Under the pressure of structural adjustment, health and veterinary services in Africa increasingly have relied on user fees and private markets. In this study, a collaborative group of African and American physicians, veterinarians and social scientists explore the different experiences of the two services with marketization through survey research in six African countries. They demonstrate that the markets for these services will function well only if important problems in the formal and informal institutions that govern them are solved. The book makes significant contributions to health and veterinary policy for emerging markets and to the new institutional economics.