This review aims to help those who work in and with water utilities, as well as organized users, regulators, and policymakers to improve the quality of water services by making service providers more accountable to the people they serve. Traditionally, users relied on politicians to maintain oversight of budgets and compliance with rules and to intervene on their behalf when services failed. This institutionalized a "long route" of accountability from user to political representative to service provider. Modern approaches to public management seek to hold service providers more directly accountable to their users for the outcomes of their work. Providers are expected to ensure that water flows safely and reliably from taps, that blocked drains are cleared, and that services are accessible and affordable to all. Accountability in this context is about establishing a direct "short route" between users and service providers. This review identifies a range of practical tools that can help to do this. It considers where they have been used, where they have succeeded and, as important, where they have failed, and draws lessons from this experience. While there is a great deal of theoretical and advocacy writing on the subject, there has been little structured investigation of how these tools work in practice. This review sets out to fill the gap in knowledge about their practical performance. Using country studies and personal interviews to complement available literature, it provides an overview, a structured analysis, practical guidance, and sources of further information for managers seeking to design and apply tools to improve the performance of utilities.