The virtues of integrated water resource management have been widely extolled in the literature. The purpose of this paper is to review selected aspects of Latin American and Caribbean experience which may provide insights on the constraints and opportunities for progressing towards such integration. Economic development and population growth are placing demands on water which are increasing exponentially. However, with a few exceptions, governments have shown little effective response to the broader issues in resolving the inevitable conflicts. Formulation of plans and policies appears straightforward and it is easier still to recommend implementation by powerful co-ordinating agencies. However, practice bears little relation to theory. This suggests that a focus on questions other than technical optimization might be relevant. Attention needs to be given to the institutional structure - formal and informal rules - which determine why decisions are made at the political, organizational and operational levels resulting in de facto water management. Greater transparency on the informal rules may enable more systematic transactions between and within these three levels (particularly within the organizational level) leading to changes which would allow incorporation of a broader and more long-term view of renewable resource management issues.