Transparency and accountability challenges exist at every level of the health system—from internal operations and responsibilities among office holders to interactions between governments and communities. TAAC supports civil society—through its Collaboratives—to collectively bridge these gaps and strengthen accountability relationships.
While accountability is often a natural outcome of advocacy, TAAC treats them as distinct but interconnected strategies. In practice, Collaboratives weave accountability and advocacy efforts together to ensure commitments, policies and strategies are not only made but followed through.
Defining accountability: Obligation of an individual or organization to explain and justify their actions or decisions to a relevant forum of stakeholders who can then assess the conduct and potentially impose consequences. Social relationship where one party is answerable to another for their performance or behavior.
(Source: Cambridge University Press, 2020)
In many contexts, both citizens and civil society organizations face difficulties accessing official government policies, strategic plans, or other critical documents. Progress is evident in countries that have created digital repositories—but even where these exist, barriers to access and usability often remain.
Access to health data presents an even greater challenge. While confidentiality concerns can justify some restrictions, even aggregate or de-identified data is often inaccessible, especially to those outside formal health systems. TAAC works with Collaboratives to understand who controls the information they need, identify points of leverage, and strategize pathways to access it.
TAAC also offers technical assistance to help Collaboratives create and manage their own knowledge repositories, ensuring members can share and use critical information more effectively.
Note: Transparency in public financing is addressed in a separate section below.
(see more on Capacity for data literacy and use
See more on Knowledge Management)
A common challenge is the inconsistency in political leaders and duty-bearers fulfilling their roles. Political or short-term priorities can overshadow the pursuit of approved strategies or national commitments. Frequent changes in leadership and brief political cycles make it difficult to sustain momentum for long-term implementation.
Starting with landscape analysis and continuing through ongoing monitoring, TAAC mentors Collaboratives to assess the political environment, anticipate shifts in leadership or priorities, and adapt their engagement strategies accordingly. We coach advocates to build and maintain relationships with key decision-makers—recognizing that generating and sustaining political will is essential to turning commitments into action.
TAAC has found that civil society plays a vital role in ensuring national strategies don’t just exist on paper but are actually implemented. Across different contexts, we’ve seen that even after a policy is adopted, office holders often struggle to translate it into action. This can be due to several factors:
Through landscape analysis, TAAC helps Collaboratives examine these stewardship dynamics to identify both opportunities and obstacles. We support them to engage constructively with decision-makers, make connections between strategies and planning or budgeting cycles, and ensure policies remain active in ongoing government processes.
Monitoring the implementation of health policies and strategies is complex—but essential. In many low- and middle-resource settings, health data systems are weak, underused, or disconnected from real-time decision-making. Public sector institutions often lack the tools, processes, and culture to analyze and act on the data they collect.
A core challenge is the limited use of health data to guide adaptive management. Data may be presented regularly—monthly or quarterly—but rarely inform course correction or highlight performance gaps. Health information officers and data managers are often sidelined, and decision-makers may not fully engage with what the data reveals about policy implementation.
Another key gap is the exclusion of stakeholders from reviewing both routine health system data and community-generated feedback. Even when stakeholders are present, discussions are often superficial, with little attention to data quality, validation, or the implications of trends. For example, TAAC has observed national policy processes using unverified National Health Accounts data that local actors knew to be inaccurate—yet the data was still used for global reporting.
TAAC supports Collaboratives to advocate for more inclusive and transparent performance review processes—whether in District Health Council meetings or national technical or interagency working groups. We help strengthen civil society’s ability to bring independent evidence, facilitate feedback loops from communities, and promote social accountability approaches. This creates space for more honest, data-driven dialogue and responsive policymaking.
TAAC also helps implement joint monitoring mechanisms, working with government partners to regularly review strategy execution. For complex efforts—such as costed implementation plans for family planning or FP2030 commitments—Collaboratives apply structured tools like the Motion Tracker® and draw on frameworks such as PAI’s Common Framework to support progress tracking and resourcing.
Over time, TAAC has seen how sustained civil society engagement in monitoring builds trust: government officials begin to rely on advocates to support reporting to global entities, helping ensure that what is reported more accurately reflects reality on the ground.
In one country, TAAC supported a Collaborative reviewing domestic resources devoted to a critical health system function. As part of that process, stakeholders were invited to examine an analysis by an international expert body, which relied on data drawn from the country’s National Health Accounts (NHA)—a common source for tracking health spending across funding streams.
Several participants raised concerns: the figures didn’t reflect their on-the-ground realities. Further investigation revealed that, although NHA data had been reported to global partners, it had not undergone any national validation. Local experts judged the numbers inaccurate, incomplete, or poorly contextualized—and no participant was sure who had submitted the data in the first place.
This experience underscores why TAAC emphasizes inclusive data review processes. Without stakeholder validation, inaccurate data can lead to erroneous conclusions in national policy—and widen, rather than close, equity and implementation gaps.
TAAC pays particular attention to public budgeting and expenditure cycles. In many settings, development financing, especially in the health sector, has long relied on external donor resources. Yet few aid-recipient countries have made strategic choices to transition toward domestic public financing of previously donor-supported initiatives.
A key component of holding duty bearers accountable for adaptive implementation involves public financing and expenditure tracking. This means monitoring not only how financing decisions are made, but also ensuring that those decisions lead to action.
TAAC and Collaboratives confront the possibility that:
At the accountability stage, TAAC supports Collaboratives to work with government counterparts to review whether allocations are consistent with approved commitments, and whether funds are released in full and on time. When the system is too slow or fragmented, implementation suffers.
Collaboratives also engage with units that receive funds to monitor whether expenditures are aligned with intended plans and commitments. In some cases, they advocate for reforms in financial reporting systems so that stakeholders—including civil society—can validate how funds were spent.
TAAC promotes transparency across the full budget cycle and calls for public participation at every stage. In all cases, we emphasize the importance of tracking equity—ensuring that public funds benefit communities fairly and in line with national goals.
Long-term change depends on strong, informed, and courageous leadership. TAAC helps develop and sustain local leadership within civil society and government to champion health equity and drive implementation.
We support leaders at all levels to navigate complex systems, build coalitions, and make use of data and evidence in their work. Whether stewarding a policy, advocating for equitable financing, or holding others accountable, effective leadership ensures that health reforms are not only adopted—but embedded, sustained, and owned by those closest to the issues.
TAAC’s principles for working with Country Collaboratives on Advocacy similarly extend to accountability, namely that they should:
Stay informed on advocacy breakthroughs, partner achievements, and health systems insights.
Kenya Office:
Email: info@taacglobal.org
Phone: +254 720731428
Address: 4th Floor, Timau Plaza, Kilimani, Nairobi, Kenya
USA Office: usacontact@taacglobal.org