This report seeks to identify changes in human development outcomes in a period of deepening decentralization and to suggest how the country's decentralized governance structure will be improved to increase access to, as well as the quality of, relevant services. The report states decentralized governance structure helped facilitate improvements in service delivery and human development outcomes. The report argues that while policymakers, providers, and citizens must work together to strengthen accountability mechanisms, there is a particular need to strengthen local government and enhance the role of service. The report focuses on key actors and their roles in accelerating progress toward achieving the Millenium Development Goals (MDGs) in Ethiopia. The report provides feedback from users of public services on access to, quality of, and adequacy of services. Improvements in health and education outcomes in the past 15 years occurred at a time of massive decentralization in Ethiopia.