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This paper explores the disconnect between policy rhetoric and implementation at the intersection of sanitation equity and climate change in Nairobi, Kenya. To examine the current sanitation adaptation trajectory, we reviewed Nairobi’s sanitation policies, planning, and investment frameworks, focusing on their integration with climate adaptation strategies and consideration of equity in terms of distribution, recognition and processes. We used a socio-technical regime framework to map the current sanitation service configurations in Nairobi and projected their future under different climate change scenarios. Our findings provide evidence for a disconnection between policy rhetoric and implementation, prioritising sewerage development at the expense of other sanitation regimes. Despite recognising equity issues in policy, substantive action towards equitable sanitation governance is lacking. This imbalance hinders the realisation of the constitutionally recognised right to adequate sanitation in the foreseeable future. The anticipated impact of climate change on Nairobi’s sanitation sector suggests an exacerbation of existing service inequalities. Our projection indicates that by 2030, a sizeable portion of Nairobi’s residents will experience poor sanitation services. Our study emphasizes the critical need for a fundamental paradigm shift. It calls for a robust and honest discussion on delivering high-quality, resilient sanitation services at scale including both sewer and non-sewered sanitation and necessitating substantial public investment and support for all systems. This reappraisal is imperative for ensuring equitable and sustainable sanitation solutions in the face of climate change.