<p>This study examines how hydrogeological risk assessment (HRA) could be integrated into mine planning in Ghana, marking a shift from simple contaminant inventories to comprehensive evaluations of contaminant transport and associated health risks. Using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) 2020 framework, a systematic review of previous peer-reviewed publications was conducted to assess existing research and regulatory frameworks, identify gaps, and propose strategies for sustainable mineral development that safeguard groundwater and public health. Hydrogeological controls across Birimian-Tarkwaian strata influence pollutant mobility, driving acid mine drainage, aquifer contamination, and arsenic-related carcinogenic risks. Comparative analysis of Ghana’s mining regulations against international standards reveals significant deficiencies in mandatory HRA implementation, technical oversight, and enforcement. This study proposes that effective HRA begins with a conceptual model defining contamination sources, migration pathways, and receptors within the hydrogeological setting, followed by an eight-phase process encompassing desk studies, field reconnaissance, soil and infiltration analysis, data collection, risk evaluation, and environmentally informed mine design. The current literature is more focused on contaminant presence rather than transport dynamics and exposure pathways. The study concludes that early integration of HRA into mine planning is essential for preventing groundwater contamination and mitigating health risks. Recommended measures include regulatory reforms mandating pre-operational HRA, establishment of independent technical review panels, enhanced monitoring systems, and formalization strategies for artisanal mining. This work provides a framework for developing context-specific HRA methodologies that balance mineral resource development with environmental and public health protection in Ghana and similar mining jurisdictions.</p>