This article examines the impact of decentralization reforms on improving access to domestic water supply in the rural districts of Kondoa and Kongwa, Tanzania, using a users' and a gender perspective. The article addresses the question whether and to what extent the delivery of gender-sensitive water services to rural households improved after the reforms. Household- and village-level data were obtained through a household survey and qualitative methods. The findings show an increase of the proportion of households using improved sources of domestic water between 2002 and 2011. However, more than half of users still travel over a kilometre and use more than an hour to collect water in the dry season. Despite the increased proportion of women in water management committees, the outcomes of these decentralized arrangements differ for men and women. Overall, the reforms have produced contradictory effects by improving access to water supply for some users, and creating or reinforcing existing inter- and intra-village inequalities.