Water, sanitation, and hygiene (WASH) are essential for human development. The lack of WASH facilities affects the livelihoods and the health of communities. Assessing the state, availability, and accessibility of WASH systems is vital for identifying gaps and formulating proactive solutions. This study assessed drinking water and sanitation access in the Central Gonja District (CGD) and Mtubatuba Municipal areas, using qualitative methods and in-depth interviews with participants. Findings revealed persistent challenges of inadequate, unaffordable, and inaccessible water, along with subpar sanitation services, negatively impacting community well-being and health. Issues like corruption, favouritism, and social networks influenced the distribution of water and sanitation systems. Infrastructure limitations, bureaucratic obstacles, and ineptitude of officials posed barriers to service delivery, exacerbated by rural–urban population shifts. A public–private partnership between Novubu and Mtubatuba Municipality enabled water treatment, showcasing a potential model for sustainable water provision and a possible replication for CGD. The study advocates for transparent governance, community-centric solutions, and inclusive strategies to address chronic challenges, emphasizing the importance of proactive leadership and maintenance to prevent environmental degradation and health risks. The local governance systems should ensure the distribution and maintenance of water and sanitation systems while emphasizing the need for inclusive, community-driven approaches for lasting improvements.