Western democracies, especially the United States, increasingly utilize foreign assistance to influence the policies of developing nations ("curative politics") despite extensive literature that this assistance is often ineffective. Cross-national data on the impact of bilateral and multilateral aid are cautionary, but these studies put the interaction between donors and recipient governments in a black box, obscuring empirical dynamics that condition success--or failure--in reform outcomes.

Using a "controlled comparison" of two cases in which international donors have tried to steer reform in Romania between 1990 and 2004, this paper asks: How does foreign assistance influence the process of indigenous reform? By selecting two cases (child welfare and healthcare reform) in the same country, during the same period, macro-economic and political factors can be controlled, allowing an analysis that highlights critical differences in domestic interests, institutions, and international engagement.

The dissertation concludes that foreign assistance is beneficial when credible international commitments spur difficult, complex change. However, the rational tendency of organized interests to undermine reform--especially if the extraction of rents is allowed by partial reform--is a strong countervailing current. Foreign assistance, too often fixated on teleological end-states and normative goals, is inefficient when: 1) Reform recommendations rely on national legislation, with little attention to intra-governmental bargaining, especially regarding budgets; 2) Reform plans fail to anticipate short-term "winners" and ignore financial incentives to subvert reform; and 3) Donors exaggerate the break between past and present, missing opportunities to better understand contemporary constraints as a function of historical legacies.

Although the ideology of state socialism was defeated in Romania in 1989, post-communist reform left bureaucratic coordination in place, especially in the provision of public services. With norms such as the reliance on soft-budget constraints maintained, and without competition or independent monitoring to enforce accountability, outside attempts to help reorganize health services failed. Performance-based conditionality tied to credible international threats led child welfare reform beyond stalemate, although deep change in the form of employment cuts or financial decentralization was resisted.