Twenty years of formal private sector participation in solid waste management in Ghana has failed to deliver an increase in collection coverage and recycling rates. This article shares lessons and experiences from Accra, Ghana, a middle-income city where researchers and municipal solid waste managers have collaborated to modernize the municipal solid waste management system by working together to develop a locally appropriate response to the informal waste service sector. Stakeholders have used inclusive decision-making and participatory research methods to bring formal service providers to work in partnership with their informal counterparts to improve collection and recycling. The Wasteaware benchmark indicator framework has been used to assess and compare the improvements in the physical and governance aspects of the municipal solid waste management system, supplemented by statistical analysis of responses to a survey on the socio-economic contribution of the informal service providers in the city. Within two years of their inclusion, the number of informal service providers has increased by 71 percent, from 350 to 600, creating new livelihoods and contributing to poverty reduction. The informal service providers have been able to increase collection coverage from 75% to 90%, waste capture from 53% to 90%, and recycling rates from 5% to 18%, saving the municipality US$5,460,000.00 in annual operational costs. The results have influenced the decision-makers to move towards structural integration of the informal service providers into the formal waste service system. The shift towards practical, locally responsive interventions in Accra provides a positive example of sustainable waste management modernization, and key lessons for cities in similar economies.