This publication aims to explore how current trends in faecal sludge management are impacting human and environmental health in Africa (both sub-Saharan and Northern Africa). Faecal sludge comes from on-site sanitation technologies in the form of raw or partially digested slurry or semi-solid material. Its management involves storage, collection, transport, treatment and safe end use or disposal. Some factors that make it difficult to manage sustainably include population growth and urbanization, over-reliance on financial aid for the construction of treatment plants, low revenue generation from users of treatment facilities, poor operation and maintenance, and inefficient institutional arrangements for faecal sludge management. Poor faecal sludge management poses major health, environmental and socioeconomic differential risks to men, women, boys and girls in Africa. Alongside poor sanitation, it contributes to the 115 deaths per hour from excreta-related diseases in Africa and huge economic losses. Some good practices along the sanitation value chain that have been reported in a few countries have the potential for replication in several other African countries. Overall, there is a need to invest in sanitation systems and mechanisms to improve faecal sludge management and direct investments to very poor households. In particular, bottlenecks in service delivery pathways require urgent attention.