This paper aims to build the evidence base for how implementers have integrated water, sanitation and hygiene and freshwater ecosystem conservation to date in sub-Saharan Africa and to document lessons learned from projects taking a more holistic approach to conservation and development. Water, poverty and environment are intrinsically connected. Well-planned sanitation infrastructure minimizes the risk of water-borne diseases, resulting in a healthier and more vibrant community and healthy ecosystems. As such water, sanitation and hygiene and conservation efforts need to be integrated.