Integrated water resources management (IWRM) has been criticized yet it is the dominant approach to water resources management in developing countries. The criticism emanates from the manifold of unfounded assumptions made during implementation on issues such as availability of technology and infrastructure, privatization and sustainable financing, human resource capacity, government interference, etc. The Pra Basin has been implementing IWRM since 2011. The basin houses nine out of the 17 artificial reservoirs constructed in Ghana for drinking water supply. It is therefore prudent that the basin's water resources are given extra management care to ensure sustainable water quality and quantity for growth and development. However, much uncertainty still exists about whether the best water management system is being practiced, whether the system is working well, or needs improvement. This study examines the effectiveness of water resources management in the Pra Basin of Ghana. This study used interviews, field observations, and documents such as Pra Basin IWRM plan, the national IWRM plan, etc. to assess the effectiveness of IWRM in the Pra Basin. The result of the study showed that IWRM although appropriate for the basin had implementation gaps. These gaps are potential contributors to deteriorating water quality.