In this dissertation, I offer institutional pathologies as a conceptual framework to analyse the seemingly intractable problems in water governance, and relate it to urban water access, using the case study of Jakarta. In this context, access to water refers to ease of accessibility to water sources in terms of quantity, quality, continuity and affordability. Institutional pathologies imply persistent institutional deviants and dysfunctional behaviours in water governance as shared by multiple actors. Specifically I develop three concepts of institutional pathologies: patrimonialism, confidentiality and informality. Patrimonialism refers to the pattern of bureaucracy that is heavily centred on central government and a central figure(s). Confidentiality denotes the style of bureaucracy that tends to maintain secrecy of public information in the name of national stability and security. Informality, refers to meta-rules that shape the habits of actors. To study the relationship between institutional pathologies and urban water access, I trace the development of Jakarta water governance from the public era of 1977-1997 to the private era of 1998-2014. Using qualitative methodology and under the influence of institutional ethnography as the fieldwork research paradigm, the fieldwork chielfy employed in-depth interviews and documentary analysis as data collection methods to investigate the ruling relations. It is suggested that rather than merely being sourced from internal bureaucratic culture of specific organisations, that is public or private, institutional pathologies are produced by the ruling relations between multiple actors. Therefore institutional pathologies can be useful as a conceptual framework that allows for an advanced and pragmatic analysis, beyond the narrow debate of privatisation. It is suggested as well that institutional pathologies can be used to analyse other southern cities, which may experience similar problems with Jakarta.