Ghana faces serious constraints to meeting the challenge of providing adequate water and sanitation for its rural and urban inhabitants. This study examined water and sanitation in Ghana and looked at the performance of water and sanitation sector in the urban and rural areas. Data collated from water and sanitation agencies in the urban and rural sector were collected on the current state of the two sectors in achieving the Millennium Development Goals. The performance of urban water supply by Ghana Water Company Limited is poor with a disputed coverage of about 60%. About 50% of the Company’s water production is still lost through un-accounted-for water. Rural water supply has coverage of 53% comprising of boreholes, hand-dug wells, and small-piped systems. Sanitation problems in Ghana have been tackled structurally, only recently. Financial constraint have been identified as a key factor hindering our chances of achieving the Millennium Development Goals coupled with the lack of proper databases on water and sanitation.