Climate-driven droughts pose major threats to rainfed farming worldwide. To address these impacts, smart agricultural approaches focusing on conservation practices (CPs) have been widely recommended by institutions such as the Food and Agriculture Organization of the United Nations (FAO), the World Food Programme (WFP), and the International Fund for Agricultural Development (IFAD), among others. This systematic review synthesizes evidence on CPs for climate-driven drought adaptation and the barriers to their adoption in southern Mozambique, where drought is predominant. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, a comprehensive search across four academic databases retrieved 595 records (2000–April 2025), of which 23 were peer-reviewed studies. Data was extracted and analyzed using Microsoft Excel 365 and NVivo 15. As a result, five major CPs were identified: (i) Minimum tillage; (ii) Mulching and residue retention; (iii) Maize–legume (cowpea, groundnuts, pigeon pea, and soybeans) intercropping and crop rotation; (iv) Drought-tolerant maize varieties; and (v) indigenous practices. The systematic review has shown that minimum tillage was associated with 89–90% increase in maize and legume yields; Mulching expands maize yields by 24–59%; intercropping increases maize and legume yields by more than 30%; drought tolerant maize varieties expand yields by 26–46%; and local practices support farming continuity and contribute to resilience, although quantitative yield effects were not reported, with adoption ranging from 75–100%. These findings suggest that minimum tillage and intercropping/crop rotation are the most effective CPs in enhancing yield and resilience. Despite their potential, the adoption is generally low (average around 40%, with some as low as 7–16% for minimum tillage). Reasons for limited uptake include economic, cultural, institutional, biophysical, and technological barriers. These findings highlight the need for integrated policy approaches that combine climate-smart agriculture with indigenous knowledge in southern Mozambique.