The provision of clean and potable water and sanitation services remains a critical challenge in Sub-Saharan Africa (SSA). This is exacerbated by climate change, an ever-increasing population, urbanisation, industrialisation, and an increase in water demand, not least for agriculture. A sustainable water future requires more strategic planning and improved decision-making processes. To accomplish this, foresight plays a critical role. Foresight is the ability to study a system and its challenges, anticipate possible future trends, and make informed decisions that foster more desired futures. This paper presents a systematic review of the literature on the strategies or methodologies of foresight utilised to enhance decision-making and future planning for ensuring equitable and sustainable access to clean water in SSA amidst uncertainty and the evolving landscape of economic, social, and environmental challenges. The findings indicate that foresight research in most countries in SSA is in its early stages, is narrowly focused, uses foresight tools or approaches in isolation, and employs siloed approaches for overall decision-making. A transdisciplinary systems approach is recommended to support improved decision-making within sustainable water futures planning.