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Motivation. Across the Global South, unclear institutional frameworks undermine progress in improving services. Often, ongoing decentralization reforms reduce clarity further. Policy professionals working on institutional reform lack comparative models. Purpose. To identify key challenges for the institutional arrangements for urban sanitation in decentralizing contexts, in Kenya and elsewhere, and to propose possible responses. Approach and methods. We use key informant interviews and literature review in a problem‐driven analysis, drawing from three comparative case studies: South Africa, Indonesia and Tamil Nadu State. The analysis builds upon research on institutional effectiveness—co‐operation, collaboration and co‐ordination—rooted in game theory and elaborated in the 2017 World Development Report. Findings. Three key problems in Kenya are identified: overlaps and competition around sector leadership at national and devolved levels; weak incentives for county governments to commit policy attention and finance, despite devolution; and limited regulatory oversight. Policy implications. We identify a range of options for urban sanitation policy‐makers: (a) to engage non‐sectoral authorities in co‐ordinating multi‐sectoral issues across all levels of government; (b) to encourage political commitment to pro‐poor sanitation services at decentralized levels; and (c) to use incentive‐based and risk‐based approaches to regulate decentralized entities and strengthen local capacity for monitoring and enforcement.