The Covid-19 crisis has revealed the extent to which public services have been under-funded for a generation across Africa, with women in the poorest communities often having to take the strain and fill the gaps through unpaid care and domestic work. This crisis is however an opportunity for some fundamental changes, with governments looking for structural solutions and new ways forward, in short to build back better. Ghana is spending 59% of its revenue in debt servicing, the second highest in the world. This must be suspended in the short term (through to end 2021) to allow for a comprehensive response to Covid-19, and then renegotiated in the medium term to ensure that debt repayments do not compromise the spending on public services needed to deliver on the SDGs. To rebuild public finances Ghana needs to rapidly and fairly expand its domestic tax revenue (from its low base on 12.6% of GDP), aiming to increase by at least 5% in 5 years, which would allow a doubling of spending on most public services. Action is also needed to push back on IMF policy advice that has pressurised the government in recent years to freeze public sector wage bills, undermining the capacity to employ more teachers (to match the scale of expansion), doctors, nurses, care workers (to respond to Covid) and other essential frontline staff. By taking a combination of actions on tax, debt and austerity the government of Ghana could transform the quality of all public services and start shaping a sustainable economy that cares for both people and the planet.