This paper was developed for the Ford Foundation. It covers the key aspects of a pro-poor and ecologically sustainable urban agenda for Africa. Drawing mainly on African researchers and activists, it reviews urban trends on the continent and discusses how these have to be understood in relation to the multiple linkages between rural and urban areas. It discusses how an environmental health (“brown”) agenda can be combined with an ecological sustainability (“green”) agenda for Africa’s expanding urban population, and considers the role of federations formed by “slum” and shack dwellers in a pro-poor agenda. It also reviews the links between HIV/AIDS and urban development on the continent, focusing not only on treatment but also on prevention and protection. Perhaps the single most important issue for external assistance to Africa’s urban areas is how to support the development of stronger local organizations that really deliver for poorer groups, that are accountable to and can work in partnership with them, and that have the potential to scale up through a multiplication of locally driven initiatives. This includes support for the organizations and federations formed by the urban poor. This requires a shift from seeing “the poor” as clients or targets to which “development” and “environmental management” must be delivered, to recognizing them as active agents with knowledge, resources and rights to influence what is done and how external assistance is used. This can transform the quality, scale and cost-effectiveness of development assistance. It can also be a central part of building more effective governance systems.