Institutional reforms and their contribution to development and growth have been a source of renewed interest as well as of many challenges over the last two decades. Identifying the forces that push towards reform and the conditions that determine the success or failure of reforms, building organizational arrangements needed to make modifications to the rules of the game sustainable, and understanding the limits to the transfer of reforms and to the help that international organizations and foreign institutions can provide to support change, raise intellectually difficult and politically highly sensitive issues. This book attempts to address these issues from an economic perspective. Combining knowledge and field experience, it develops an analysis of institutional changes and organizational transformations based on the experience of the public procurement reforms carried out in sub-Saharan Africa. This highlights the economic significance of procurement and the formidable obstacles that institutional changes face. Using an original dataset, it explores the gap between the expectations and what has been achieved. It develops a framework that intends to capture the complex interaction between the different components of reform and aims to provide useful insights for researchers and policy makers.