Urbanization is a product of development and in recent years, most cities have been experiencing unprecedented growth with improvements in their infrastructure. The obvious benefits of the process tend to paradoxically overshadow its insidious symptoms, as unregulated growth tend to create huge unmet needs such as lack of access to good-quality services, increasing poverty and deteriorating environment. The origin of this dichotomy is rooted in the governance practices where city authorities pay greater attention to issues of managing the ‘global commons’ than the critical ‘brown issues’, such as improving water supply and sanitation that affect the urban poor. Using multiple research techniques, this study highlights how such neglected necessities consign sections of the population to one of the deadly infectious diseases Ghana has ever known—cholera. The paper calls for an all-inclusive and explicitly pro-poor community-led orientation as one of the effective strategy for achieving equity in the urban settings and possibly, helps win the ‘war’ on poor sanitation.