This chapter focuses on hygiene and sanitation conditions in the Eastern and Southern Africa region. It 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). The water and sanitation target of the Millennium Development Goals (MDGs) is used as a basis for making any evaluative comments. Racial residential segregation had far-reaching implications for the distribution of hygiene and sanitation facilities in human settlements throughout the continent. South Africa boasts the most extensive sewerage coverage as well as the most impressive inventory of other sanitation infrastructure in the region. The natural environment is at once a blessing and a curse for the Eastern and Southern Africa region. The reverberating effects on water and sanitation of Kenyan political crisis continue to be felt in most parts of the country today.