This  report  examines  the  role  of  incentives,  trust,  and  engagement  as critical  determinants  of  service  delivery  performance  in  MENA  countries. Focusing  on  education  and  health,  the  report  illustrates  how  the  weak external and internal accountability undermines policy implementation and service  delivery  performance  and  how  such  a  cycle  of  poor  performance can  be  counteracted.  Case  studies  of  local  success  reveal  the  importance of  both  formal  and  informal  accountability  relationships  and  the  role  of local  leadership  in  inspiring  and  institutionalizing  incentives  toward  better service delivery performance. Enhancing services for MENA citizens requires forging  a  stronger  social  contract  among  public  servants,  citizens,  and service providers while empowering communities and local leaders to find 'best fit' solutions. Learning from the variations within countries, especially the  outstanding  local  successes,  can  serve  as  a  solid  basis  for  new  ideas and  inspiration  for  improving  service  delivery.  Such  learning  may  help  the WorldBank Group and other donors as well as national and local leaders and civil society, in developing ways to enhance the trust, voice, and incentives for service delivery to meet citizens’ needs and expectations.