The World Bank and IMF launched the Poverty Reduction Strategy Initiative in the context of longstanding criticisms of their structural adjustment programmes. This article examines the process of formulating Ghana's Poverty Reduction Strategy Paper (PRSP) from two perspectives. From the perspective of reforming the Bretton Woods institutions, it assesses the extent to which the PRSP approach alters the lending practices of these institutions in Ghana. From the perspective of understanding policymaking in highly indebted, aid-dependent African countries, it reveals the multiple interfaces of politics in such countries produced by relations among and within donors/creditors, the government and non-governmental actors. Its conclusions echo the growing body of literature critiquing PRSPs, and emphasise the constraints which the foreign aid regime places on democratic governance.