Accountability

WHO Definitions of Accountability

WHO Health Systems Strengthening Glossary

Accountability: The result of the process which ensures that health actors take responsibility of what they are obliged to do and are made answerable for their actions. 

WHO health laws and universal health coverage website

Accountability describes a relationship between a duty holder and a person or organization to whom a duty is owed. It describes the capacity to demand that a person or organization give reasons to justify their behavior and the capacity to impose a sanction if they fail to give reasons, or if their performance is poor.

Accountability involves three key elements: Delimitation of responsibility; Answerability; Enforcement

WHO Accountability Framework [1]

Accountability is the obligation of the Organization and its staff members to be answerable for delivering specific results that have been determined through a  clear and transparent assignment of responsibility, subject to the availability of resources and constraints posed by external factors.  Accountability includes achieving objectives and results in response to mandates,  fair and accurate reporting on performance results,  stewardship of funds,  and all aspects of performance in accordance with regulations, rules, and standards, including a clearly defined system of rewards and sanctions.

WHO The Alliance for Health Policy and Systems Research (HPSR) [2]

Modern conceptualisation of accountability includes:

• Financial accountability typically encompasses compliance with laws, rules and regulations regarding financial control and management;
• Performance accountability encompasses public sector management reform, performance measurement and evaluation, and service delivery improvement; 
• Political or democratic accountability range from theoretical and philosophical analyses of state-citizen relationships, to discussions of governance, increased citizen participation, equity issues, transparency and openness, responsiveness and trust-building.

Other Definitions of Accountability

UNDP (2010) [3]

Simply defined, accountability is the obligation of power-holders to take responsibility for their actions. It describes the rights and responsibilities that exist between people and the institutions [including governments, civil society and market actors] that have an impact on their lives.

OECD Glossary of statistical terms [4]

Accountability (in management theory): A key concept in modern management theory and practice. It means that managers are held responsible for carrying out a defined set of duties or tasks, and for conforming with rules and standards applicable to their posts.

Brinkerhoff (2004) [5]

General definitions of accountability include the obligation of individuals or agencies to provide information about, and/or justification for, their actions to other actors, along with the imposition of sanctions for failure to comply and/or to engage in appropriate action. -p. 372.

Hoover website [6]

There is clearly an obligation of accountability by states to their own citizens. There is also, however, a growing expectation — and often times obligation — of accountability by states to international institutions, organizations, actors, and the public. These obligations arise not only in foreign affairs and war-and-peace-related issues, or when there is a clear violation of another state’s rights, or in matters of human rights or laws of war, but also in numerous areas that were traditionally considered domestic ones.

Population Action International [7]

A duty or willingness to accept responsibility for one's actions. Downward accountability refers to domestic accountability of governments to civil society and other domestic constituencies, and upward accountability is accountability of governments to donors

*Note: See also 'Upward Accountability', 'Mutual Accountability', ''Downward Accountability' in the same document.

MacArthur Foundation [8]

The exercise of power constrained by external means or internal norms.

*Note: Grantees generated the definition, resulting in a MacArthur Foundation maternal health accountability grant portfolio with four accountability strategies: budget analysis, community mobilization, legal approaches, and maternal death audits, and spans three government levels (federal, state, local), 12 states and the Federal Capital Territory (FCT), and five geopolitical zones.

Definitions of Social Accountability

UNDP (2013) [9]

‘Social accountability’ refers to a form of civic engagement that builds accountability through the collective efforts of citizens and civil society organizations to hold public officials, service providers and governments to account for their obligations with responsive efforts. It describes the principle of a vibrant, dynamic and accountable relationship between states and citizens underpinning efforts to ensure equitable development.

PubMed Medical Subject Headings (MeSH)

The obligations and accountability assumed in carrying out actions or ideas on behalf of others.

Year introduced: 1978

ODI [10]

"The concept of accountability carries many definitions in the literature. A common definition, informed from work on social accountability, is of ‘a pro-active process by which public officials inform about and justify their plans of action, their behaviour and results and are sanctioned accordingly’ [11]

Open Society [12]

Social accountability refers to actions other than voting that citizens and civil society can use to hold the state to account. Social accountability approaches and tools, such as budget advocacy, community monitoring and social accountability monitoring, enable civil society to increase communities’ awareness of their health rights; make key social and health policies and legislation accessible; equip communities with knowledge and skills to monitor health system practices to identify state failures in ensuring health rights; and mobilize and organize communities to take collective action to address those failures (e.g. protest marches, petitions, pickets, collaborative problem solving through negotiations, public hearings, etc.). These activities enable communities to assert their political power and to hold local authorities to account. Common health system failures addressed through this approach include absenteeism of health care workers; shortage and/or stock-out of medicines; weak and often distrustful relationships between health care workers and the communities; issues of discrimination, timing of service availability or incorporating special needs and sensitivity of different population groups in service provision at the point of delivery; petty corruption and misuse of resources; and inadequate resource allocation.

Cases of Government Accountability

Example 1: Open Society

Open Society Foundation's Governmental Accountability for Torture and Ill-Treatment in Health Settings for discussion of government accountability.

Example 2: IOM

IOM's For the Public's Health: The Role of Measurement in Action and Accountability

"outlines a framework for the collection, analysis, and dissemination of population health data that help assess the social, economic, and environmental factors affecting health to increase clinical effectiveness and enhance government accountability."

Example 3: Hewlett Foundation

Hewlett Foundation's Global Development Program: Transparency and Accountability

Example 4: Deutsches Institut für Entwicklungspolitik (DIE)

DIE Jones Accountability for Development Cooperation under the 2030 Agenda

[1] WHO. WHO Accountability Framework. 2015, March. Geneva, Switzerland: WHO. Definition proposed by the Secretary-General of the United Nations in his Report to the United Nations General Assembly at its sixty-fourth session.

[2] Loewenson R. Neglected Health Systems Research: Governance and Accountability. 2008. Geneva, Switzerland: WHO HPSR.

[3] UNDP. Fostering Social Accountability: From Principle to Practice. Guidance Note. 2010. New York: UNDP.

[4] Effects of European Union Accession, Part 1: Budgeting and Financial Control, OECD SIGMA Paper No. 19, March 1998, Appendix 3: List of Useful Terms

[5] Brinkerhoff DW. Accountability and health systems: toward conceptual clarity and policy relevance. Health Policy and Planning. 2004 Nov 1;19(6): 372.

[6] Matias S. Accountability in a Globalized World. 2014, January 29. URL: https://www.hoover.org/research/accountability-globalized-world

[7] Dennis S. Making Aid Effectiveness Work for Family Planning and Reproductive Health. 2009, September. Washington, D.C.: Population Action International. 25

[8] Development Diaries. Nigeria: MacArthur Maternal Health Portfolio Accountability Baseline Project. 2015, April 29. 

[9] UNDP. Reflections on Social Accountability: Catalyzing democratic governance to accelerate progress towards the Millennium Development Goals. 2013, July. UNDP: New York.

[10] Tembo F. Citizen Voice and State Accountability: Towards Theories of Change that Embrace Contextual Dynamics: Overseas Development Institute (ODI)(ODI Working Paper Series, 343).

[11] Ackerman  JM. ‘Social Accountability in the Public Sector: A  Conceptual Discussion’. Social Development Papers: Participation and Civic Engagement 2. 2005. Washington, DC: World Bank. 18

[12] Ezer et al. "Expert Meeting on Social Accountability and Legal Empowerment: Allied Approaches in the Struggle for Health Rights" 2015: