This study examined the relationship between local government sanitation practices and the health of rural dwellers in Ibiono Ibom Local Government Area of Akwa Ibom State, Nigeria. The study was motivated by persistent sanitation challenges in many rural communities, including poor waste disposal practices, inadequate drainage systems, environmental pollution, and the prevalence of sanitation-related diseases. Despite the constitutional responsibility of local governments to provide environmental sanitation services, concerns remain regarding the effectiveness of sanitation interventions and their impact on the health status of rural residents. The specific objectives of the study were to examine the effects of waste management practices, drainage maintenance, environmental sanitation exercises, and public hygiene sensitization campaigns on the health of rural dwellers in the study area. The study adopted a cross-sectional survey research design. The population comprised 145,750 adult residents of Ibiono Ibom Local Government Area, from which a sample size of 400 respondents was determined using Taro Yamane’s formula. A multi-stage sampling technique was employed in selecting respondents. Data were collected through a structured questionnaire and analyzed using descriptive statistics, while hypotheses were tested using Analysis of Variance (ANOVA). Findings revealed that local government sanitation practices significantly influence the health of rural dwellers. The results showed that regular sanitation exercises, proper waste management, drainage maintenance, and public hygiene campaigns contributed positively to reducing disease prevalence and improving environmental health conditions. Specifically, the hypothesis tested indicated a significant relationship between local government engagement in sanitation activities and the health of rural dwellers (F = 85.62, p < 0.05), leading to the rejection of the null hypothesis and acceptance of the alternative hypothesis. The study concluded that effective sanitation practices constitute a critical determinant of public health in rural communities. It therefore recommended increased funding for sanitation programmes, regular maintenance of drainage infrastructure, intensified public health awareness campaigns, strengthened enforcement of sanitation regulations, and enhanced community participation in environmental sanitation activities. These measures are necessary for improving health outcomes and promoting sustainable rural development in Ibiono Ibom Local Government Area.