Many African countries are facing unprecedented challenges in finding ways to sustain water quality and ensure that growing demand for water resources can be met while preserving the integrity of their aquatic ecosystems. Water-borne and water-washed illnesses continue to be a major source of disease and mortality, particularly among African children. At the same time, access to sufficient water for domestic purposes and livelihoods continues to pose challenges for many in both rural and urban areas. Moreover, entire ecosystems in Africa are greatly affected by even minor fluctuations in water levels. As populations increase and demand for water multiplies, the need to cooperate in managing internationally-shared water resources also becomes more evident. Doing this effectively requires legal and institutional frameworks that transcend political boundaries, incorporate citizens in water-related decision-making, provide adequate protection of water quality and instream flows, and provide incentives for demand management, re-allocation, and innovative conservation measures. The specter of climate change highlights the need for such frameworks to be adaptable in the face of daunting uncertainty. The future of Africa will be largely shaped by the governance systems created to manage and allocate its water resources.