Lack of attention to groundwater governance and to water resources management is irreversibly depleting and degrading the strategic resource, not only threatening national economies but also contributing to social unrest, civil war and millions of refugees. This paper identifies needed governance reforms and obstacles that undermine those reforms. Leadership has been insufficient and is needed at all levels to make progress. A number of cases are presented to illustrate ways to foster such leadership, ranging from NGOs and academia to communities, local governments, national sector ministries as well as transboundary and global institutions. Case studies funded by the Global Environment Facility (GEF) are described illustrating five GEF processes and tools that can be used to foster partnerships and leadership. Integrated approaches to land and water resources management (integrating surface water, aquifers, and recharge areas) represent keys to balancing competing water uses in basins and aquifers. Other reforms such as pricing water use, land tenure reform, water allocation systems based on consumptive use have been piloted, and now need scaling-up. Professionals need to be ready with reforms when disasters like drought strike, which provide political driving forces for leaders to finally exercise political will for improving groundwater governance.