Public toilet is an unavoidable option for sanitation in many low-income towns and cities of developing countries. In most parts of Ghana, it is common practice for people to answer the call of nature in the open field as a result of the lack of household and public toilet facilities, which results in a poor sanitary, health and environmental situation. This paper assesses the accessibility and utilisation of public toilet facilities in Wa, a medium-sized city located in north-western Ghana. Using a stratified random sampling technique, a total of 123 households and 110 house owners were selected for the study using questionnaire survey. In addition, hand-held global positioning system (GPS) receivers were used to pick geographic coordinates of various public toilets. The results indicate inadequacies in the spatial distribution of public toilets with a concentration of these facilities in the central areas of the town. It also revealed financial constraints, distance travelled and poor condition of public toilets as the main factors determining utilisation of public toilet facilities. The study opined that given several sociocultural conditions, the current system of public toilet operating in the town cannot be resource intensive to meet households’ aspirations because they do not respond to local sanitation needs. On the contrary, it tends to create even more problems, thereby encouraging open defecation. Also, their impact on human and environmental health needs to be taken into account. The paper thus calls for suitable alternative sanitation options which consider local beliefs and needs of potential users such as the flush system of public toilets.