Improving public sector performance in service delivery is an absolute necessity for alleviating poverty and improving welfare in Africa. Basic services and infrastructure for providing health care, education, water, sanitation etc. often fail the poor because they are either unavailable, inaccessible, unaffordable, or of poor technical quality or dysfunctional. Poor service delivery may result from inefficiencies or poor decision making by central government, for example a failure to spend budgets for essential services, or not supporting frontline health providers. Governments may have inadequate or poorly trained staff, particularly when budgets are tight or salaries are poor. Moreover, demand for services by poor people may be weak because of travelling distance and logistical constraints, levels of formal education and literacy, cost (direct costs, and transaction costs), cultural factors including restrictions placed on movement, or beliefs restricting the use of western health and maternity care. A weak demand for services like health care will not contribute towards a redesign of service delivery or more investment.