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West and East Africa experience high variability of rainfall that is expected to increase with climate change. This results in fluctuations in water availability for food production and other socioeconomic activities. Water harvesting and storage can mitigate the adverse effects of rainfall variability. But past studies have shown that when investments in water storage are not guided by environmental health considerations, the increased availability of open water surface may increase the transmission of water-related diseases. This is demonstrated for schistosomiasis associated with small reservoirs in Burkina Faso, and for malaria in Ethiopia around large dams, small dams, and water harvesting ponds. The concern is that the rush to develop water harvesting and storage for climate change adaptation may increase the risk for already vulnerable people, in some cases more than canceling out the benefits of greater water availability. Taking health issues into account in a participatory approach to planning, design, and management of rainwater harvesting and water storage, as well as considering the full range of water storage options would enable better opportunities for enhancing resilience against climate change in vulnerable populations in sub-Saharan Africa. [ABSTRACT FROM AUTHOR]