Evidence of human adaptation actions responding to climate impacts is increasing in Africa. However, a holistic understanding of effective adaptation across the diversity of African contexts is still limited at a continental scale. Despite high reliance on indigenous knowledge (IK) and local knowledge (LK) for climate adaptation in Africa, the potential risk reduction of IK and LK and its role in supporting transformative adaptation responses are yet to be established. Here, we assess the influence of IK and LK on the implementation of water sector adaptation in Africa and describe the relationship between adaptation and indigenous and local knowledge systems. Eighteen (18) water sector response types were identified from the academic literature through the Global Adaptation Mapping Initiative (GAMI). The most implemented measures across Africa influenced by IK and LK were household-level and individual measures and included irrigation, rainwater harvesting, water conservation, and ecosystem-based measures (mainly agroforestry). Southern, west, and east Africa show relatively high evidence of the influence of IK and LK on the implementation of water adaptation responses while the north and central Africa show lower evidence. At the country level, Zimbabwe displays the highest evidence (77.8%) followed by Ghana (53.6%), Kenya (46.2%), and South Africa (31.3%). Adaptation responses with IK and LK influence recorded higher evidence of risk reduction compared to articles without IK and LK. Analysis of intended nationally determined contributions (iNDCs) shows the most implemented water adaptation actions in the academic literature are consistent with water sector adaptation targets set by most African governments. Yet only 10.4% of the African governments included IK and LK in adaptation planning in the iNDCs. The study recommends a coordinated approach to adaptation that integrates multiple knowledge sources including IK and LK to ensure greater effectiveness and scalability of current and potential water adaptation measures in Africa.