The global community is not on track to achieve Sustainable Development Goal 6 (SDG 6) by 2030. Many low- and middle-income countries like Ghana still struggle with water insecurity. In semi-arid regions like Ghana’s Upper West, climate change has worsened water insecurity, leading to health and livelihood consequences. In UWR, limited studies have explored water insecurity in rural areas. This study fills a knowledge gap by investigating the determinants of water insecurity in Ghana’s Upper West Region (UWR) from a political ecology of health (PEH) perspective. It comprehensively explores the interplay of social, economic, political, environmental, and health-related factors contributing to water insecurity in the UWR. The results from binary logistic regression show that households in the wealthier category (OR = 0.475, p<0.05) and those that spent less than thirty minutes on a roundtrip to fetch water (OR = 0.474, p<0.01) were less likely to experience water insecurity. On the other hand, households that did not use rainwater harvesting methods (OR = 2.117, p<0.01), had to travel over a kilometer to access water (OR = 3.249, p<0.01), had inadequate water storage systems (OR = 2.290, p<0.001), did not treat their water (OR = 2.601, p<0.001), were exposed to water-induced infections (OR = 3.473, p<0.001), did not receive any water, hygiene, and sanitation education (OR = 2.575, p<0.01), and faced water scarcity during the dry season (OR = 2.340, p<0.001) were at a higher risk of experiencing water insecurity. To mitigate the risks of water insecurity and adverse health impacts, policymakers and practitioners must work together to educate households on effective water conservation, storage, and treatment techniques. It is recommended that households harvest rainwater as a coping strategy, construct appropriate storage systems, and treat their water. Communal self-help water investments should be encouraged and supported. Given the significant aquifers and semi-arid landscape of the UWR, investing in groundwater development should be a top priority.
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