Reforms intended to improve the equity and efficiency of health service delivery in developing countries have had a mixed record of success, for reasons that are at least partly understood. One of the factors distinguishing more successful from less successful reform initiatives is the degree to which stakeholder interests and other political-economy factors are taken into account during design and implementation. This generalisation is supported by a significant literature, based mainly on Latin American and Asian experience. Some of the literature goes on to propose the adoption of a prospective and proactive management of the political dimensions of reform by a wider array of reform-oriented
stakeholders, including aid donors. It therefore provides a useful point of departure for the consideration of the more generic question of what role donor agencies can and should have in the political-economy of reform at sector level in their partner countries.