Foreign aid is under a microscope because of its potential impact and, in some cases, the harm it has brought. Donor countries, which do not want simply to give money away; recipient countries, which need to make the most of what they have and get; and analysts, policymakers, and writers are all scrutinizing how much is spent and where it goes. But aid is only a small part of what developing country governments spend. Their own resources finance 80 percent or more of health and education spending except in the most aiddependent countries. Lives in the Balance investigates a vital aspect of this landscape—how best to ensure that public spending, including aid money, gets to the right destination.

The development of democratic institutions and the spread of cheap communications technologies in developing countries make it possible for citizens and civil society institutions—the “demand-side”—to advocate for improved transparency, stronger accountability, better priorities, reduced corruption, and more emphasis on helping the poor. Securing real reform depends not only on knowledge of how the recipient government operates, but also on how to work with partner entities—the media, the private sector, other organizations, and legislators—to raise awareness and compel change.