Water pollution with pathogenic microorganisms is one of the serious threats to human health, particularly in developing countries. The main objective of this article is to highlight microbial contamination of drinking water, the major factors responsible for microbial contamination, and the resulting health problems in Pakistan. Furthermore, this study will be helpful for researchers and administrative agencies to initiate relevant studies and develop new policies to protect further deterioration of water supply with pathogenic microbes and ensure clean and safe drinking water to the public in Pakistan. In Pakistan, water at the source, in the distribution network, and at the consumer tap is heavily polluted with coliforms and fecal coliforms all over the country. An overview of more than 7,000 water samples reviewed here reveals that an average of over 71 and 58 % samples in the country was contaminated with total coliforms and fecal coliforms, respectively. Drinking water contamination accounts for 20 to 40 % of all diseases in the country, which causes national income losses of Rs 25-58 billion annually (US$0.25-0.58 billion, approximately 0.6-1.44 % of the country's GDP). Improper disposal of industrial and municipal wastes is the most important factor responsible for water pollution in the country followed by cross-contamination due to old and leaking pipes and lack of water filtration and disinfection facilities. There is an urgent need for emergency steps to stop further deterioration of water quality and improve the existing water quality so as to protect the public from widespread waterborne diseases.