The use of evidence in policymaking is often argued to improve accountability, effectiveness, and stakeholder involvement in policy decisions. The features of this practice, however, remain vague in the discourse of evidence-based policymaking, with the risk of obscuring important governance and legitimacy implications. In programme planning and evaluation especially, the use of evidence can be critical to translate technical measurements of policy achievements into political values for shaping future policy directions. This chapter presents a case study from Ghana to discuss how institutionalized evidentiary practices used in policy review affect aspects of governance. Drawing on interviews, we reflect on how the evidence review process—agreed in collaboration with development partners—links to the evidence advisory system and the accountability systems in place. We find that the uses of evidence promoted by international donors actually creates disconnect with the national accountability system in place, with implications for democratic governance.