The 2026 Review of Program Design and Conditionality (ROC) assesses the effectiveness of IMF-supported programs during 2018–24 in solving members’ balance of payments (BOP) problems and restoring medium-term external viability. This period has been marked by large systemic shocks such as the COVID-19 pandemic and major geopolitical disruptions, weaker global growth, tighter financing conditions, and elevated social strains, which have severely complicated the pursuit of economic stability. In this context, the review will examine whether Fund program design and conditionality are fit for purpose. This paper, and a companion background paper, provide input for the first informal engagement with Executive Directors.