This volume’s Introduction, its case studies, and the preceding chapter have pointed out common innovations in the pragmatic economic and social rights(ESR) campaigns of its featured African activists. The volume has documented how these innovative practices can lead to changes in the agencies of government—agencies like Ghana’s Ministry of Health, which is charged with securing economic and social rights guarantees. In this chapter we look more closely at the link between those innovative advocacy practices and subsequent changes in the design and delivery of social and other public goods. We examine how innovative advocacy links up to institutional change.