Prudent economic policies, combined with the enabling conditions created by a high endowment of water, have transformed Vietnam from a low-income to a middle-income country within two decades. Though growth has produced vast benefits, it has also placed unrelenting pressures on water resources, which in turn lead to economic stresses. This report assesses how secure Vietnam’s water resources are and its economic implications and focuses on reducing the threats of “too little, too much, and too dirty.” Specifically, the report focuses on increasing water productivity in irrigated agriculture, water security and services for settlements, and on how Vietnam manages water quality and pollution issues, as well as climate change adaptation, disaster risks, and risks from infrastructure gaps and vulnerabilities.