This is a book chapter in the proceedings of the 9th Annual CABRI Seminar on Exploring the Missing Links in PFM Reforms. The chapter discusses the most recent literature on the patterns, failures and successes of PFM reforms in Africa and identifies avenues for future work. In providing a basis for the remainder of the volume, it adresses questions such as: Why have international best practice ‘solutions’ not adequately addressed our critical challenges? What are the missing links and gaps in our approaches to reform? How do we do things differently to deliver PFM reforms that are needed, relevant and accepted, and successfully implemented?