Metro Manila's water privatization is one of the world's largest and longest-running privatization programs for a water utility. While traditional efficiency metrics show significantly improved service levels under this schema, local anti-privatization activists maintain that the program does not benefit the urban poor. Assessments from an equity lens offer a fresh perspective, using information from a consumer survey of 53,733 residential households, privatization reports, and field interviews. Results show that access and affordability remain critical concerns for impoverished urban households despite major service improvements. Philippine policy makers must address these twin concerns in order to ensure a level playing field for these vulnerable households.