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Service Systems Strengthening and Social Accountability Approach (4SA)

CARE is continuing its journey to influence systemic change in and beyond the communities where we work as part of our vision for 2030 through an approach called service system strengthening and social accountability (known as 4SA). Through 4SA, we aim to strengthen and transform structures and institutions to deliver services in ways that are accountable, equitable, inclusive, and effective.


4SA is one of six CARE pathways to impact at scale. CARE’s 4SA approach is focused on gender-transformative, citizen-centered, and rights-based approaches that are equitable and inclusive and hold power holders to account.

4SA building blocks

CARE’s service systems strengthening framework has six interdependent building blocks. Building blocks are a simple way of defining the core functions of a service systems system that need to operate effectively, both independently and in relation to all other building blocks, for the service system to deliver its objectives. These building blocks prioritize and integrate gender-transformative approaches to address unequal power structures that sustain inequality.

  1. People and skills: Service users/citizens and duty bearers have the knowledge, skills, and capacities to demand and deliver quality, equitable, and accountable services.
  2. Information, negotiation, and accountability: Inclusive spaces for citizens and power holders to dialogue, give feedback, and negotiate, and to collectively plan and be held accountable, based on equitable access to relevant information and analysis.
  3. Institutional leadership, governance, and coordination: Institutions have the policy, regulatory and legislative frameworks; clarity of mandates; coordination and communication mechanisms in place to embed and scale gender-transformative approaches that deliver quality, equitable, and accountable services for all.
  4. Service delivery, infrastructure, and resources: Institutions have service delivery models, infrastructure and technology, quality standards, natural resource and asset management, mediation, and protection mechanisms in place to deliver quality, equitable, and accountable services and rights for all.
  5. Planning and financing: Institutional strategic planning, (gender) budgeting, and financing mechanisms deliver quality, equitable, and accountable services for all.
  6. Community and social norms: Social norms at the household and community level support active participation in public life for all and promote social and political incentives to serve and be accountable to the rights of all.

An Overview of 4SA

Service Systems Strengthening and Social Accountability (4SA)

4SA theory of change

CARE’s 4SA framework is based on our theory of change that:


  • We share resources and skills;
  • Facilitate access to information, negotiation, and accountability spaces;
  • Build institutional leadership, governance, and coordination;
  • Strengthen service delivery, infrastructure, and resources;
  • Facilitate inclusive planning and financing; and
  • Transform social norms within communities and societies

THEN this will

  • Build AGENCY of citizens to participate in public life and demand, and public and private sector to deliver and better services;
  • Build RELATIONS between citizens/service users and duty bearers for more responsive, equitable and accountable social contracts; and
  • Build STRUCTURES to deliver effective, inclusive, and accountable institutions and remove barriers within society for active participation of all.

Which will RESULT IN

  • Quality, equitable, and accountable services and support for marginalized and excluded people of all genders.

Key strengths of CARE’s service systems strengthening approach

CARE’s service systems strengthening contributes to sustainable shifts in transforming structures and systems for progressive realization of human rights to create more equitable communities and responsive and inclusive services. Key commonalities and strengths in CARE’s 4SA approach consist of:

  • Gender-transformative service systems strengthening
  • Long-term convener and relationship builder
  • Decentralized service systems strengthening and reaching the ‘last mile’ in service delivery
  • Monitoring and data management
  • Institutionalizing the DNA of ‘what works’
  • Embedding sustainability and scaling impact

of CARE's projects in 2021 used the 4SA approach.

of CARE's projects in 2021 used the 4SA approach.

These projects are responsible for over 80% of CARE's global direct and indirect reach.

Priority 4SA outcomes: Quality, equitability, accountability

In 2021, 4SA was the second-most common pathway to impact at scale, after advocacy and influencing, and included ~50% of CARE’s projects. These projects are responsible for over 80% of CARE’s global direct and indirect reach, and a significant share of CARE’s reach in all impact areas. To strategically tie our work together, CARE prioritizes service system outcomes that are of quality and are equitable and accountable.

Priority outcome

CARE global indicators

Quality: The system delivers effective support/services to a reasonable standard, as defined by the service user/right holder.

4, 5, 7, 12, 18, 22, 23, 24, 26, 27, 28, R2H Sup 1, 2, and 4

Accountable: The system is responsive to all core users and for meeting its expected outcomes.

19: Humanitarian response

15: Service providers

4SA building blocks: Also consider outcomes related to resilience, sustainability, and scalability.

16: Positive shifts

17: Policies and legislation


Resources and contact information

For further information on 4SA, please contact:

Shivi Thakur
Senior Program Officer, CARE

Andrew Patterson
Senior Director, Strategic Alignment, Knowledge Management, and Learning; CARE