As published in Global Health Magazine, October 24, 2009.

FREETOWN, Sierra Leone – Inside the fifth-floor conference room at the Ministry of Health and Sanitation, Minister Sheiku T. Koroma faced a team of visiting financial auditors, and laid open his troubles.

"We have a budget of nearly $11 million, and here we are in the seventh, eighth month of the year, and we've spent just $3 million," he told them. "Something is wrong. There is money. But how do we spend it? We don't know. The system is broken and we want you to help us.''

If the auditors were startled, they didn’t show it. They simply nodded and scribbled notes. They were at the meeting as part of a project by the Ministerial Leadership Initiative for Global Health (MLI), a four-year initiative funded by the Bill & Melinda Gates Foundation and the David and Lucile Packard Foundation to help strengthen the capacities of five health ministries in the developing world.