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According to the World Health Organization, more than 80% of the world’s current smokers live in low- and middle- income countries. In Sub-Saharan Africa (SSA), the increase in tobacco smoking is facilitated by the fast-growing population, increase in purchasing power of the consumers and massive efforts by the tobacco industry to expand their reach in this region. Until the World Health Organization’s Framework Convention on Tobacco Control (FCTC), many countries in SSA had weak or non-existent tobacco control policies, about 44 countries in the region are currently signatories to the treaty. Despite being signatories to the FCTC, many sub-Saharan African countries have not been able to implement and/or enforce comprehensive tobacco control policies. This chapter is intended to share the challenges facing existing public health advocacy and interventions against tobacco smoking in SSA countries and to make recommendations necessary to control tobacco smoking in the SSA countries.