Wastewater surveillance, also known as wastewater-based epidemiology (WBE), is a robust public health tool that facilitates the tracking of infections within communities. It is founded on the idea that pathogens, particularly those responsible for gastrointestinal or respiratory diseases, may be expelled by infected individuals, including asymptomatic individuals, through bodily fluids and faeces for extended or brief periods, eventually making their way to centralised waste treatment facilities via the sewer system. Historically, WBE was employed to monitor Poliovirus, yielding significant insights that aided polio eradication initiatives in multiple regions. This method offers an economical and non-invasive means for the early identification and monitoring of disease outbreaks. Despite its valuable role in disease monitoring, WBE was not highly used as an epidemiological tool, especially in Africa. However, it could be a useful instrument for evaluating viral transmission dynamics in communities with inadequate healthcare infrastructure in some areas of sub-Saharan Africa, where testing and clinical case reporting may be sporadic or inefficient. Thus, this chapter addresses the challenges and prospects of using WBE as an early warning tool for monitoring diseases in Africa. It identifies some studies that have used the approach and concludes with recommendations on the effective use of this useful tool on the continent.