Few programmes in the field have methodically applied multiple-use by design approaches. To some extent, this reflects both the novelty of the MUS approach, as well as the disconnect between water research, policy and practice. While water policy-makers have in recent times found the MUS approach attractive, there is significant resistance to actualizing the interdisciplinary approach. Although policies are slowly changing, much of the MUS experiences on the ground have evolved from a more innate process of programmes delivering to the ‘expressed’ needs of user communities. Drawing on eight years of MUS development effort in Nepal, this paper describes the critical components of the multiple-use water services projects in Nepal and the outcomes seen at the community level from these projects. Further, it reviews some of the gaps and limitations of the projects in order to explore opportunities for future MUS implementation not only in Nepal, but globally.