Water access is the cornerstone of livelihoods for most rural communities in Tanzania. Yet limited capacity for effective planning, management and governance of water sources is deepening vulnerability to the increasing and often unpredictable impacts of climate change. This paper assesses Tanzania’s recently centralised approach to rural water planning through a climate resilient development lens, drawing on consultations in Dodoma Region. We find that integration of climate resilience principles including integration of local knowledge and cross-sectoral collaboration could be improved. We also find growth of a scarcely regulated private sector for water access with mixed outcomes for resilience of communities.