Milk is a valuable and nutritious food product that can partially fulfill the rising food demand of the growing African population. The microbiological status of milk and derived products was assessed throughout the milk and dairy chain in Rwanda by enumeration of the total mesophilic count, coliforms, and Staphylococcus aureus and detection of Salmonella and Listeria monocytogenes. The quality of raw milk was satisfactory for the majority of samples, but 5.2% contained Salmonella. At the processing level, the total mesophilic count and coliform numbers indicated ineffective heat treatment during pasteurization or postpasteurization contamination. Increasing bacterial counts were observed along the retail chain and could be attributed to insufficient temperature control during storage. Milk and dairy products sold in milk shops were of poor and variable microbiological quality in comparison with the pasteurized milk sold in supermarkets. In particular, the microbiological load and pathogen prevalence in cheese were unacceptably high.