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This perspective document: 1 Provides examples of ‘no regrets’ approaches, applied in small island countries to cope with current climate variability and adapt to future climate change, at different levels ranging from communities, local administrations and national governments. 2 Demonstrates the need for a sound knowledge base and information system, as well as a better understanding of the relation between water resources, water and health, and climatic extremes. 3 Discusses the need for integrated approaches such as offered by integrated water resources management and drinking water safety planning, and how these concepts can mainstream climate adaptation and should be linked to disaster risk reduction and disaster management. 4 Influences policy and decision-makers of small island countries, and mobilise increased efforts to take funding for adaptation in the water sector up in the broader development finance discussions.