Africa is at present one of the most dynamic continents. It will play a key role in the next decades in relation to the growth of cities, and environmental conditions will be of primary importance. The structural lack of water and sanitation infrastructure affects the development of growing African cities. This paper analyses the status of the sanitation and drainage systems of Dar es Salaam (Tanzania), a city with a structural lack and general deterioration of the existing infrastructure, and with high annual growth, which has contributed to increasing water demand and strained the water and sanitation system. In particular, the paper describes the water and sanitation conditions of the city, and examines three areas in the city that highlight the relation among the evolution of the city’s growth, sanitation system, and type of settlement. The analysis leads to three main findings. Firstly, urban planning and water management must find common ground and work closely together. Secondly, both on-site (boreholes, wells, on-site latrines, etc.) and off-site (pipes) systems should be considered for the provision and safe discharge of water. Finally, local governments need to take a major step in the water and sanitation sectors in relation to the city.