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The World Development Report (WDR) 2004 warns that broad improvements in human welfare will not occur unless poor people receive wider access to affordable, better quality services in health, education, water, sanitation, and electricity. Without such improvements, freedom from illness and from illiteracy, two of the most important ways poor people can escape poverty, will remain elusive to many. This report builds an analytical and practical framework for using resources, whether internal or external, more effectively by making services work for poor people. The focus is on those services that have the most direct link with human development, education, health, water, sanitation, and electricity. This presents an enormous challenge, because making services work for the poor involves changing, not only service delivery arrangements, but also public sector institutions, and how foreign aid is transferred. This WDR explores the many dimensions of poverty, through outcomes of service delivery for poor people, and stipulates affordable access to services is low especially for poor people in addition to a wide range of failures in quality. The public responsibility is highlighted, addressing the need for more public spending, and technical adjustments, based on incentives and understanding what, and why services need to be improved. Thus, through an analytical framework, it is suggested the complexity of accountability must be established, as well as instruments for reforming institutions to improve services, illustrated through various case studies, both in developing, and developed countries. The report further outlines that scaling up reforms means sectoral reforms must be linked to ongoing or nascent public sector reforms, in areas such as budget management, decentralization, and public administration reform, stimulated through information as a catalyst for change, and as an input to prod the success of other reforms.