During the 1990s, far-reaching reforms in the health and education sectors have become a high priority in much of the developing world. The surge of attention reflects three sets of pressures: the need to consolidate hard-won fiscal and market-oriented reforms; new or renewed attention to poverty reduction; and the requirements of democratic consolidation.
Multilateral organizations, especially the World Bank and Inter-American Development Bank, encourage and support the new emphasis on health and education reforms. They have dramatically increased their lending in these areas since the mid-1980s and work closely with reform-minded officials in many countries.
But with few exceptions, reforms in these fields have proved slow, modest,and subject to erosion or reversal. Reforming health and education entails institutional changes and political challenges even more complex and formidable than earlier macroeconomic shifts or the re- structuring offinancial sectors. Dr. Nelson explores the obstacles to reform and the potential and limits of the Banks' roles in helping to overcome these obstacles. She reviews the substantial changes already made in lending instruments and approaches, and identifies constraints within the Banks themselves that are yet to be effectively addressed.