In 2024, the UK Foreign, Commonwealth & Development Office (FCDO) commissioned Mott MacDonald to conduct an in-depth review of "The Health Sector in Ghana and the Role of UK Development Assistance" over the past 30 years (1993-2023). This report provides a comprehensive analysis of the progress and transformation of Ghana's health sector over the past three decades, with a focus on the influence of UK development assistance. The shape and volume of the UK development assistance to Ghana’s health system has evolved over the 30 years. The narrative is structured around six phases, each highlighting key developments, different aid modalities, and strategic interventions that shaped the sector. In 1993, Ghana's health system faced severe underfunding and deteriorating infrastructure. The UK government supported the introduction of the Sector Wide Approach (SWAp). This novel modality brought together the Ghanaian government and several development partners to align their activities under ‘One Plan, One Budget, One Report’. This laid the groundwork for improved healthcare delivery through better financial management and resource utilization. Ghana’s health sector went through several reforms, including the establishment of the Ghana Health Service and the development of the National Health Insurance Scheme, both with support from UK Aid. This opportunity to undertake such a long-term review of the UK's development work is rare and offers an important chance to draw valuable insights. The UK's support has adapted significantly over this period to reflect changing priorities, levels of resourcing, and the political landscapes of Ghana and the UK. The report underscores the importance of aligning development assistance with national priorities and discussing changes in both Ghanaian and UK political priorities. It also highlights the benefits of international collaboration in development, and the sustained political will and robust management practices required to maintain it. By documenting successes and challenges across multiple phases, the report provides valuable insights for future partnerships, emphasizing a balanced approach that combines financial aid, technical assistance, and strategic collaboration. In summary, the report highlights how UK development assistance has supported the evolution of Ghana's health sector, offering lessons for future development cooperation and emphasizing the need for a collaborative approach to support sustainable health improvements.

This work was funded by DFID, the West Africa Research and Innovation Hub, FCDO, and Mott MacDonald Ltd. This paper does not necessarily represent the views of the funders.