The Medium Term Expenditure Framework (MTEF) and Integrated Financial Management Information Systems (IFMIS) are two major public expenditure management reforms that have been adopted in many developing countries in recent years. A review of the publicly available literature on the implementation of these reforms in three African countries considers the history of their introduction and their relative success. On the basis of this review, consideration is given to the risks involved with adopting such large scale reforms; the extent to which the international financial institutions and consultants were wise to recommend such widespread adoption of large scale reforms; and whether public sector financial officers in developing countries were wise to accept these prescriptions quite so uncritically in preference to paying more attention to tried and tested financial controls and getting the basics right. However, additional research is needed to ascertain whether the introduction of an MTEF or IFMIS can successfully ensure the effective use of public sector resources whilst maintaining the principles of universality, equity and accountability.