The Hindu Kush Himalaya Region is the source of 10 major river basins and is therefore widely regarded as the “water tower” of Asia. The Asian Development Bank, with financing from the Japan Fund for Poverty Reduction, is supporting the governments of Afghanistan, Bhutan, and Nepal to strengthen the role of RBOs and promote integrated water resources management in the region. This assessment contributes by identifying the capacity development needs of RBOs. Its lessons and recommendations focus on technologies, the enabling policy environment, and the need for performance assessment.