The 2026 Review of Program Design and Conditionality (ROC) assesses the performance of IMF-supported programs during 2018–24 and recommends measures to ensure that programs are well calibrated to help member countries resolve their balance of payments (BOP) problems in a more uncertain and shock-prone global economic environment. Successive systemic shocks, tighter financing conditions, including higher interest rates and lower donor support, and weak growth are adding to the size and persistence of BOP needs. At the same time, eroded policy buffers and political economy constraints are narrowing the room for policy maneuver, complicating program ownership and implementation of adjustment and reform. In this challenging environment, the premium rises on coherent macroeconomic policies, well-targeted reforms, and adaptability.