In sub-Saharan Africa, concerns have been raised regarding the quality of services delivered and health outcomes [
1]. Existing health system bottlenecks such as drug shortages [
2,
3], disrespect of patients in public health facilities [
4], health workers’ focus on donor-funded activities that offer access to per diems [
5,
6], and drug and bed net pilfering [
7,
8] are among the factors that affect health service functioning in sub-Saharan African countries. The 2008 Accra Agenda for Action and the 2005 Paris Declaration on aid effectiveness emphasized country ownership for development policies through citizen engagement. Social accountability is a process in which citizens are engaged to hold politicians, policy makers public officials accountable for the services that they provide. It can be defined as “an approach towards building accountability that relies on civic engagement, i.e., in which it is ordinary citizens and/or civil society organizations who participate directly or indirectly in exacting accountability” [
9]. In the context of health care, social accountability is a form of participatory citizen engagement in which citizens are recognized as service users who are ultimately impacted by health care decisions and thereby can affect change in health policies, health services and/or health provider behaviour through their collective influence and action [
10]. Scholars consider two key aspects of social accountability: answerability and enforceability [
11,
12]. Answerability is the obligation of politicians, policy makers, and providers to explain and justify their actions. This includes being answerable for meeting performance objectives, measured against a number of goals or standards in a complex relationship that involves several stakeholders with vested interests and different levels of authority [
13]. Enforceability refers to the capacity to ensure an action is taken and can involve penalties, consequences or remedies for failure to do so
. In many sub-Saharan African countries, community participation, especially women’s, in accountability processes is fragmented [
2,
14,
15]. Social accountability can play an important role in addressing corruption, increasing trust in public servants and government, which is key to accelerating efforts to achieve the Sustainable Development Goals (SDGs), and increasing the power and influence of citizens on agenda-setting [
16‐
19]. Identifying the conditions for implementing successful social accountability initiatives can help community leaders, civil society organizations (CSOs), or non-governmental organizations (NGOs), to increase their leverage. While there have been several studies examining social accountability initiatives on health outcomes in various sub-Saharan African countries, there has been no systematic analysis of these initiatives in aggregate to identify common enabling and limiting factors to success. The objective of this paper is to analyze the conditions that foster effective social accountability initiatives in sub-Saharan African countries.