Contemporary planning at the national level in Ghana is realized under two legal instruments—the National Development Planning (System) Act (Act 480, 1994) and the Land Use and Spatial Planning Act (Act 925, 2016). These instruments have established two seemingly different planning systems—the development planning system and the new spatial planning system—all of which draws on the governance structures established by the decentralization law (i.e. 1933 Local Government Act (Act 462)) to deliver their objectives. This chapter firstly examines the focus and scope of three decades of national-level planning under the established tradition of development planning. Next, it presents a detailed discussion of the newly established spatial planning system and identifies the institutional arrangements for spatial planning at the national level. The ensuing institutional conflicts and duplication of competences, after the inception of the new spatial planning system that operates alongside the entrenched tradition of development planning are also examined. The two main national-level spatial policy instruments (i.e. the National Spatial Development Framework and National Urban Policy Framework) are briefly discussed with the aim to illustrate the functioning of the new spatial planning system in practice at the national level. Following from this, an analysis of the practical challenges of and pathways towards realizing long-term national spatial development imperatives, within a culture of medium-term national development planning, which is essentially dictated by the constitutionally guaranteed tenure of governments, is provided.