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This study rigorously analysed policy deficiencies and structural vulnerabilities in climate-resilient water and sanitation governance in the Eastern Cape Province of South Africa. The research employed a qualitative approach, utilising semi-structured interviews with fifteen purposefully selected stakeholders, comprising municipal water technicians, engineers, planners, national and provincial authorities, and civil society representatives. The investigation examined the interaction between climate-induced pressures—such as droughts, floods, and rainfall variability—and governance deficiencies that undermine water and sanitation systems. The data collection concentrated on personal experiences of infrastructure failure, discrepancies between policy and reality, and obstacles in institutional coordination. Findings indicated that despite the province functioning inside advanced national frameworks like the National Water Act and the Disaster Management Act, their execution is cursory and predominantly reactive. Participants emphasised an excessive dependence on obsolete national climate models that neglect spatially distinct vulnerabilities across urban, peri-urban, and rural areas. Chronic underinvestment in infrastructure maintenance has become a persistent issue, as municipal budgets prioritise new capital projects over lifespan asset management. The technical team had institutional memory but lacked decision-making power because of bureaucratic procurement processes and disjointed interagency collaboration. The study additionally revealed significant deficiencies in real-time monitoring and enforcement capabilities, as well as gender discrepancies that marginalised women's involvement in governance frameworks. The study concludes that without immediate reforms to decentralise climate data generation, incorporate localised risk assessments, enhance preventive maintenance systems, and institutionalise participatory, technology-driven governance mechanisms, the water and sanitation systems in Eastern Cape will continue to be structurally fragile and susceptible to climate impacts. These insights provide novel empirical evidence to the discourse on sub-national climate adaptation in Africa, highlighting the necessity for multi-tiered, data-driven, and gender-sensitive reforms rooted in the realities of communities impacted by climate change.