Accountability in Health Systems | World Bank Institute (WBI)

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(c) Dominic Chavez/World Bank

A perspective from Maria-Luisa Escobar, Manager, Health Systems Practice, WBI.

April 22, 2014―Paul Hunt spoke at the Fourth Latin American High Level Meeting on the Right to Health and Health Systems, and I was struck by his thoughts on the topic of accountability, where he pointed out how health professionals and lawyers interpret this word differently and why it’s important to have a common understanding of this concept.

Hunt noted that when he would say “accountability” to people working in the health sector, they didn’t understand what he meant. He said, “When I would say accountability to health professionals, they would hear monitoring. When I said accountability to lawyers, they would hear evaluation.” Neither one comprises the whole meaning of this concept. As a result, Hunt unpacked the concept of accountability, which has three different dimensions of meaning: 

  1. Monitoring – Gathering of information and data so you know what’s happening.
  2. Review – Process or body to consider monitored information and data, and assess the degree to which commitments have been kept, promises made, pledges honored. The review process must have an independent element or voice.
  3. Remedy – Someone has to take remedial action to check whether or not action has taken place. 

open-quotesWhen I would say accountability to health professionals, they would hear monitoring. When I said accountability to lawyers, they would hear evaluation.close-quotesPaul Hunt, former UN Special Rapporteur on the Right to Health
Hunt went on to say, “One of the most distinctive aspects of human rights is that it makes accountability a necessity. Lawyers often think of judicial accountability when they hear of health rights, but in my view it is the accountability of last resort – there are other forms of  non-judicial accountability that are important and should be taken up for health rights.” For countries to realize the right to health for all, it is necessary to introduce, in all its meaning, accountability not only for the state but for each and every actor in the health system. Therefore, parliaments, ombudsmen, the governing boards of hospitals, health professionals, insurers, patients and the media could be accountable. Paul Hunt argued that it is unreasonable to expect judges to be the only ones holding everyone accountable for everything related to the realization of health rights.

I tend to agree. If a health system is a set of relationships among actors and institutions, accountability is at the core of a well performing health system. If relationships are broken due to lack or weak accountability on the part of the state, or of providers, or of citizens, an environment of mistrust easily evolves and ends in polarization. The current climate of litigating for health rights illustrates the problem, and we hope that by bringing multiple stakeholders together to debate and discuss the right to health and health systems at the regional and national levels, we will be able to get more people to be accountable for the realization of the right to health.

Please also take a look at the video interview with Paul, in which we get a chance to discuss the right to health and his views on it in some detail. To view Paul Hunt's complete presentation, go to

Comments (1)


I totally agree with Paul Hunt on his research on how accountability in health sector is still a major blow.Anyway you still find in many developing countries not mention names there is still no accountability when it comes to helping the sick. Funds allocated still find there ways out some individual pockets or some other in designated allocations and yet its suppose to serve the the citizens as required. I know there are monitoring tools set aside to do this but still its not making real impact when it comes to times of evaluation. There has to be honesty 100% in delivering health services nothing less.

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