Debt sustainability among the 30 African low-income countries that previously received debt relief has deteriorated sharply. More than one-third are either back in, or at high risk of, debt distress. Outcomes of the 2017 review of the International Monetary Fund and the World Bank Debt Sustainability Framework for Low-Income Countries and improvements in country-specific debt sustainability assessments can help strengthen the diagnosis of debt vulnerability and improve the quality of policy recommendations respectively.