Children regularly receiving health visits and education, the sick receiving proper and timely health care, safe water flowing out of the tap, electricity reliably reaching homes and businesses-these apparently simple events are taken for granted in developed countries. In Latin America, despite two decades of social and infrastructure improvements, the poor and many of the middle class make do with low-quality services. Far too many of the poor receive no services. Improving service delivery to the poor is both a widespread political demand, and central to the realization of the Millennium Development Goals (MDGs). This book interprets service delivery successes, and failures in Latin America and provides guidance to policymakers, and development practitioners on shaping public action to provide better-quality services for all. Its analysis builds on the accountability framework developed in the Bank's World Development Report 2004: Making Services Work for Poor People, which emphasizes the behavior of people-from teachers to administrators, politicians, and rich and poor citizens-within the chain of interactions, from demand to actual service delivery. The report seeks to answer an essential question: If accountability relationships among citizens, policymakers, and service providers are key to effective service delivery, and there have been both systemic reforms (expanding national and local democracy), and an array of specific experiments (privatization, increased choice), why is service delivery in Latin America still so inequitable, and often of low quality?