Background: Previous research suggests that rural water infrastructure investments in developing countries may be expensive, culturally inappropriate and do not result in clean water being consumed at the household level. Interventions and planning that incorporate community-based planning approaches with a careful consideration of cultural and historical connections may be the most effective method of implementing successful improved water projects. Objective: This dissertation examined the outcomes, cultural challenges and successes of water infrastructure projects in two indigenous communities of Baja California, Mexico and developed a low-cost method of assessing rural water systems to improve targeted outcomes of water system improvements. Methods: Both quantitative and qualitative data from a longitudinal study and focus groups were obtained. Survey data regarding health and water practices, along with water samples in each community were collected before and after new water systems were installed and gastrointestinal illness rates calculated. Transcripts from focus groups conducted after the new infrastructure was implemented were examined for cultural attitudes and beliefs towards water use. Field observations from both communities were used to develop a low-cost assessment tool with a scoring method for determining vulnerabilities in water systems. Results: After receiving new water infrastructure in both communities, neither saw a reduction in rates of gastrointestinal illness. Household point-of-use water quality was still poor despite new infrastructure. One of the two communities receiving new water systems did not accept their new system. Cultural significance of the previously used water source was likely the most significant reason for non-acceptance. Conducting a thorough assessment of each point of the communities' water systems using the low-cost indicator method developed could have provided a better assessment of vulnerabilities in the systems and a better approach to intervention. Discussion: This work provides support for incorporating community participation into the planning and implementation of water improvements, and stresses the importance in addition of examining water beliefs and practices.. Poor water quality at point of use underscores the importance of measuring this water quality indicator. Meaningful inclusion of communities can be used to inform approaches to community development that simultaneously take into account community perspectives as well as technical capacity.