Many global development initiatives focus on improving access to safe and affordable water. Governments and infrastructure in rapidly urbanizing cities struggle to meet the increased demand for water, especially in peri-urban and informal settlements of sub-Saharan Africa. The private sector, in the form of small water enterprises (SWEs), plays an increasing role in satisfying demand for water, but their greater effects have seldom been investigated. This research explores how SWEs affect access to household water in a peri-urban settlement of Accra, Ghana and investigates their social, economic, and environmental impacts in the community. This research also examines how SWEs influence security and sustainability goals within the framing concepts of the US Army’s Stability doctrine and the United Nations Sustainable Development Goals (SDGs). The methods employed in this study were interviews, observation, and review of existing literature and case studies. Results of this qualitative analysis reveal that while SWEs increase and diversify local access to clean water, provide economic opportunities and jobs—especially to women—they also present environmental and health concerns when unregulated and unaddressed by educators, city officials, and community leaders. Further, in cases where municipal governments cannot provide safe and consistent access to clean water in the given location, results show that SWEs enterprises can work in cohesion with both the SDGs and the US Army stability goals. Moving forward, city officials, development programs, and US Army stability doctrine should consider supporting SWEs to increase water access and improve other developmental outcomes, while working to avoid potentially negative environmental and health outcomes.