Monitoring of water and sanitation services has for a long time been project driven in the developing world. The need for data to inform subnational planning and delivery of quality services has led to the adoption of decentralised integrated monitoring. However, little is known about the strengths and weaknesses of this approach in the monitoring of water and sanitation services. A case study design in which document reviews were combined with 22 key informant interviews held between March and July 2019 in the Upper West Region of Ghana were used to investigate the research problem. Findings show that integration enhanced the processes for validating and using monitoring data and ensuring downward accountability. However, logistical and financial support and inadequate critical reflection is a major challenge under the integration. The paper calls for special attention to be paid to funding and logistics for monitoring water and sanitation services.