ABSTRACT
This chapter argues that the best response to this dilemma is to focus on development strategies that aim to both deliver at scale for the poorest and simultaneously empower the poorest themselves to address the causes of inequalities in power, wealth, and influence. It argues that the poorest also often lack room for maneuver and may have few strategic options available. The chapter approaches relevant to both delivery and to evaluation. The key to understanding it lies in the idea of "system transformation". The first is system support in which the aim is to "prop up" a failing part of the system. The second is system strengthening, and this might involve, for example, training birth attendants with the aim of leaving a sustainable training system with an appropriate curriculum and long-term funding. The third is system transformation, which aims to change the way in which the system as a whole works.
