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Groundwater plays a fundamental yet often little appreciated role in supporting economic development and human well-being in both urban and rural environments, as well as supporting many aquatic ecosystems in Africa. Thus, groundwater has high relevance to the development and well-being of Africa, if adequately assessed and sustainably exploited. Whilst the potential for groundwater-resources development continues to be reported in the literature, a quantitative understanding of these issues remains poor. The objective of this paper is to highlight the main groundwater issues and problems in Africa and the current and expected opportunities for sustainable groundwater management. This will be done through the review of existing knowledge of groundwater resources and of ongoing and planned groundwater management programs and initiatives. Groundwater resources in Africa face increasing threat of pollution from urbanisation, industrial development, agricultural and mining activities, and from poor sanitation practices and over-exploitation due to increasing demand to meet human and agricultural needs. However, despite the existence of a number of groundwater management challenges, groundwater resources in Africa are still generally under-developed and can meet the various needs in a sustainable manner if better managed. Thus, strategies to ensure sustainable development and management of groundwater resources need to be put in place. These include establishment of groundwater monitoring systems, understanding of the groundwater-aquatic ecosystem relationships, management of transboundary aquifers, addressing climate-change impacts on groundwater, assessing the impact of increased pumping from various types of aquifers on sustainability of groundwater abstraction, and capacity building in groundwater management.