In spite of many decades of development planning and assistance much of the rural and urban population in the Ejura-Sekyedumase District has low sanitation coverage. This study therefore assessed the situation of sanitation services delivery and its effect in the district and made recommendations to inform policy. The study adopted and used the case study design limiting itself to six communities namely, Ejura, Sekyedumase, Anyinasu, Dromankuma, Kasei and Ebuom in the Ejura-Sekyedumase District. Purposive sampling techniques were adopted to select the relevant respondents for the study. These included staff from the Central Administration, District Health Directorate, District Environmental Health Unit, Ejura market and sub-district institutions. Others included the District Water and Sanitation Team (DWST), WATSAN Committees, opinion leaders, and households. From these respondents, questionnaires, informal interviews, interview guides and telephone conservations were used to collect the required data and analyzed to produce the needed results. The study revealed that that toilet facility coverage was low. The study again revealed that implementation of sanitation projects were driven by donors, low ownership of home toilets, low budgetary allocation to the sanitation sector and inadequate data for planning and implementation. The study further revealed poor hygienic practices, inadequate arrangements for cleaning and maintenance, no clear policy on public toilet management, no fees charged against waste dumping and preparedness of the people to pay towards an improvement programme for sanitation services. In line with the findings, the study recommended, increased sanitation coverage, increased budgetary allocation for investment in sanitation infrastructure, preparation of operation and maintenance plan, development of policy for the management of public toilets and the provision of a central repair and maintenance workshop. To improve sanitation, the District Assembly and its partners must take a broader view of sanitation to prevent diseases resulting from a wide range of activities and multiple exposure routes. All major stakeholders in sanitation services delivery need to work together to place a higher priority on providing incremental sanitation improvements to the communities. This can be accomplished through participatory planning with the community, public education and openness to innovative technical approaches.