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Due to the negative impacts of poor environmental sanitation (ES) on the environment, economy, public health, and livelihoods, various efforts are constantly being made in countries all over the world, particularly by their governments, to regulate public behaviour to conform to acceptable sanitation standards. However, public compliance with sanitation regulations is low in Ghana, culminating in the lowering of the country’s international image in recent years as far as sanitation is concerned. The study examined the phenomenon of low public compliance with ES regulations in Ghana. Qualitative data were collected from purposively selected experts and key informants in ES management, using in-depth interviews. Data were analysed using the thematic technique. The findings revealed that the low compliance phenomenon was due to ineffective law enforcement, inadequate public education and sanitation infrastructure, low capacity of implementing institutions, lenient penalties, and poor sanitation culture. Compliance management seemed linear in theory, as it appeared the government could simply compel everyone to comply; but in practice, it was a complex problem that required a multi-dimensional solution. The government and its implementing agencies should commit to strict law enforcement, provide adequate ES facilities, undertake intensive public education on sanitation, provide adequate funding, and build the capacity of the implementing institutions to enforce compliance. There was the need to strategically combine coercive and catalytic approaches to ensure compliance with the regulations. The study contributes to achieving Sustainable Development Goal 6 — access to water, sanitation, and hygiene — in Ghana.