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Collaborative approaches are seen as a promising way to strengthen Water, Sanitation, and Hygiene (WASH) service delivery systems when challenges exceed the mandates and capabilities of any single entity. While collaborative approaches are well studied in high-income country contexts, current understanding of their application to international development contexts is limited. This paper uses fuzzy-set Qualitative Comparative Analysis to assess what conditions and pathways drove or impeded progress within eleven collaborative approaches for WASH service delivery in Eastern Africa. Evidence supported three main findings: (1) Government uptake of recommendations is necessary for progress but cannot be guaranteed solely by government participation in the collaboration, (2) different forms of problem identification are possible; problem scopes are often predefined to align with funders and partner government agendas, but flexible scopes that foster collective problem identification can reap benefits, and (3) hub convening power can be critical and convening power can be gained in different ways. Political dynamics, shifting priorities, and turnover undermine collaborative efforts, but collaborative approaches can still make progress in spite of turnover if funds are available for implementation of activities (i.e. in addition to funds for meetings and hub roles) and program implementers either facilitate collective problem identification or establish a hub with convening power. Yet even these tactics are vulnerable to instability, thus in highly unstable contexts, stakeholders and funders should be realistic from the outset about what they may be able to achieve. Building on existing theories of collaborative approaches, this work revealed that there is no single best design for collaborative approaches in WASH, rather, core elements worked together in different ways depending on the context., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 The Authors. Published by Elsevier B.V. All rights reserved.)