsened by institutional and socio-economic factors. Similar challenges were noted in countries like China, Ethiopia, India, Pakistan, Malaysia, Brazil, and Libya. To enhance water management efficiency and compliance, the study recommends more training, standardized procedures, proactive maintenance, and stakeholder involvement.