Urban centres in Ghana continue to expand to areas with difficult accessibility, severely impacting location decisions on solid waste disposal sites (SWDS). This study uses the location theory to examine the spatial distribution of SWDS in urban Ghana. Methodologically, it uses the nearness neighbour tool, which is a key component in GIS for spatial analysis. The results show that the distribution of SWDS was clustered, randomized, and skewed. The distribution was influenced by accessibility and the ability to pay for waste management services. For these reasons, high-density populated communities were serviced through the central container collection system, while high-class residential areas benefited through the door-to-door collection system. Access to regular waste collection was challenging for the majority in low-class residential neighbourhoods and peri-urban communities. It is argued that unequal access to waste management services raises important policy issues. The unserved communities are more likely to be exposed to the potential negative impact of poor solid waste management. It is further argued that if vulnerability and location are linked to deprivation, it is necessary to understand how and why this has happened.