Water services in Pacific Island Countries are particularly vulnerable due to a range of circumstances such as the scale of operation, remoteness of location, financial constraints, cultural complexity and the ability to access technical and other capacity by their administrations. Additionally, the authors argue that comparative assessment of water needs for differing locations is fraught with difficulty because of the combination of systemic complexity, diversity of situations and lack of suitable, consistent and objective data. In these challenging situations, a method for assessment of the vulnerability of water services has been developed on the basis of knowledge and experiences of water professionals, elicited using a structured group interaction known as a Delphi survey. The Delphi survey has been undertaken with a range of stakeholders including panels of experts, funding agencies and local decision makers. Through the Delphi process, key factors contributing to vulnerability have been identified and the output has been used to develop an index methodology. Such an index methodology, similar to the Climate Vulnerability Index, has a number of dimensions, variables and appropriate weights expressed within a set of equations. Given quantification of variables, this method can be used to assess the relative vulnerability of water services in Pacific Island Countries. The method used to develop this index could also be applied to other contexts where appropriate.