Communicable diseases attributable to poor sanitation, and which principally affect the underprivileged sections of the population, are still considered as major health problems in Ethiopia. Despite a relatively long history of environmental health activities in the country, their service provisions in the field are so far not up to expectations. An extensive literature review was made in this study in order to examine the status of environmental health with particular emphasis to drinking water and sanitation with respect to its legal, institutional, human resource frameworks and service outputs. It was found out that environmental health services in Ethiopia have a documented history spanning five decades. The creation of the Gondar Public Health College in 1954 was the springboard for the commencement of training and activating sanitation services in the country. Environmental sanitation became a component of PHC in the 1970-80’s. While the regulatory function in sanitation was developed in the 1950’s, it was dramatically reoriented in the 1970’s. Sanitation regulations and related activities are now readdressed with the National Health sector Development programme and Health Extension Packages developed by the MOH. The progresses made so far in environmental health, however, did not show any significant changes over the last three decades. Currently, the coverage of safe drinking water and latrines remains very low, at about or less than 30% and 13% for the country, respectively. The per capita drinking water can not satisfy 50% of the minimum requirement. Access to latrines as well has similar drawbacks. Out come indicators as measured by diarrhoea prevalence still remain to be significant. KAP towards sanitation is at the low side. The poor achievements in environmental health service coverages over the past decades are attributed to various socio-economic factors and weak implementation practices that are detached from policies. Impacting on both the internal and external environment is believed to bring changes in the current sanitation status.