In the first part of this series, I argued that Ghana does not lack policies. It lacks the consistent implementation that turns them into results (Ghana Does Not Lack Policies: It Lacks Consistent Implementation). The obvious next question is what must change. The answer is neither mysterious nor new, and Ghana’s own recent experience shows both what is at stake and what is possible.
Three Ghanaian lessons
Start with Agenda 111, the programme to build 111 district and regional hospitals, launched in 2021. The intention was sound: bring healthcare closer to people. But on 9 July 2026, the Minister of Health told Parliament’s Government Assurances Committee that more than GH¢20 billion is still needed to complete the projects, that about GH¢4.8 billion has already been spent and that the government owes contractors more than GH¢1 billion. He said the three facilities he cited, Bokoro, Oforikrom-Kokoben and Trede, stand at roughly 67, 74 and 73 per cent complete, and that none of them is operating. The present government has said it will complete 35 of the hospitals in a first phase. That is a sensible choice, and it is also an admission: a programme of 111 was announced before the money to finish it was secured.
Now look at the other side of the political divide. In March 2025, the finance minister announced in the budget that the One District, One Factory programme, along with GhanaCares and YouStart, would no longer be part of the government’s policy framework. A government has every right to end programmes it believes are not working. But the announcement offered no public account of what had been delivered, how many factories were running, or what would happen to those under construction. Citizens were left with a decision but without the evidence behind it.
These two stories belong together. In one, a programme was launched without a secured path to completion. In the other, a programme was closed without a published account of results. Both are about the same weakness, and neither party has a monopoly on it.
The Auditor-General’s 2025 reports point in the same direction. They cite more than eight abandoned Ministry of Health projects and an overpayment of GH¢820,377 on a grain warehouse in Tumu after consultants certified work that had not been done. They also found that 48 district assemblies failed to collect GH¢10.55 million in rates, permits, tolls and rents, and that assemblies are not committing the mandatory share of their internally generated funds to capital projects. The pattern is weak procurement, weak supervision and slow action on earlier recommendations. These are failures of discipline, and discipline is something we can fix.
What must change
First, every major policy should have a clear implementation framework. It should state the problem being addressed, the expected results, the institutions responsible, the resources required, the timetable and the indicators against which progress will be measured. Responsibilities must be clear enough that institutions cannot shift blame when results are not achieved.
Second, budgets must reflect priorities. It is not enough to include a project in a national or district plan. Government must show how it will be financed and how funding will be sustained. Where money is short, priorities should be revised openly, as with the choice of 35 Agenda 111 hospitals, rather than leaving a trail of unfinished commitments. A hospital that is 70 per cent complete helps no patient.
Third, monitoring must lead to corrective action. Monitoring reports should not become papers prepared to satisfy a reporting requirement. They should help decision-makers see delays, understand their causes and act on time. The public should also be able to see in plain language what was promised, what was delivered and what remains outstanding.
Ghana has a foundation to build on. In July 2026, the National Development Planning Commission, working with UNICEF, validated the results framework for the 2026 to 2029 national policy framework. The framework shifts from counting inputs and outputs towards outcome and impact indicators, with baselines and targets, and requires core indicators to be reported by all metropolitan, municipal and district assemblies. The Commission’s Director for Monitoring and Evaluation described it as “a roadmap and a scorecard.” The test now is whether the scorecard influences decisions, budgets and appointments, or stays in a planning document.
Fourth, political leadership must protect continuity. Governments should keep effective programmes, complete viable inherited projects and explain their reasons for changing existing policies. Completing Agenda 111 is a good example of an inherited project being carried forward, and it should be recognised as such. Parliament, professional bodies, civil society, the media and citizens all have a role in asking for evidence that public money is producing public value.
Fifth, public institutions must develop a culture of responsibility. Leaders should model integrity, apply standards fairly and recognise employees who deliver. Persistent negligence, abuse of authority and deliberate non-performance should carry consequences, and those consequences must rest on fair procedures and credible evidence, not political affiliation or personal relationships. The Auditor-General’s recurring findings mean little if recommendations are not acted upon.
Finally, citizens must be treated as participants in development, not merely recipients of programmes. Communities should help identify local priorities, monitor projects and report service failures. Participation must be real: authorities should explain how feedback shaped a decision and what action followed when concerns were raised.
Development must be measured by what changes
There is a difference between measuring activity and measuring development.
The number of policies introduced, workshops held, roads commissioned or programmes launched tells us something about government activity. It does not tell us whether people’s lives have improved. A hospital building is not healthcare until it has staff, equipment and patients. A factory is not a job until someone is employed in it.
A better assessment asks whether children are learning, whether healthcare is within reach, whether farmers can earn a sustainable income, whether businesses are creating decent jobs, whether communities have reliable sanitation and whether public institutions are becoming more responsive.
These outcomes take time, and not every result can be credited to one policy. Economic conditions, private-sector decisions, community behaviour and external shocks all play a part, which is why evaluation must be evidence-based and realistic. The goal is not to condemn every programme that meets difficulty. It is to build a system that learns from experience, corrects mistakes and steadily improves.
When a programme fails, the first question should not be how quickly another can be announced. It should be why the original one failed, what the evidence shows and what must change. That is the difference between managing appearances and managing development.
The responsibility we all share
Implementation is not the job of government alone. The private sector must turn strategy into productive investment and decent employment. Universities and schools must connect teaching and research to society’s needs. Traditional authorities and community organisations must support local development while promoting accountability. Citizens must respect public property, comply with legitimate regulations and hold institutions to account.
Shared responsibility, however, must never become an excuse for weakening the accountability of those entrusted with public authority. Government has a particular duty to build effective institutions, provide essential services, enforce the law fairly and manage public resources responsibly.
Ghana has the constitutional structures, planning institutions and professional expertise it needs. The challenge is to make them work together consistently, across sectors, districts and political administrations. We do not need to abandon policy making. We need to strengthen the discipline that connects policy to execution.
So, the next time a new initiative is announced, citizens should ask five plain questions. What problem will it solve? Who is responsible for delivering it? How will it be funded? How will progress be measured? And what happens if the promised results are not achieved?
These are not hostile questions. They are the questions of a society that takes its development seriously.
Ghana’s progress will depend not on how many policies it produces, but on how faithfully, competently and consistently it carries out the ones that matter. The real measure of development is not what a country promises its people. It is what its institutions consistently deliver.
