Ghana has developed a "New Approach to Public Sector Reform", which seeks to focus reforms on results, particularly the delivery of the Government's main priorities for (i) job creation and (ii) food production, distribution and processing. The impetus for the reform is being led from the center of Government, by the Presidency and through the strengthening of collective cabinet level coordination, while recognizing that implementation will continue to be the responsibility of the line Ministries that typically already have well articulated sector strategies. These sector strategies are largely consistent with two main priorities and are supported by Ghana's main international partners. The New Approach emphasizes the need for greater coordination of the Government's activities, combined with mechanisms to encourage greater performance and accountability amongst senior managers, combined with innovative partnerships with the private sector that could help to ease the binding financial constraints. This report summarizes the results of a four-day fact finding mission conducted 4-8 October 2010. The Report is divided into four parts as follows: Part A - Short term opportunities: The report welcomes the focus on delivering specific change in job creation and food production, distribution and processing. The Government should consider further developing its Delivery Model, as partly implied under the 'New Approach,' by creating a delivery unit in the President's Policy Unit to help promote coordination at the center of Government and to remove bottlenecks to critical reforms.The Report also suggests ways that Ghana might tackle some specific challenges in strengthening the role of the Presidency in promoting delivery. Part B - Identifying and monitoring the delivery chains for food production and job creation and Illustrating the delivery chain for food production as well as Illustrating the delivery chain for PPPs, a key component of job creation. Part C - Implications of the adoption of the Single Pay Spine, the report notes that the single pay spine model adopted in Ghana is somewhat different to those implemented in other countries in terms of design and sequencing - and urges that consideration is given to a delayed implementation while these challenges are resolved. The costs of implementing the Ghana Single Pay Spine are likely to be very significant.There are significant future refinements of the single pay spine arrangements which will likely be necessary - and some very urgent steps will need to be taken in the light of the fiscal situation and managing from the center of government, One part of the report identifies two key roles of the center of government (defined as the offices of the President and Vice President, and the Cabinet Office) - ensuring that government is "reliable" and overseeing reform. There are significant capacity gaps in undertaking these roles, requiring a more detailed technical review of staff and organizational structures. This is an urgent priority. If a high-level institution/mechanism - such as a delivery unit - is to be established at the Presidency level then it must be sufficiently robust to remain in place across political transitions to help drive reforms. It will be important to minimize the risks associated with such an approach, specifically, in terms of the duplication of units and roles and responsibilities, and the need for broader buy-in from key actors across Government. The broader public sector reforms that will likely be necessary include further work on improving inter- and intra-sectoral coordination, performance management, and using PPPs and more to achieve efficiency savings in the light of the fiscal consequences of the Single Pay Spine.