The region is drained by the Black Volta with several seasonal streams. The longest is the Kulkpawn which gets inundated in the rainy season. Water coverage in the region has increased significantly over the years due to ground water supply. The region has a rural water coverage of 74.13% serving a rural population of 567, 570 out of 884, 197. The region has 2,139 boreholes and 27 Small Town Pipped Water Supply Systems of varying sizes with ground water sources. Support towards achievements has been generally donor driven.  Sanitation coverage is however estimated at below 10% despite the persistent sanitation and hygiene promotion in communities over the past decades.

Water and sanitation activities are championed by three institutions. Ghana Water Company limited is responsible for water supply to the Wa township, CWSA provides water to Small Towns and rural communities in the Region. CWSA is also responsible for water related sanitation activities. Other forms of sanitation are provided by Environmental Health and Sanitation Department.

In the past years CWSA has concerned itself with facilitating water facilities to Small Towns and rural communities, the management of which was left to the communities under the Community Operation Management (COM) policy.  In 2017 CWSA reviewed the approach to achieve sustainability of water and sanitation facilities by the introduction of the reforms