Alternative conceptions of accountability.

The following view of accountability-the guidance approach-is the view closest to my heart. It took me 600-odd pages to explain it elsewhere." Here I will simply susgcst its chief points relevant to the issue at hand. Accountability is based on a variety of interacting forces, not one lone attribute or mechanism. The direction health administrators take, in accountability as in other matters, is affected by all the factors already discussed and some others still to be mentioned. In part, administrators respond to articulations of rights by thc community, its leadcrs, the press, ctc., that is, to claims of accountability. I n part, their accountability is circumscribed and delineated by the legalities and formalities of the state, etc. Hence, changes in any and all of thew factors are effective ways to change the level and scope of accountability; none of them is all inclusive. Moreover, several missing elements must still be ac!dcd to complete thc analysis. For example, in contrast to thosc who pcrccive power as the core cxplanatory factor. I perccivc accountability as having both a power and a moral base. in the sense that the values