Provision of urban water supplies to rapidly growing cities of South East Asia is difficult because of increasing demand for limited water supplies, periodic droughts, and depletion and contamination of surface and groundwater. In such adverse environments, effective policy and planning processes are required to secure adequate water supplies. Developing a Water Needs Index reveals key elements of the complex urban water supply by means of a participatory approach for rapid and interdisciplinary assessment. The index uses deliberative interactions with stakeholders to create opportunities for mutual understanding, confirmation of constructs and capacity building of all involved. In Can Tho City, located at the heart of the Mekong delta in Vietnam, a Water Needs Index has been developed with local stakeholders. The functional attributes of the Water Needs Index at this urban scale have been critically appraised. Systemic water issues, supply problems, health issues and inadequate, poorly functioning infrastructure requiring attention from local authorities have been identified. Entrenched social and economic inequities in access to water and sanitation, as well as polluting environmental management practices has caused widespread problems for urban populations. The framework provides a common language based on systems thinking, increased cross-sectoral communication, as well as increased recognition of problem issues; this ought to lead to improved urban water management. Importantly, the case study shows that the approach can help to overcome biases of local planners based on their limited experience (information black spots), to allow them to address problems experienced in all areas of the city.