In this study I investigate sub-national governments to determine whether the accountability derived from local elections improves the delivery of a vital resource – potable water – to the population and, additionally, consider accessibility to improved sanitation. I utilize a cross-national differenced random effects model of 156 countries from 1990-2007 and examine the complex relationship between water, sanitation, and local government. This analysis finds that States with locally elected municipal government have a higher percentage of people with access to improved water and sanitation facilities as opposed to States without locally elected municipal government.