Groundwater use and its governance should serve a purpose that is well defined and has a broadly accepted mandate, without it, there is a risk that benefits will accrue to existing elites only for their own benefits. Access to safe, affordable water is a recognised Human Right and a Sustainable Development Goal because it is critical for the health and wellbeing of every person in the world. Groundwater represents 96% of all liquid freshwater in the world and so any discussion about groundwater is also a discussion about human rights, development, health and social equity. Groundwater is used in many different ways, many uncontrolled and unmonitored and this can cause substantial problems – even causing cities to sink below sea level. Recent recommendations on improving groundwater governance may not be adequately aligned with the Human Right to Water or giving sufficient priority to poverty alleviation. However, groundwater use unlocks the potential of human ingenuity, cooperation and enterprise that can build the foundations for health, resilient livelihoods in the face of growing global uncertainties. The three areas identified for further focus are: increase understanding of the links between groundwater use and poverty; improve understanding and management of private ‘self supply’ groundwater sources; improve the training and professionalisation around groundwater technology innovation and scaling up.