We examine access to, use of, and participation in decisions on improved water supply in the Volta basin of Ghana, one of the first countries to introduce a community-based approach to rural water supply on a large scale. While 71 percent of the households interviewed have access to improved water, 43 percent of these continue to use unsafe sources as their main domestic water source. Our results indicate that quality perceptions and opportunity costs play an important role in households’ choice of water source. The effect of prices and income levels on this choice differs according to the pricing system used. Given that supply characteristics such as the location and pricing system affect household decisions to use the improved source, households may try to influence these characteristics in their favor during the community decision-making process for the improved source. However, less than 40 percent of the households interviewed participated in decisions on location or technology. We argue that the decision whether to participate depends on three main factors: (i) the household’s bargaining power, (ii) the potential benefits from influencing outcomes, and (iii) the cost of participation, (mainly opportunity cost of time). Our results indicate that bargaining power matters more than potential benefits. Moreover, we find an extremes effect: the poorest, uneducated and the richest, highly educated segments of the community are more likely to participate in decision-making for improved domestic water supply than the middle class. We conclude with policy implications and needs for further research.