Evaluating Social Accountability in Private Healthcare Institutions in Gezira State, Sudan: Application of the Social Responsibility Assessment (SRA) Tool

The equitable delivery of healthcare services remains a critical challenge in low- and middle-income countries, including Sudan. Private health institutions, pivotal in supplementing public healthcare, often face scrutiny regarding adherence to social accountability principles. This study evaluates the compliance of private health institutions in Gezira State, Sudan, with social accountability standards using the Social Responsibility Assessment (SRA) tool. A cross-sectional descriptive design was employed, encompassing all 52 registered private healthcare facilities in Gezira State. Data were collected through structured observations, semi-structured interviews, focus group discussions, and document reviews. Quantitative and qualitative analyses were conducted to assess compliance across transparency, community engagement, and ethical governance indicators. The findings reveal significant disparities in compliance between urban and rural healthcare facilities. Urban institutions, particularly tertiary care centers, demonstrated higher adherence to social accountability principles, benefitting from better infrastructure, resource allocation, and workforce capacity. Conversely, rural facilities faced systemic challenges, including limited resources, inadequate infrastructure, and logistical barriers. Compliance rates were moderate for labor rights and community engagement indicators but notably low for gender equity and grievance mechanisms. This study underscores the need for targeted reforms to address resource inequities, enhance operational efficiency, and promote equity in healthcare delivery. Strengthening governance frameworks, fostering public-private partnerships, and integrating technology can enhance accountability and improve health outcomes. The findings provide actionable insights for policymakers, healthcare providers, and community stakeholders to ensure socially accountable healthcare systems in Sudan.