Land use has a major influence on water quality, and the issue is of great concern in developing world urban areas where there are competing land uses. Kumasi, Ghana like most cities in the developing world, struggles to control and prevent urban water supply pollution through appropriate water resource protection measures that minimize or eradicate adverse impacts of land uses. Presently all rivers in the city are highly polluted, including the one where raw-water is obtained for treatment and supply of potable water. This study investigates how sources of drinking water are impacted by land use in Kumasi, the implications associated with the impacts, community perceptions of urban land use impacts on sources of drinking water, and community adaptations to water supply problems. It relies on field data collected through semi-structured interviews, a transect walk conducted upstream from the source of public water supply, and a transect walk bisecting the river in each of two communities characterized by differing levels of economic affluence. The study also draws on other secondary data sources. Using these methods, the study finds that urban land use is increasing the nutrient content of the source of public water supply, threating water quality, reducing a water reservoir’s storage capacity, increasing the cost of water treatment, and contributing to water supply restrictions causing water scarcity at the household level, especially in the poor urban community. As a result residents use various coping mechanisms to manage with water scarcity. To ensure sustainable water supply, there is the need to address land use challenges and the threats they pose for sources of public water supply, and this calls for collaboration among all departments, institutions, agencies, and interest groups involved in land use and water resource protection issues.