This chapter focuses on hygiene and sanitation conditions in the Eastern and Southern Africa region. It is particularly concerned with the nature of the region’s hygiene and sanitation problems as well as the initiatives that have been summoned to resolve them. Also of essence are government institutions with major responsibilities in the water and sanitation policy field. Finally, it sheds light on major constraints to efforts to facilitate access to improved water and sanitation in the region. The chapter employs the definition of ‘access to improved water and sanitation’ proffered by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF). Thus, access is viewed as the proportion of a country’s or city’s population that uses improved sanitation facilities. The WHO/ UNICEF’s definition of improved sanitation includes any system that is capable of systematically separating human excreta from human contact. The Joint Monitoring Programme (JMP) of WHO/UNICEF further proposes a classification scheme that permits the international comparison of these systems. The scheme contains two major categories, namely ‘improved’ and ‘unimproved’ sanitation facilities. The improved sanitation systems or facilities include three types. The first is flush or pour flush, which is typically linked to piped sewer, septic tank, or pit latrine. The second type is the ventilated improved pit latrine (VIP). The third is the pit latrine with slab. Finally, there is the composting toilet. The unimproved sanitation system includes five different but overlapping types, viz., flush or pour flush to a different location, pit latrine without slab or open pit, the bucket toilet, the hanging toilet or hanging latrine, and no facilities at all, which implies open defecation. Improved water includes all potable water systems. Access to improved water is typically facilitated by making such water available within convenient reach of users.