Poor water and sanitation brings health inequalities in Dar es Salaam, which sets great challenges to achieve health justice. Finding routes to water and sanitation equity is an important development agenda in Dar es Salaam. To answer the research question about how the current water and sanitation governance of Dar es Salaam affects health justice, the dissertation adopts literature review and case study to have an analysis. Through literature review, vulnerabilities in the relationship between poor water and sanitation and health inequalities in Dar es Salaam are founded. Through three cases, Kombo (Ilala Municipality), Keko Machungwa (Temeke Municipality) and Tandale Slum, interactions among all kinds of determinants and stakeholders in Dar es Salaam’ water and sanitation governance are analysed and discussed. Drawing the analytical framework of health justice, all cases are analysed from environmental justice, social justice and planning justice, these three aspects that help to achieve health justice. In the end, the dissertation identifies future challenges to water and sanitation equity in Dar es Salaam and proposes recommendations to the local and global water and sanitation governance.