Globally, about 10 Mha of agricultural land is lost annually due to salinisation, of which about 1.5 Mha is in irrigated areas. While some climate and management aspects are common to semi-arid regions, the detailed mechanisms and options to secure ecological sustainability and economic viability may vary considerably from case to case. This paper applies a whole of system-water balance to compare irrigation in three semi-arid regions suffering from similar sustainability issues: Rechna Doab (RD), Pakistan; the Liuyuankou irrigation system (LIS), China; and Murrumbidgee irrigation area (MIA), Australia. Soil salinity, lack of adequate water resources and groundwater management are major issues in these areas. The MIA and LIS irrigation systems also suffer from soil salinity and low water-use efficiency issues. These similarities occur in spite of very different climatic and underlying hydrogeological conditions. The key data used to compare these different regions are climate and soils, available water resources and their use, as well as components of the water balance. In addition, the history of water resource development in these areas is examined to understand how salinity problems emerge in semi-arid regions and the consequences for production. Based on the efficiency parameters and the definitions of sustainability, approaches are explored to solve common environmental problems while maintaining economic viability and environmental sustainability for irrigation systems.