While inadequate water and sanitation services have both been implicated in a number of mortality and morbidity situations all over the world, the improvement in sanitation provision lags far behind that of water. This paper therefore seeks to examine the spatial variation in sanitation provision in Ghana and assess the factors that have contributed to the low investment in sanitation infrastructure as well as how sanitation can be improved. It revealed that the low sanitation has its roots in somewhat complicated political, institutional, economic and socio-cultural factors, including inadequate political commitment, poor monitoring, higher negative externalities associated with sanitation compared with water, and low sanitation demand resulting from poor social marketing for sanitation. Sanitation should therefore be marketed as a concept that has public health benefits and not merely as a toilet facility. Proper social marketing for sanitation and scaling up the community-led total sanitation approach should be pursued to stimulate individual demand for private sanitation.