This chapter explains the Northern Africa as the only region in Africa on track to meet the hygiene, water and sanitation targets of the Millennium Development Goals (MDGs). The Northern Africa region as delineated by WHO/UNICEF consists of five sovereign nations. These include Egypt, Sudan, Morocco, Algeria, Tunisia, Libya and Western Sahara. The chapter focuses on the hygiene and sanitation situation in the region. It examines the influences of Western urban planning principles and philosophy on spatial organization in this region. Colonial authorities thus sought to reverse the situation by introducing basic Western-style hygiene and sanitation facilities. This essentially marked a policy change. The institutional context for water and sanitation policy making in Northern Africa is dominated by state or public agencies. Northern African countries face daunting problems resulting from their difficult natural environment. Soil erosion, often caused by overgrazing and poor farming practices, is commonplace.