<p>Water, essential to human and environmental health and development, is scarce in Lima. Water quality issues must be highlighted to alert stakeholders and policymakers of risks and solutions. A comprehensive plan, integration, governance, and long-term water management approach are needed to conserve water quality and quantity. Lima's megacity status and population growth heighten this need. The growing demand for industrial and human water, and the challenge of protecting water quality from pollution and climate change, underscore the urgency of the situation. All stakeholders are valued and empowered to contribute to this quest. Our study focuses on centralized, integrated water resource management systems for urban and peri-urban hydro development, stakeholders' and communities' perceptions of water resource conditions, and the effects of water quality on human health. Clarifying these objectives helps stakeholders understand the study's relevance and policy consequences. We use human perception data from water-quality sampling tests (<i>n</i> = 80), stakeholder and key-informant interviews (<i>n</i> = 29), and a megacity community survey (<i>n</i> = 439). We found that lead levels in urban Lima exceed the US EPA standard by 4.3 times, posing health risks. Key informant interviews and a community poll show that government transparency builds public trust in water management operations. SEDAPAL's Lima water management programs promote health and a sustainable future by involving public and private companies. This study involved social, industrial, and government actors. All stakeholders may transform the water management system into a community benefit, giving Lima, Peru, hope for sustainable water systems.</p>