The principal water supply development concerns in Pakistan today are related to upland watershed management practices that result in erosion of hillsides and siltation of reservoirs and in unreliable water quantity and quality. This article discusses the sociocultural background of the Pakistanis that makes it difficult to create an awareness of health and water quality issues, mismanagement of upland watersheds and its consequences, and the current role of development agencies in upland watershed management. Suggestions for project success in Pakistan are offered. Includes 8 references.