Over the past decade, Ghana has made significant progress in health coverage gains. These gains, however, are at risk with Ghana’s reclassification as a middle-income economy, which means that support from donors is set to decline over the next five years. This policy brief, which outlines the identified inefficiencies, their implications, and policy options, is written based on that analysis, with the recognition that changes in the health system may have taken place since the study was conducted.