Private sector involvement in solid waste management in developing countries has increased, but the effect is not always clear. This study assesses how it has been organized in five cities in Ghana, what has been its effect and what lessons for private sector development in developing countries can be drawn. Data were collected from 25 private companies and a sample of 1200 households. More than 60% of solid waste in Ghanaian cities is now collected by private enterprises. Sometimes, and increasingly, competitive bidding takes place, although sometimes no bidding is organized leading to rendering of this service and no contract being signed. Local governments and local solid waste companies have not changed to more customer-oriented delivery because of the slow pace of charging users and the resulting low rate of cost recovery. The participation of the population has been limited, which contributes to low cost recovery. However, a gradual better functioning of the system put in place is shown. We observed an increasing use of competitive bidding, signing of contracts and city-wide user charging.