The past, present, and future of Ghana’s WASH sector. An explorative analysis

•Colonialism, self-governance and neocolonialism have shaped WASH sector reforms.•Rural-urban WASH access divide is a persistent determinant of WASH reforms in Ghana.•Access to at least basic drinking water services for over 95 % of the population by 2030.•Access to at least safe sanitation and hygiene services will remain a significant challenge by 2030.•Ghana’s feasible pathway is immediately prioritizing open defecation and surface water use eradication. Water, Sanitation, and Hygiene (WASH) are fundamental to human health and development. Initiatives like the Sustainable Development Goals (SDGs) propelled WASH inequities to the forefront of development. Several countries have undergone reforms to ensure universal access to WASH. Using Ghana as a case study, we traced the evolutionary path of Ghana’s WASH sector highlighting persistent socio-ecological and political-economic factors shaping the current WASH sector reforms and access. We then engage in an integrated assessment modelling to examine the viability and implications of achieving targets of SDG 6 using the International Futures simulation. We find a more feasible pathway to achieving universal WASH access should prioritize eradicating open defecation and surface water use often experienced in rural and urban slums.