Farmer-led irrigation development (FLID) is a process in which farmers take the lead in improving the water use for agriculture. FLID is growing as a means for small-scale farmers to enhance their income, food security, nutrition, and resilience to climatic, economic, and other shocks. Farmers tend to prefer groundwater-based irrigation when expanding or intensifying production because of the relatively secure availability of groundwater. However, overexploitation of groundwater for irrigation can result in negative social, economic, and environmental consequences, especially for the poorest. The World Bank has been supporting FLID across Sub-Saharan Africa to exploit available, accessible water, including shallow groundwater. While groundwater-based irrigation has great potential for socioeconomic transformation and improved food security in the region, it also poses risks of overexploitation of the resource and environmental damage, as witnessed in other parts of the world that have relied on groundwater-based irrigation at a more intensive scale. Hence, addressing sustainability issues upfront and devising the best approaches is essential for any groundwater-based FLID program in Sub-Saharan Africa. This report highlights the importance of strategies for making groundwater-based FLID more sustainable. It provides suggestions of solutions for governments and development partners engaged in projects and programs that support and catalyze FLID, with a focus on Sub-Saharan Africa. It discusses the concept of groundwater sustainability, and the potential benefits and risks of groundwater use in irrigated agriculture. It presents possible ways to manage those risks, particularly within the context of climate change. This report draws on a review of existing experiences in Sub-Saharan Africa and, importantly, on lessons learned from comparable settings around the world, including more mature groundwater economies in South Asia, East Asia, and Southeast Asia. This approach provides a menu of evidence-based solutions and the conditions under which they may apply. Finally, the report provides recommendations for effectively managing groundwater irrigation in the FLID process and FLID value chain in Sub-Saharan Africa while enhancing outcomes that are equitable, sustainable, and climate resilient in the short and long term.