During the wave of constitutional reforms, which started in the late 1980s, Institutions of Direct Democracy (IDD) have been incorporated into most Latin American constitutions, and over the past fifteen years, an increased use of these instruments by Latin American governments has been observed. This article deals with two questions related to this phenomenon: (1) what motivated the adoption and use of these institutions; and (2) what consequences can be expected with regard to democratic accountability in the region? To answer these questions, first, a classification of IDD is developed. In this, special attention is paid to the ability of the various types of IDD to introduce accountability into the representative structures of presidential systems. This classification is subsequently applied to analyse constitutional frameworks and direct democratic experience in the region. The findings suggest that the rise of IDD in Latin America was mainly induced by executive-legislative conflict and has done little to foster accountability. Finally, therefore, a detailed account of the specific constellation that led to the adoption of IDD in Bolivia is analysed in order to illustrate under which circumstances political actors choose to adopt and employ these tools.