Developing nations are faced with challenges of meeting the development needs of their people. They are faced with what is termed the 'The Forex Exchange Gap and Investment Gap. The developed world in their bid to ameliorate the situation have given billions of dollars in the form of aid to the developing world of the years. Despite aid, developing countries are still faced with challenges of extreme poverty, preventable diseases and weak economies.As such lots of questions were asked about aid effectiveness. This resulted in discussions on aid effectiveness. Two important conferences that discussed aid effectiveness were the Paris High-Level Forum and the Accra Agenda for Action.The outcome of these meetings were the establishment of the tenets of harmonizing donor assistance in order to make it more effective. The Multi Donor Budget Support programme was designed as a general budget support through which aid is made available to Ghana, to augment its budget. The MDBS followed the principles of the Paris Declaration to make aid effective. This book assesses the effectiveness of the MDBS in the areas of poverty reduction, aid predictability and aid alignment with national policies.