This Occasional Paper analyzes the experience of countries that have implemented very sizable fiscal adjustments over the past three decades. It aims to identify key conditions and institutional approaches that have contributed to sustained outcomes and to favorable macroeconomic developments. In this way, the paper may provide operational guidance to policymakers. The key findings were: large adjustments have occurred relatively frequently over the past 30 years; macroeconomic conditions at the outset of large fiscal adjustments were relatively difficult; durable large fiscal adjustments relied primarily on expenditure reduction; there were also cases of durable fiscal adjustments based on revenue enhancement, particularly in countries with low initial revenue-to- GDP ratios and where the pace of adjustment was more gradual