Waste management (WM) remains a significant challenge for most developing countries where rapid population growth and urbanisation influence annual waste generation, with the consequent proliferation of traditional waste management approaches and varying peculiarities yet to be comprehended. This study applied household surveys and expert interviews to explore WM dynamics in Ghana's rural settings using Kwahu East District (KED) as a case example. The study (1) examines traditional WM systems, (2) the perception of rural households on existing WM systems, and (3) explores the existence and effectiveness of relevant local policies and or by-laws. The results point to diverse traditional WM measures with minimal to almost no interventions from the formal sector (the district assembly). Although most respondents (66 %) held a positive perception of sustainable WM practices, these do not translate into good practices due to the combined effects of the lack of enforcement of WM regulations and lack of WM facilities (e.g., waste bins) in the study communities, resulting to indiscriminate dumping of waste in some communities. For a proper WM in the rural settings of the KED, there should be a multidimensional and multilevel WM approach to identify and strengthen best practices of WM with emphasis on the importance of formal WM interventions. From a policy standpoint, decentralised enforcement of WM policies is essential to guarantee the long-term adoption of best practices.