What is the role of the public sector in sub- Saharan Africa, and how effective is it? Is reform possible where economics clashes with political reality? A University of Birmingham report examines the debate amongst World Bank and IMF economists, focusing on attempted reform of Ghana’s urban water supply. Despite poor economic performance, Ghana has undergone successful structural adjustment since independence, including reform of the civil service and to some extent, the public sector. The study highlights the politics that have made quick reform of Ghana’s Water and Sewerage Corporation (GWSC) an impossibility.