Accountability and health systems: toward conceptual clarity and policy relevance
Abstract
Improved accountability is often called for as an element in improving health system performance. At first glance, the notion of better accountability seems straightforward, but it contains a high degree of complexity. If accountability is to be more than an empty buzzword, conceptual and analytical clarity is required. This article elaborates a definition of accountability in terms of answerability and sanctions, and distinguishes three types of accountability: financial, performance and political/democratic. An analytic framework for mapping accountability is proposed that identifies linkages among health sector actors and assesses capacity to demand and supply information and exercise oversight and sanctions. The article describes three accountability purposes: reducing abuse, assuring compliance with procedures and standards, and improving performance/learning. Using an accountability lens can: (1) help to generate a system-wide perspective on health sector reform, (2) identify connections among individual improvement interventions, and (3) reveal gaps requiring policy attention. These results can enhance system performance, improve service delivery and contribute to sound policymaking.
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Throughout the procurement tendering process (pre-bidding, bidding, post-bidding), there are clear corruption risks, including different bidders having the same contact information, forged documents, colluding companies, and bribes and kickbacks to government officials.
“Throughout the procurement tendering process, namely pre-bidding, bidding and post-bidding, there are a number of clear corruption risks. These are highlighted in Table 1. Some examples include ‘different’ bidders having the same contact information, forged documents, colluding companies, and bribes and kickbacks to government officials [25].”
From The risk of corruption in public pharmaceutical procurement: how anti-corruption, transparency and accountability measures may reduce this risk (2020) · cites this paper as [25]
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- Authors
- Brinkerhoff, D. W.
- Affiliations
- RTI International (US)
- Corresponding author
- Brinkerhoff, D. W
- ORCID
- Brinkerhoff, D. W
- Venue
- Health Policy and Planning
- Publisher
- Oxford University Press (OUP)
- Published
- 2004-11-01
- Volume
- 19
- Issue
- 6
- Pages
- 371-379
- ISSN
- 0268-1080 (ISSN-L)
- 1460-2237
- OpenAlex
- W2154074623
- Cited by
- 458
- References
- 43
- Citations by year
- 2026: 21 · 2025: 28 · 2024: 17 · 2023: 29 · 2022: 36 · 2021: 32 · 2020: 41 · 2019: 31 · 2018: 48 · 2017: 23 · 2016: 23 · 2015: 26 · 2014: 24 · 2013: 18 · 2012: 7
- FWCI
- 8.05
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Health Policy and Planning (publishedVersion)
- PubMed (publishedVersion)
- Funders
- United States Agency for International Development
- Topics
- Social Sciences › Economics, Econometrics and Finance › Finance › Healthcare Systems and Reforms
- Health Sciences › Health Professions › General Health Professions › Healthcare Systems and Practices
- Health Sciences › Health Professions › Health Information Management › Healthcare Quality and Management
- Keywords
- accountability, health care system, answerability, sanctions, financial accountability, performance accountability, political accountability, democratic accountability, oversight, health care reform, health policy, service delivery, health system performance
- MeSH terms
- Delivery of Health Care, Developing Countries, Health Policy, Policy Making, Social Responsibility, United States
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