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During the 1990s, reforms in the health and education sectors became a 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-orientated 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, have encouraged and supported this new emphasis and have dramatically increased their lending in these areas since the mid-1980s, working closely with reform-minded officials in many countries. But with few exceptions, reforms 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 restructuring of financial sectors. This work explores the potential and limits of the Banks' roles in helping to overcome these obstacles. Joan Nelson 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.