The article analyzes the difficulties and political conflicts that affect the processes of defining and implementing social reforms in Latin America, focussing especially on education and health. It describes problems in execution and the institutional consequences of the proposed changes, management styles, forms of interactions and tensions among the different interest groups involved. The analysis is based on the results of case studies from1998 and 1999 in the Program for Social Reforms in Education and Health in Latin America sponsored by the IDB, the ICRD of Canada and coordinated by the CIDE and llades of Chile.