The document summarizes a discussion at an international conference on obstacles to public financial management (PFM) reform. Participants identified the greatest obstacles as lack of institutional capacity, human and financial resources, unclear objectives, and lack of political leadership and accountability. Key elements needed before beginning reforms include political support, stability, clear objectives, and good management. The sequence of reforms depends on the country-specific priorities but generally involves establishing political will, leadership, diagnostic studies, legal frameworks, and action plans. Benefits of PFM reform are difficult to measure and depend on the country context.