In the 1990s, the coordination and management of aid in the health sector became more firmly established on policy agendas as a result of concern that the increased volume of aid and increasing number and diversity of donors in the sector was leading to an unmanageable proliferation of demands on recipient Governments. Global interest in coordination, coupled with a dearth of critically-informed, conceptual or empirical, analyses of the subject, gave impetus to this in-depth examination of the processes at work. Based on a review of the literature, this study began by defining the issues and developing a typology of instruments used to coordinate aid. A conceptual framework was developed for assessing coordination mechanisms. The framework was tested through an historical analysis of aid coordination revealing the enabling and constraining factors governing progress in this area of development management. Bangladesh was chosen as a case study, primarily due to a long-standing, concerted effort of the World Bank to coordinate a number of bilateral donors through a country-based Consortium. Drawing upon interviews with stakeholders, documentary analysis, as well as a questionnaire survey, an entrenched, non-comprehensive system of aid coordination and management exercised by donors was exposed. Caution on the part of Government officials in assuming a prominent role in aid management was exacerbated by fragile systems and weak capacity. This was reinforced by aid agency practices. Evidence suggests that coordination may be less concerned with the purported aims of rationalising external assistance to Government's programmes, than with the desire among competing agencies for leadership in the sector. Aid agencies and Government recognise that aid coordination provides a powerful tool with which to exercise leverage over the policy process. This consideration has coloured their desire to lead coordination processes and conditioned the extent and manner they wish to be involved in coordination arrangements. Given the findings of this study, the prospects for improvements and government leadership in aid coordination and management appear equivocal at best.