Pakistan is highly dependent on irrigated agriculture for employment, income generation and food security—around 90 percent of all food production relies on either surface or groundwater irrigation. The growing dependence of agriculture but also industries and the drinking water sector on groundwater has led to the overexploitation of groundwater resources and, in some areas, to the deterioration of groundwater quality. Fiscal incentives for solarization of irrigation/drinking water pumps are likely to further increase water withdrawals and make water governance more complex. To understand the perspectives of groundwater users, a qualitative study was conducted in the alluvial groundwater systems of Punjab as well as the hard rock systems of Balochistan. Interviews with key informants at federal, provincial, and district level were also conducted to capture insights from additional decisionmakers affecting groundwater management and governance. The study identified a series of challenges around groundwater management and use, including overexploitation of groundwater resources, worsening groundwater quality raising serious health challenges, lack of communities’ participation in decision making, particularly women, non-availability of actionable data, weak enforcement of laws and regulations relating to groundwater governance, and partisan decision-making driven by political influentials and local bureaucracies. Solarization of irrigation pumps without proper regulatory and monitoring framework is expected to exacerbate groundwater extraction and accelerate water stress. The study strongly suggests an urgent need for not only integrated water management at all levels with equitable distribution of water resources but also to engage local communities and other stakeholders, including women in water conservancy awareness campaigns, groundwater quality monitoring, and decision-making. Moreover, the management and governance of water, particularly groundwater, must be insulated from political and partisan decision making. It is equally important to look at the quality of groundwater from a wider prism, considering health and water supply, sanitation and hygiene to address the increase in water borne diseases.