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The evaluation concludes that Danida has played an instrumental role in the acceleration of the decentralisation reform process in Ghana over the past 10 years, however the area of civil society is where Danida has left the most significant mark. Danida’s support to developing the National Health Insurance System (NHIS) has also been instrumental in transforming the provider payment system, i.e. the form, scale, quality and scope of health service delivery. The support to tax reforms has been less successful and the limited results obtained may not be sustainable. In general, the enabling environment for transformative change has not been conducive and in the absence of progress on the overall policy framework for private sector development, Danida’s decision to focus on enterprise level support in its private sector programme is assessed to be then right one.