The Sustainable Development Goals agenda 6.2 aims to increase access to equitable and adequate sanitation by 2030. However, sewer systems serve only 17 %of the Sub-Saharan African population in informal settlements. Possible interventions and options to address sanitation issues in informal settlements have been advanced through research. However, upscaling and improving fecal sludge management in slums has been a challenge because of overpopulation, land tenancy issues, complex roles of stakeholders, and technical and political constraints. This study examined the political economy of sanitation delivery in Mukuru Kwa Reuben, focusing on technologies used, the role of actors, and policy–practicegaps. Using a convergent mixed-methods design, data were collected from152participants—100 household heads via cluster random and simple random sampling, and52stakeholders through purposive and snowballing techniques. Quantitative data were analyzed in SPSS and qualitative data in NVivo. Reliability of instruments was moderate (Cronbach’s alpha = 0.62). Findings showed that the type of toilet and construction/installation processes significantly influenced accessibility, affordability, and availability. Costs of installation, emptying, and sludge transport were major barriers, with landlords citing high sewer connection fees (KSh 5000). It was observed that the operation of sanitation systems was constrained by the presence of cartels that controlled water provision. Despite the devolution of sanitation functions, the County Government was perceived as unwilling to service loans for sanitation infrastructure. Manual sludge operators faced poor pay, while water cartels and limited county support further constrained services. Policy gaps included weak enforcement, partial devolution, inadequate partnerships, and informal service delivery. The study concludes that governance of sanitation is inadequate and fragmented. It recommends adopting innovative and context-appropriate technologies, formalizing and regulating informal services, and harmonizing sanitation policies. The results provide insights for residents, utilities, policymakers, NGOs, and urban planners seeking to improve sanitation in informal settlements.