Belize is planning to transition to accrual accounting over the medium term. This reform is considered an advanced practice on the public financial management (PFM) spectrum and has been attempted by few regional comparators (Barbados, Bermuda, Cayman Islands and Curacao). There is a strong commitment and enthusiasm for reform from the Treasury’s new leadership. The authorities want to improve transparency and accountability as well as shift their current focus on payments and reconciliations to include modern Treasury functions such as financial management, cash management and financial reporting. While full accrual practices may not be achieved in the short term, the reform presents opportunities for more efficient work procedures, greater cross-cutting collaboration, improved transparency, lower borrowing costs and the possibility to become a regional example.