In developing countries, an increasing number of civil society organizations (CSOs) engage in independent monitoring and evaluation (M&E) of government programs and policies. Most CSOs rely on a range of M&E tools in combination with advocacy strategies to hold government accountable and improve the implementation of programs and policies. Despite the popularity of such initiatives, their effectiveness and impact remain unconfirmed and are not well understood. In addition, little is known about the influence of this type of CSO-led M&E at the district level. Using a case study design, the current research provides a map of the different influence mechanisms that occurred following the M&E of the National Health Insurance by Ghanaian CSOs. The research further suggests that the built-in dialogue space is acting as a catalyst for certain influence mechanisms.