Using the Ghanaian LEAP benefit programme as a case study, we investigate how administrators, service personnel and beneficiaries perceive and respond to implementation dilemmas. The investigation focuses on the LEAP benefit for caregivers of children, which is conditional on children's school attendance, health check-ups and vaccinations. An ethical dilemma concerns whether non-compliance should be sanctioned, since this may push caregivers and their children deeper into poverty. Other dilemmas concern how administrative resources should be allocated for the targeting, monitoring, sanctioning and exiting of beneficiaries; how spending should be allocated between providing cash benefits and securing health and education services of sufficient quality; whether available money should be spread widely but thinly to provide incentives for many caregivers to send children to schools and attend health check-ups, or be targeted more narrowly to enhance relief for the very poorest; and whether funding would be less forthcoming if the minimum benefit was not a conditional cash transfer (CCT). We discuss whether similar dilemmas are likely to be present in other low-and middle-income countries operating similar CCTs, and whether some of these also apply to "active" minimum benefits