This document reports on the findings from the first Consultative Citizens' Report Card exercise undertaken in the City of Accra, Ghana. The work began in late 2009 and continues in 2010 with the dissemination of the findings to, and consultations with, City residents. The Citizens' Report Card was undertaken by the World Bank with the full support and engagement of the Mayor's office, Accra Metropolitan Authority, Ghana. The Citizens' Report Card involved a large-scale household survey which was designed to be statistically representative to the sub-metropolitan level. It incorporated Geographic Information Systems (GIS) and Google mapping which significantly aided fielding of the survey and which helps give a spatial dimension to the findings. The survey gathered information from City residents about the coverage and quality of seven core urban services, and also gathered perception-based information on residents' views of the efficiency and effectiveness of City officials, on the accessibility and effectiveness of local political representatives, and on residents' views of their quality of life and standard of living. The findings from the Citizens' Report Card are being used by the Mayor's office, City of Accra, to inform policy on urban service coverage and quality.