Sustainable Development Goal target 6.2 calls for ‘adequate and equitable sanitation for all’. In dense, rapidly urbanising cities, the challenge of providing household sanitation means that many countries include shared, community and public toilets in their national strategies to meet global goals. However, shared sanitation is associated with several problems including poor management and exclusion. This study examines shared sanitation access and use by using innovative mapping methods in compound house units in Fante New Town, Kumasi, Ghana. This study reveals that 56% of house units have at least one toilet. Of the 47% of people living in these house units, almost a third were excluded from using the toilet. Tenure status was the main driver for exclusion, with nearly half of people reporting non-usage ‘not allowed’ to use the toilet by the landlord. This study outlines key policy interventions to address broader institutional and regulatory barriers to shared sanitation. At the settlement level, this includes the provision of safe, well-managed public toilets and engagement with landlords to improve house unit toilet access. At the national and global level, this study calls for nuanced indicators to assess the quality of access and to ensure shared sanitation works for everyone.