The Sanaga River is the largest in Cameroon and one of the main resources for the economic development of the country. A lack of electricity is one of the primary setbacks for the Cameroonian economy, and the national authorities plan to at least double, from 2,000 MW, the nation's hydropower electricity supply by 2035. Representing more than 75% of the estimated total hydro potential of Cameroon, the Sanaga River has one of the greatest hydropower potentials in Africa. As well as being a vital asset for the national economy, it possesses exceptional natural features such as waterfalls, biodiversity hotspots with endemic and rare wildlife (e.g., the West African manatee, hippopotamus, chimpanzee and forest elephant), and very high cultural diversity, with numerous ethnic groups represented. There are many human activities along the river (use of water resources for food security and irrigated agriculture, inland fisheries, intensive aquaculture, sand extraction and hydropower production) that are increasing, and with visibly detrimental effects. The construction of dams has forced the local population to move from one livelihood activity to another. The unique cultural heritage and biodiversity are hence under pressure, due to over-fishing, logging, hunting, agrochemical pollution and habitat destruction. Unfortunately, the management actions necessary for remediation of these detrimental impacts are not well captured in basin development plans. It is therefore considered urgent to implement more sustainable human activities, including the development of alternative economic resources, such as ecotourism.