Access to clean water is recognised by the United Nations as a fundamental human right. However, in urban Ghana, significant disparities exist in access to clean water, particularly in poor communities. This chapter analyses the persistent inequalities in urban water accessibility in Greater Accra to understand the barriers hindering equitable water provision. We do this by examining four interconnected aspects: colonial legacies that shape fragmented water infrastructure, contemporary infrastructural deficits, commodification and privatisation of water services, and fragmented governance and regulatory mechanisms. Using these dimensions as analytical lenses, we demonstrate how historical patterns of urban planning and water infrastructure development under colonial rule established spatial inequalities that persist today. Contemporary infrastructure gaps and poor water governance further deepen these disparities, particularly in low-income and informal urban communities. These areas often rely on costly informal water sources such as tankers and sachets/bottled water. Privatisation efforts promoted under neoliberal policies and commodification practices have further exacerbated these inequities by prioritising profit over equitable distribution. By unpacking these interconnected factors, the chapter calls for a new paradigm of urban water governance, one that explicitly prioritises equity, reclaims water as a social and ecological good, and foregrounds the voices and agency of marginalised communities. This lays the foundation for advancing sustainable water management to drive resilient urban waterscapes.