Recent studies have shown that over half of the world’s population lives in urban areas, with the number of people living in slums growing by over 20 million per year and people living in urban areas lacking access to adequate sanitation. This study presents a review of the challenges facing fecal sludge management (FSM). A globally relevant issue in developing urban centers, especially in selected developing countries in West Africa was discussed. Some key findings of the review are that effective sanitation in developing areas depends on the chain of services and that one of the largest problems in sanitation is FSM. This study presents the initial steps toward understanding the main issues involving FSM in developing cities of West Africa. Results are intended to be used as a support for decisions on policies, strategies for FSM, and investments for improved treatment facilities in the region. The study suggests that governments and private sector organizations should develop adequate measures for handling fecal sludge.