The report presents the main accountability agents in Botswana’s health sector, their roles and recommendations. Political decision-makers define programs, allocate resources and evaluate policies; Parliament allocates the health budget and has a Public Accounts Committee. The Ministry of Finance and Economic Development seconds staff to the Ministry of Health and organizes consultative forums. The Agence nationale de promotion de la santé et de lutte contre le SIDA organizes workshops to identify priorities. Service providers and managers, organized around District Management Teams (DHMTs), design and implement programs, but suffer from a centralized monitoring and evaluation system that creates a communication gap with programs. Village health committees extend the promotion and registration of home-based care. Civil society organizations provide services, mobilize communities and advocate, but are largely dependent on donors and government. The media have been sensitized to health priorities, but remain limited by access to information. Recommendations include improving policy evaluation to strengthen parliamentary accountability, strengthening coordination between the Ministry of Finance and sector ministries at program level, decentralizing monitoring and evaluation within the Ministry of Health, building the capacity of village health committee members, developing resource mobilization to reduce donor dependency, and enacting a freedom of information law.