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.