Water scarcity is a global challenge, yet existing responses are failing to cope with current shocks and stressors, including those attributable to climate change. In sub-Saharan Africa, the impacts of water scarcity threaten livelihoods and wellbeing across the continent and are driving a broad range of adaptive responses. This paper describes trends of water scarcity for Africa and outlines climate impacts on key water-related sectors on food systems, cities, livelihoods and wellbeing, conflict and security, economies, and ecosystems. It then uses systematic review methods, including the Global Adaptation Mapping Initiative, to analyse 240 articles and identify adaptation characteristics of planned and autonomous responses to water scarcity across Africa. The most common impact drivers responded to are drought and participation variability. The most frequently identified actors responding to water scarcity include individuals or households (32%), local government (15%) and national government (15%), while the most common types of response are behavioural and cultural (30%), technological and infrastructural (27%), ecosystem-based (25%) and institutional (18%). Most planned responses target low-income communities (31%), women (20%), and indigenous communities (13%), but very few studies target migrants, ethnic minorities or those living with disabilities. There is a lack of coordination of planned adaptation at scale across all relevant sectors and regions, and lack of legal and institutional frameworks for their operation. Most responses to water scarcity are coping and autonomous responses that showed only minor adjustments to business-as-usual water practices, suggesting limited adaptation depth. Maladaptation is associated with one or more dimension of responses in almost 20% of articles. Coordinating institutional responses, carefully planned technologies, planning for projected climate risks including extension of climate services and increased climate change literacy, and integrating indigenous knowledge will help to address identified challenges of water scarcity towards more adaptive responses across Africa.