Inequities and inefficiencies in development aid arise from donor–recipient motivational conflicts, agency problems, and institutional deficiencies. Recent thinking on reforming official aid recommends technocratic solutions including recipient ownership, selectivity, budgetary grants, and multilateralization of aid management. Locating persistent policy failure in Africa primarily in its political institutions, this paper explores three alternative models of multilateral aid for reconciling need and effectiveness. They are the European Union's (EU's) model of regional aid, the International Development Association's (IDA's) model of concessional loans, and a synthesis model (S-model). Implications are drawn for redesigning aid to Africa that would adequately account for the peculiarities of the world's most prominent development challenge.