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Many Ghanaians are bemoaning indiscriminate disposal of solid waste (IDSW) which has reached crisis level. People wonder: why a problem that has been duly identified and recognised by major stakeholders, and for which numerous approaches and efforts have been attached by the designated institutions in order to meet the MDGs on sanitation appears not to yield the desired results? Most of the existing literature blames peoples' attitudes, rapid urbanisation and bad cultural values without considering how institutional ineffectiveness affects sanitation service delivery in the cities. This study assumes that peoples' attitudes, rapid urbanisation and bad cultural values are amenable and hypothesizes that indiscriminate disposal of solid waste (IDSW) thrives on institutional ineffectiveness. It uses institutional assessment procedure to investigate the institutional causes of IDSW in the Central Business Areas (CBAs) of Kumasi Metropolis. The findings reinforce the relationship between attitudes to waste disposal and some behaviour interventions such as provision of litter bins, public education and law enforcement.