The understanding of access and quality of urban services provides an engaging perspective on environmental problems and attendant health consequences at both neighbourhood and household levels in third world cities. Perhaps the most striking difference between houses and neighbourhoods in deprived and non-deprived areas in a pre-colonial African city is the availability of-and access to environmental services. This paper examines the perception of households on the availability of and accessibility to selected environmental services and the consequences of this on household health. The aim is simultaneously identifying neighbourhood perception and the impact of environmental and household services on human health. A sample of 480 households were drawn from the indigenous and Frontier Native area wards of Ilorin metropolis and a structured questionnaire was administered for a survey of residential quality and environmental services available to the households. The questionnaires were drawn to reveal, among others, the socioeconomic characteristics of households, dwelling conditions and environmental problems relating to water, solid waste and sanitation. Households were sampled using systematic random method in the twelve wards that make up the inner city and frontier native areas (Raheem’s Classification in ongoing PhD thesis) in the metropolis. The data obtained were analyzed using simple parametric and non-parametric statistics including contingency tables and chi-squares. In all cases, p-Values less than 0.05 were used as the confidence level. The result shows that dwelling conditions were poor with disproportionally low scores in residential quality. Residents also perceived living and neighbourhood conditions as poor but a significant proportion also perceived the situation as ‘helpless’. Diarrheal occurrence in children and symptoms of respiratory track infections were common in households where piped water connections, sewers and garbage collections were inadequate. A number of strategies were identified in the survey as coping mechanisms. The study concludes that an understanding of neighbourhood conditions is crucial for local level environmental improvements by guiding towards a well informed priority-setting. While noting the strategic role of household environmental improvements for that attainment of the MDGs, the paper recommend a deliberate planning policy for the innercity and native areas of pre-colonial African cities.