||Background: Social accountability has been emphasised as an important strategy to increase the quality, equity,
and responsiveness of health services. In many countries, health facility committees (HFCs) provide the
accountability interface between health providers and citizens or users of health services. This article explores the
social accountability practices facilitated by HFCs in Benin, Guinea and the Democratic Republic of Congo.
Methods: The paper is based on a cross-case comparison of 11 HFCs across the three countries. The HFCs were
purposefully selected based on the (past) presence of community participation support programs. The cases were
derived from qualitative research involving document analysis as well as interviews and focus group discussions
with health workers, citizens, committee members, and local authorities.
Results: Most HFCs facilitate social accountability by engaging with health providers in person or through
meetings to discuss service failures, leading to changes in the quality of services, such as improved health worker
presence, the availability of night shifts, the display of drug prices and replacement of poorly functioning health
workers. Social accountability practices are however often individualised and not systematic, and their success
depends on HFC leadership and synergy with other community structures. The absence of remuneration for HFC
members does not seem to affect HFC engagement in social accountability.
Conclusions: Most HFCs in this study offer a social accountability forum, but the informal and non-systematic
character and limited community consultation leave opportunities for the exclusion of voices of marginalised
groups. More inclusive, coherent and authoritative social accountability practices can be developed by making
explicit the mandate of HFC in the planning, monitoring, and supervision of health services; providing instruments
for organising local accountability processes; strengthening opportunities for community input and feedback; and
strengthening links to formal administrative accountability mechanisms in the health system.