There is a continuing debate over the value of public-partnerships in providing public services in poor urban areas. Many policy-makers in the developing countries have been persuaded that the main problem with established direct public service provision lies in principal-agent problems, i.e. the alleged lack of incentive for regularly-employed public servants to provide a good service. They have therefore sought to involve local communities, citizens and the private sector more directly in the management of services. This paper examines the impact of the new forms of partnership between the public authorities and private/citizen-based organisations on urban environmental sanitation in the two largest cities of Ghana – Accra and Kumasi. It traces the history of public toilet policies in the two cities and analyses the factors that contributed to their relative failure in poor neighbourhoods. Toilets consistently have been poorly managed and have been the site of local political conflicts – toilet wars – despite efforts at franchising them and involving communities in their management. This is attributable to the politics of patronage at the urban level, the relationship between city government patronage and community level groups, and the failure of regulation. Public-private partnerships have not worked. The provision of reasonable sanitation facilities may require: full public provision of basic infrastructure; transparent, independent and rigorous regulation of any contracts for service provision given to non-state agencies; and the enforcement of “conflict of interest” laws applying to elected local representatives.