In 2016, USAID's Center of Excellence on Democracy, Human Rights, and Governance launched its Learning Agenda—a set of research questions designed to address the issues that confront staff in USAID field offices working on the intersection of development and democracy, human rights, and governance. This literature review—produced by a team of sociologists and political scientists—synthesizes scholarship from diverse research traditions on the following Learning Agenda question:

How and when does grassroots reform scale up? When citizen participation has led to local reforms in a particular sector (e.g., health), what processes lead to these reforms' influencing the regional or national levels of that sector (e.g., citizen groups monitoring medicine supplies in local clinics leads eventually to pharmaceutical procurement reform in the Ministry of Health)?

The report itself is divided into four principal sections:

• Section 1 outlines the context for the report by discussing the importance of grassroots reform, defining key terms, and describing its methodology.
• Section 2 documents the experiences of different regions with an eye toward intra-regional comparisons.
• Section 3 distills two types of lessons from the regional experiences: relatively abstract lessons of broad relevance and relatively precise lessons of less general relevance.
• Section 4 discusses the translation of the authors' findings into actionable lessons and concludes by discussing the limits to their knowledge base, pending research questions, and methodological impediments to their resolution.