Over a three-year period in the government-to-government agreements (G2G) intervention zones in Senegal, USAID’s capacity strengthening support to the Ministry of Health and Social Action (MHSA) increased assisted births from 58 percent to 82 percent and decreased malaria transmission in children under five from six percent to less than one percent. The G2G approach also strengthened the Government of Senegal’s capacity in fnancial management and accounting, internal control, human resources management, procurement, planning, budget reforms, monitoring and evaluation, and health information systems—all of which improved the ability of the Government to deliver on stated health plans and be more accountable to citizens for public fnancial management.