Ineffective solid waste management remains a major challenge to many developing economies, Ghana inclusive. This study therefore chronicles issues relating to solid waste management, drawing experiences from Wa, the regional capital of the Upper West Region. Based on 150 administered questionnaires to purposively selected respondents and 10 in-depth interviews of core staff of the Municipal Waste Management Departmentand private waste collection company, the study interrogates issues regarding solid waste generation, collection and disposal practices that are employed by households and city authorities in the rapidly urbanizing city -Wa. Our findings revealed that 810 tonnes of solid waste is generated daily, out of which; 216 tonnes are collected leaving backlog of 594 tonnes uncollected posing serious environmental and public health hazards. This study identified two main forms of solid waste collection services; house-to-house (HtH) waste collection - implemented in middle and high income, low density suburbs and the communal container collection (CCC) - implemented in low-income, high density haphazard suburbs where infrastructural facilities are in bad state and in some cases none existent. We argue for a comprehensive approach that combines infrastructure improvement, health promotion, and community participation in solid waste management processes to improve the inefficiencies to ensure quality sanitation.