Around 70 per cent of Tanzania’s population lives in rural areas. Hence, sanitation challenges in the country are mainly driven by the state of sanitation in its rural areas. Only 24 per cent of rural Tanzania has access to basic sanitation facilities. The lack of safe sanitation has led to contamination of groundwater, the main source of drinking water in villages, leading to regular outbreaks of water-borne diseases. The cumulative economic loss due to lack of safe sanitation is huge: the country loses about US $206 million annually. To its credit, Tanzania has recognised the challenge and is moving forward to meet it. What it needs is to focus on safe sanitation – starting from retrofitting of faulty toilets, planning for periodic desludging, and ensuring safe transport and treatment of faecal sludge wherever necessary. The country has policies and strategies to promote safe sanitation, but the strategy for treatment of faecal sludge and wastewater needs a reinvention. There is also a need to strengthen the institutional structure to manage faecal sludge, including resource recovery. The country must review budget allocation for the water and sanitation sector. This document reviews the state of sanitation in Tanzania, and recommends some guidelines for attaining safe sanitation in the country, especially in the rural areas.