Rapid urban growth in developing countries has led to an increase in unplanned, high-density settlements dependent on public toilets for sanitation, yet we know relatively little about users' perceptions and concerns about such facilities. This paper seeks to explore user satisfaction and willingness to pay for improved sanitation services in Accra. Utilising a questionnaire, data were gathered from 245 users of public toilets in two low-income communities of Accra. 80.8% of users expressed overall dissatisfaction with the public toilets, the main areas of concern being: long queues and waiting times, unpleasant smells, dirtiness, concerns about security and lack of running water and soap. The majority of the respondents said that they would be willing to pay higher fees for improved services. Operators should take note of this and explore the potential market for building and maintaining high-quality public toilet facilities as a means to ending open defecation and getting on the first step on the sanitation ladder.

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