This Technical Focus Paper is the second in a series of papers that provide a critical review of progress made in planning and putting integrated water resource management (IWRM) into practice. The papers synthesise the challenges, the successes, the setbacks, and the direction for further integration. They provide valuable insights from which others can learn lessons and apply them to their particular and often unique circumstances. This paper focuses on IWRM experiences in Central Asia where the major rivers – the Amudarya and Syrdarya Rivers – flow from the headwaters in Kyrgyzstan, Tajikistan, and Afghanistan to the downstream Fergana Valley in Kazakhstan, Turkmenistan, and Uzbekistan, and are a part of the Aral Sea Basin. Water demand is dominated by energy requirements and irrigation, which are central to economic life in the region. There is a long history of irrigation in the region, the influence of the Soviet Union, and some 15 years' post-independence experience of introducing IWRM in the Fergana Valley. The paper describes building new infrastructure and, equally important, reforming institutional structures from the 'top-down' and from the 'bottom-up'. It also addresses the successes and the immense challenges still facing the region, particularly the transboundary water issues where nation States have differing views and priorities for water use.