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Unaccountable government is a substantial obstacle to development. It prevents people from exercising their rights and accessing health care, education and the other essential services they need in order to work their way out of poverty. At best, poor governance leads to mismanagement of public funds; at worst to outright corruption. The experiences of Sierra Leone and India in health reform show how citizen activism, combined with democratic reforms, can improve both service delivery and health outcomes. The key objective of development finance should be increased transparency, participation, and accountability, and aid donors should assist the efforts of community organizations to influence government and engage the public in demanding their rights.

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