Dissertation (MA Public Administration)The research has aimed at examining the Leadership Accountability in service delivery and the selected health service. The main objective was to investigate the Leadership Accountability and the delivery of health service. Specific objectives were to examine the role of the leaders on health service provision in Songea district, examining the influence of Leadership Accountability in improving health service provision, and to identify the factors and challenges affecting the effectiveness of the Leadership Accountability in bringing better health service. The study adopted a crossectional design where data were collected at once and on time. Primarily data were through survey method using questionnaires and an interview method, using an interview guide. Again these data were collected through direct observation. The study covered 108 respondents who were selected from the four wards and eight villages. These were Mtyangimbole ward which comprised Luhimba and Likarangilo village as selected areas, Mpandangindo ward with Mpandangindo and Liweta villages and Mbingamhalule ward, with Mbingamhalule village. There was Peramiho ward also which composed Peramiho „A‟ and Peramiho „B‟ villages. The findings revealed that there was a limited Leadership Accountability enough to make health service delivery, to be in an efficient and effective manner. The majority of people who were interviewed, were dissatisfied with the service provision and accountability of the leaders, both elected and appointed ones. The study consequently through the categories of institutional, legal, policy and resource recommendations, suggested that it was for all stakeholders involved in health service and leadership affairs, to make their contributions so as to enable the service to be provided, as required or expected. Policy makers specifically were advised to create and or review policies relating to health, motivations and incentives. Again it was recommended that different legislations should also be formulated, so as to scrutinize public officials and enabling participations in decision making processes