A Medium Term Expenditure Framework (MTEF) and an Integrated Financial Management Information System (IFMIS) are two of the standard reforms promoted and supported by the World Bank and other aid agencies in almost every country in Sub-Saharan Africa. This paper provides a balance sheet of the relative success, or otherwise, of these reforms over the last decade. The aims and objectives of the MTEF and the IFMIS are outlined, indicating the initial hopes for these reforms and the increasingly strident warnings that this promise was not being delivered. The paper then argues that it was the economic problems across Sub-Saharan Africa, especially in the late 1970s and early 1980s, resulting from external events, which led to a worsening of the quality of financial management and governance. This contrasts with the dominant view that it is poor governance that is holding back economic development across the continent. This leads to considerations of effective alternative approaches; the need for real country led reforms which build on the particular existing public sector financial management system in each country; and puts a priority on basic internal financial controls and reforms which have been clearly proved to be successful in similar environments