This study is an exploratory examination of the effect of the Ghana government’s flagship program known as the One-Village-One-Dam (1V1D) initiative on the livelihoods of rural farmers in the five regions of Northern Ghana. A total of 15 constituencies proportionate to the number of constituencies in each of the five beneficiary regions were selected from the region. Data were collected from a total of 1585 respondents, comprising 785 from the control group and 800 from the treatment group. The survey focused on access to water, crop and livestock productivity, income generation, and overall well-being. Four main findings are reported. First, the results show differential effects of the 1V1D initiative. There was an increase in reliance on 1V1D dams for water, particularly in the Northern region, where challenges such as insufficient water storage and poor dam maintenance hindered their effectiveness for irrigation and livestock rearing. Second, the use of water from boreholes was more popular in the other parts of Northern Ghana. Third, the shallowness of most of the dams meant that they dried up during the dry season and, therefore, did not have a significant effect on crops and livestock productivity. Finally, the dams had a marginal effect on food security, income levels of the farmers, and consequently on their overall livelihoods.