Drought intensity and associated risks are increasing in sub-Saharan Africa (SSA) with dire implications for sustainable livelihood. Yet, there is a limited comprehensive understanding of the severity of drought risks in dryland farming systems in sub-Saharan Africa including Ghana, where climate change has multiple effects on farming operations. Monitoring episodic droughts is particularly important for developing local-based adaptive interventions to sustainably improve livelihood and food systems. Drawing evidence from Northwest Ghana, this study used a Rainfall Anomaly Index (RAI), Principal Component Analysis (PCA) and Binary Logistic Regression (BLR) to understand drought indices and risks of 40 years (1981–2020), and assess prioritized coping measures and determinants in rural farming communities. The study revealed that farmers in Northwest Ghana have been experiencing severe intermittent drought risks in the last four decades, with extreme episodes observed in 1983 and 1984. Results show that northern Ghanaian households are coping with drought risks using several strategies such as picking edible wild fruit, migration for labour work, remittances from family members and friends, livestock rearing and sale, petty trading, and basket weaving as the key coping measures by households to counteract drought risk. The BLR estimates show that socio-economic variables such as marital status, household size, market access, and farmland size are significant factors that can predict farmers’ coping interventions. The sale of livestock as a buffer to support households rebound from a climate disaster is critical. We suggest that decision-makers and policy-makers mainstream access to social safety schemes in drought-affected locations to sustain local food systems, agricultural biodiversity and livelihoods.