The Millennium Development Goals call for a 50 per cent reduction in the proportion of people without sustainable access to safe drinking water and sanitation. Provision of these services by city authorities is often absent in slum(1) settlements in developing countries as these settlements are classified as illegal by city authorities. A field survey was conducted in two urban slums in the Asawase constituency of Kumasi, Ghana to ascertain the extent of "improved" water and sanitation coverage as defined by the WHO/UNICEF Joint Monitoring Programme. The study revealed adequate levels of improved water coverage, but both communities had extremely low coverage for improved sanitation (toilet) facilities within the households and most people depended on a very inadequate number of poorly maintained public toilets. Waste management practices in the two communities were also very poor. Findings from this study can be used by city authorities in planning effective sanitation intervention strategies for the communities.