LOOKING A GIFT HORSE IN THE MOUTH - THE SHIFTING POWER BALANCE BETWEEN THE MINISTRY-OF-HEALTH AND DONORS IN GHANA

This paper describes the way in which the Ghanaian Ministry of Health deals with conflicts between donors and government which impact negati vely on health system development. It argues that controlling donor in vestment and harnessing it towards long-term development is vital for health system sustainability. A brief background to the concept of sus tainability is provided with examples of the way in which donors have exacerbated the 'sustainability problem' in Ghana. However, Ghana's un ique context and its recent process of health sector reform are enabli ng the MOH to take the upper hand in working with donor agencies. Thro ugh decentralization, integration of health activities and restructuri ng, the MOH has improved its capacity to manage the process of investi ng in the health sector. Donors have adapted to improved MOH capacity by introducing more flexible and appropriate modes of assistance. The paper concludes that health system sustainability depends on the prese nce of a strong MOH to oversee investment and ensure that external res ources are coordinated and channelled in a single direction, towards a single goal.