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In this chapter we set out to consider what is needed to ensure that Africa’s infrastructure remains financially sustainable throughout its life cycle. Managing the operational phase is at least, if not more, crucial than ensuring a project is constructed in the first place, but evaluation, particularly in relation to affordability, is weak even at the global level. We identify that in Africa there are frequently weak systems of governance, fragile and risky political institutions and lack of financial management capacity. We empirically examine five Ghanaian projects in electricity generation, water desalination, and the use of private finance to deliver and operate university buildings, to demonstrate financial and accountability shortcomings. We identify four methods that could improve financial sustainability for African infrastructure projects: namely, the establishment of independent infrastructure agencies; training and salary support of competent government technical staff; a move to more transparent decision-making; and the introduction of project monitoring and contingency planning.