Western Pacific small island rural communities suffer from waterborne diseases and are among the least wealthy, most remote and resource-poor across the globe. Small landmasses, geologic composition, geographic isolation, a colonial history, and weak educational, technological and financial resources constitute significant barriers to strengthening capacity to access safe drinking water. High-technology, high-cost and complex Northern (Western) models for mitigating water access problems often prove inappropriate and unsustainable. The aim of this paper is to offer a non-traditional approach for improving both sub-national environmental analysis capacity and engaging in low-technology and low-cost mitigation of vulnerability to waterborne disease at the village-scale. The approach involves a combination of techniques, including Geographic Information Systems (GIS) training, basin management, environmental health education at the grassroots scale and working with civil society to support appropriate technologies. The findings improve understanding of remote, rural and least-wealthy small island conditions, offer guidance regarding environmental management in the Western Pacific, and provide insight for developing outreach programmes with the aim of improving conditions on similar islands globally.