The welfare implications of safe water and sanitation cannot be overstated. The economic gains from provision of improved services to millions of unserved Africans in enormous. The international adoption of Millennium Development Goals brought the inadequacies of service provision sharply into focus. With only 58% and 31% enjoying access to water and sanitation services respectively, Sub-Saharan Africa is the only continent that is off-track in achieving the MDGs in 2015. The problem is compounded by the fact that a rigorous and credible baseline did not exist on coverage to improved water and sanitation and resources required to meet the MDGs. This book aims to contribute to this gap by collecting a wealth of primary and secondary information to present the most up-to-date and comprehensive quantitative snapshot of water and sanitation sectors. The book evaluates the challenges to the water and sanitation sectors within the urban and rural areas and deepen our understanding of drivers of coverage expansion in the context of financing, institutional reforms, and efficiency improvements. Finally, the book establishes the investment needs for water and sanitation with a target of meeting the MDGs and compares with the existing financing envelopes, disaggregated by proportions that can be recouped by efficiency gains and net financing gaps. The directions for the future draw on lessons learned from best practices and present the menu of choices available to African countries. There is no recipe book that neatly lays out the possible steps the country should adopt to enhance coverage and quality of service. The challenges differ to a significant extent among African countries and solutions must be tailored to individual national or regional conditions.