Abstract. Full Text Book Chapter available at: https://doi.org/10.4324/9780429279171Social accountability monitoring (SAM) is an approach widely employed by many civil society organizations to promote active participation of people in governance processes, especially in the context where government traditionally is dominant governance actor. This chapter scrutinizes certain attempts to promote change in current citizenship habits obtained through different forms of participation. It discusses how implementation of SAM initiatives encounters multiple context-based factors that affect the expected outcomes. The discussions draw illustrative experiences from local NGO working in Kondoa district to promote change of state-citizens relations in order to improve service delivery in the health sector. The chapter analyses the ways in which the implementation of SAM both promotes and hinders citizens’ active participation focusing on the balance between ideal model and reality during its implementation in Tanzania.