In sub-Saharan Africa problems associated with water scarcity are aggravated by increasing demands for food and water, climate change and environmental degradation. Livestock keeping, an important livelihood strategy for smallholder farmers in Africa, is a major consumer of water, and its water consumption is increasing with increasing demands for livestock products. At the same time, current low returns from livestock keeping limit its contribution to livelihoods, threaten environmental health and aggravate local conflicts. The objectives of this review are to: (1) synthesize available knowledge in the various components of the livestock and water sectors in sub-Saharan Africa, (2) analyze livestock–water interactions and (3) identify promising strategies and technological interventions for improved livestock water productivity (LWP) using a framework for mixed crop–livestock systems. The interventions are grouped in three categories related to feed, water, and animal management. Feed related strategies for improving LWP include choosing feed types carefully, improving feed quality, increasing feed water productivity, and implementing grazing management practices. Water management for higher LWP comprises water conservation, watering point management, and integration of livestock production in irrigation schemes. Animal management strategies include improving animal health and careful animal husbandry. Evidence indicates that successful uptake of interventions can be achieved if institutions, policies, and gender are considered. Critical research and development gaps are identified in terms of methodologies for quantifying water productivity at different scales and improving integration between agricultural sectors.