Access to clean, affordable, and safe water remains a persistent challenge in East Africa, despite substantial investments in water infrastructure and policy reforms aligned with Sustainable Development Goal 6. This chapter examines the social factors influencing household access to clean water across diverse rural, peri-urban, and urban settings in East Africa, advancing beyond infrastructure-centric enlightenments to highlight the role of social inequality and governance. This chapter employed mixed social ecological outlooks to analyse and synthesizes household-level evidence on social capital, land tenure security, gender dynamics, income stability, education, and institutional trust as critical determinants of water access and reliability. Integrated policy measures that integrate infrastructure development with social protection, inclusive governance, and community empowerment are necessary to address these discrepancies. For the region to achieve sustainable development, improve public health outcomes, and increase climate resilience, social fairness in water access must be strengthened.