The region is situated at the northern part of the east coast of Madagascar.

It is bordered by the region Diana to the north, Sofia to the west, and Analanjirofo to the south.

The name of the region is composed of the initial letters of its four principal towns: Sambava, Antalaha, Iharana (Vohimaro), and Andapa.

The economic importance of vanilla cultivation in the Sava Region encouraged the reconstruction of the road that connects the towns, called the Route de la vanille (The Vanilla Route), in the latter half of 2005.

However, due to the volatile fluctuations in the price of vanilla, in turn often caused by the dramatic cyclones occurring in the southwestern Indian Ocean, many poor vanilla farmers in the Sava Region have periodically been forced to resort to the mostly illegal logging of ebony, palisander, and rosewood.