The Inter-American Development Bank (IDB) introduced policy-based lending (PBL) in 1989, in response to the Latin American and Caribbean debt crisis. The instrument has evolved over time, leading to a decoupling from International Monetary Fund (IMF) support, and the introduction of a programmatic variant (consisting of a series of single-tranche loans in support of a reform program) and of a deferred draw-down option. Policy-based lending has historically been subject to a lending limit which has changed over the years. In 2005–2019, policy-based lending accounted for about 28% of IDB’s sovereign-guaranteed approvals, with the share increasing over the period. All borrowing member countries except one used policy-based loans to varying degrees in the period. IDB’s policy-based loans are rarely co-financed by other institutions and IDB tends to support reform processes in areas in which it has accumulated experience and knowledge. Emergency budget support has been provided through separate budget support instruments that have also evolved over time. This form of support accounted for only 2% of sovereign-guaranteed approvals in 2005–2019. During the first half of 2020, in response to the coronavirus disease (COVID-19) pandemic, policy-based, and emergency budget support lending have spiked.