In a study to identify strategies to deal with rapid urbanization and threatening climate change, in Can Tho City, Vietnam, a survey of 1200 households was undertaken to investigate water access and sanitation services. The survey targeted three different groups based on their access to water services: (a) those with piped water supply, (b) without piped water, and (c) a mix of (a) and (b). Socio-economic factors and level of urbanization significantly influenced the different water sources accessed by households and their type of sanitation. Results indicated that householders often employed multiple water sources in an attempt to match source with intended use. The use of multiple water sources, levels of sanitation and the quality of water were found to be good indicators of reported rates of illness. Results also showed that the provision of piped water does not always provide the desired health outcomes, as the definition of adequate water supply does not include water quality objectives. Therefore, more detailed assessments may be required to understand how people use and access water and sanitation, and the impacts on public health.