This book is based on a simple concept: no one is in a better position to hold a government accountable than those it governs.

When governments fail to meet the needs of their citizens, the international community often turns to large external organizations such as the International Monetary Fund or the World Bank. These analysts and monitors may have the resources and expertise to analyze and advise on public spending and governance, but where do they go when the time comes to implement new policies? And can they really have a more nuanced understanding of the country's problems...

Because of its potential impact, and, in some cases, the harm it has brought, foreign aid is under the microscope. Donor countries, who don't want simply to give money away; recipient nations, who 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. Perhaps more important, 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 aid-dependent countries. "Lives in the Balance"...

Over the past twenty years, many low- and middle-income countries have experimented with health insurance options. While their plans have varied widely in scale and ambition, their goals are the same: to make health services more affordable through the use of public subsidies while also moving care providers partially or fully into competitive markets.

Colombia embarked in 1993 on a fifteen-year effort to cover its entire population with insurance, in combination with greater freedom to choose among providers. A decade later Mexico followed suit with a program tailored to its federal...