This descriptive case study of the communication strategies employed by a US-based transnational non-governmental organization (NGO) contracted to implement an indoor residual spraying aid program in the Northern Region of Ghana with the aim of eradicating malaria holds that aid recipients should hold decision-making power, be provided with information to make decisions, and collaborate with NGOs in order for an aid program to be successful and sustainable. A top down management approach by the NGO worked in concert with traditional and democratic structures in this collectivistic culture with high power distance leaving out meaningful participatory communication with the intended aid recipients.