Bangladesh has recorded many impressive achievements in economic and social development in the last decade and a half. It has achieved steady economic growth of over 5.5 percent annually (over 6 percent on average since 2004), maintained relatively low inflation and stable levels of domestic debt. More remarkable have been its achievements in reducing income poverty and improving social indicators, such as life expectancy, fertility control, child mortality, literacy and enrollment rates, which, in many cases, exceed other countries in the region and outside. In addition to standard expenditure policy analysis typically associated with Public Expenditure Reviews (PERs), this study combines an assessment of key institutional elements that are likely to affect budget outcomes with political economy analysis of the budget institutions, in order to discover the underlying reasons behind the existing equilibrium. While the Public Expenditure and Institutional Review (PEIR) does not include a description of the technical aspects of Public Financial Management (PFM) institutions, it makes use of the numerous studies that exist in this area to illustrate their effect on incentives. This approach is motivated by Bangladesh's long journey of 14 years towards reforming PFM systems, which is yet to result in a fundamental break with past practices of input-oriented incremental budgeting and relatively weak expenditure controls, especially at the sector-specific level. This requires different thinking and an approach aimed at addressing the incentive structure of those who can influence more fundamental reforms in PFM.