Multiple-use services (MUS) have recently gained increased attention as an alternative form of providing rural water services in an integrated manner. This stems from the growing recognition that users anyway tend to use water systems for multiple purposes. This paper aims to characterise this practice on the basis of case evidence collected in eight countries in Africa, Asia and Latin America. The cases show that people almost universally use water for both domestic and productive activities at and around the homestead. Although seldom the main source of people’s income or food production, these activities are of considerable importance for people’s livelihoods. The extent to which people use water for multiple purposes is closely related to the level of access to water expressed in the form of a water ladder in this paper. The case studies presented demonstrate how access is created by different types and combinations of well-known technologies. Additional financial and management measures are required to ensure sustainability of services. Despite the practical feasibility of the MUS approach, it is not yet widely applied by service providers and sector agencies due to observed barriers in institutional uptake. A better characterisation of MUS, alongside a learning-driven stakeholder process was able to overcome some of these barriers and improve the consideration of multiple uses of water in policy and practice.