In 2015, Ghana launched the National Drinking Water Quality Management Framework (NDWQMF) to promote risk-based water quality management via water safety plans (WSPs). This narrative review assesses WSP implementation progress, identifies practice gaps, and offers recommendations for improvement. Findings reveal limited adoption: only 3 of 88 urban water systems and 177 of 1,022 small-town systems under the Community Water and Sanitation Agency have implemented WSPs, while community-managed systems remain uninvolved. Key issues include incomplete hazard assessments, weak improvement plans, and missing standard operating procedures. Strengthening implementation requires robust regulation, tailored guidelines, and support structures across urban and rural systems.