This report examines the opportunities for developing equitable and efficient means to manage water resources in the Dudh Koshi river system in Nepal. The report suggests economically and environmentally sustainable management considering challenges that involve climate change. The study proposes a strategic planning framework that covers the holistic, technical, economic, social, and environmental aspects of integrated water resources management and development of the river system. It also contributes to strategic planning from a basin-wide perspective by supporting the design of the Dudh Koshi Storage Hydroelectric Project.