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Executive Summary Understanding how civil society can get government to respond to their needs, preferences and demands, and deliver goods and services to citizens is a central concern in social accountability initiatives. It is widely argued that sanctions make a key difference to service delivery outcomes, and that without them, transparency and accountability interventions are less likely to be effective and less likely to be sustainable (Anderson et al., 2020; Arugay, 2016; Fox, 2020; Goetz and Jenkins, 2005; Grandvoinnet et al., 2015; McGee and Gaventa, 2011; Molina et al., 2017; Joshi, 2010; Joshi, 2017; Tsai et al. 2019). In this paper, sanctions refer to the threat or imposition of a punishment for transgressing a rule or norm. Yet, what evidence is there to support the claim that sanctions are king? How much do we actually know about social and formal sanctions and their effectiveness in improving service delivery? Looking at 11 meta-reviews and 35 cases, this background paper sheds light on these questions and the conditions under which sanctions promoted within social accountability interventions may have contributed to improved service delivery. Sanctions, both social and formal, feature very prominently in the scholarly literature related to accountability, so much so that some scholars have argued that it has become synonymous with punishment (Mansbridge, 2014; Schedler, 1999). While it may not be true that these concepts are fully synonymous, this trend in scholarship significantly influenced the thinking of donors such as the Department for International Development (DFID) and the World Bank over the last two decades (Grandvoinnet et al., 2015; Malena and McNeil, 2010; Moore and Teskey, 2006; World Bank, 2003). As a result, sanctions also feature in the dominant models, or theories of change, in the social accountability sector. Yet, in reviewing 11 meta-reviews in the transparency and accountability sector we found that while there is plenty of theoretical argument asserting the potential effectiveness of social and formal sanctions, there was limited empirical evidence to support the claim that sanctions were key. Our review of 35 cases revealed five mechanisms of change related to social and formal sanctions. These were: (i) “sticks” – response to punishment; (ii) “big brother is watching” – response to threat of formal punishment; (iii) diagonal accountability – response to threat of formal punishment by horizontal accountability agencies; (iv) litigation – response to legal investigations or lawsuits supported by community paralegals and legal aid organizations and; (v) response to “naming and shaming” by civil society and/or media. We challenge the dominant view in scholarship that harder social sanctions and enforcement of stronger formal sanctions are either necessary to the achievement of higher-level service delivery outcomes or that they will deliver better and more sustainable outcomes. We find that both social and formal sanctions can contribute to improving service delivery outcomes across a variety of country contexts. In half of the 35 cases reviewed, we were able to establish a likely link between social or formal sanctions and intermediate effects over the short term with some degree of confidence. These effects ranged from increased service provider awareness and motivation, increased availability of funding, staff, and materials, to improved infrastructure quality, and in a minority of cases impact level changes such as improved test scores. However, the role of sanctions in delivering outcomes was often unclear, outcomes were almost never sustainable, and in close to half of the 35 cases reviewed there were substantial negative effects. These effects ranged from reducing transparency and funding, to discrediting, relocating, and reprisals for advocates and whistle-blowers, threats of violence to collaborating government actors, damaging staff morale, reducing attendance, and generating conflict among staff and between staff and community members and between staff and patients, damaging trust. There are therefore some serious ethical dilemmas associated with sanctioning efforts which need to be carefully considered. We argue that imposing sanctions without building relationships or systems to promote good behavior is unlikely to improve service delivery outcomes in a sustainable way. Another, perhaps surprising, finding was that there are some actors that are regular targets of sanctions, and in many cases, these actors are a lot weaker than is commonly assumed. Three broad types of actors were the most common targets of punishment: (i) absentee nurses or teachers who had their pay or allowances reduced; (ii) offending officials who were either suspended, relocated, or fired; and (iii) contractors who had to cover the cost of rejected materials or faced lawsuits, alongside civil servants involved in contracting. We suggest that closer relationships may perhaps reduce stakeholders’ appetite to impose sanctions. Particularly in the health sector, we found that more proximate relationships created disincentives for confrontation, and in such circumstances, a “policing” approach to monitoring was also deemed inappropriate and counterproductive. Conversely, it seems that actors generally prefer to sanction “others,” i.e., when an actor/organization was outside the group. Short-term consultants, contractors, and suppliers were easy (and quite vulnerable) targets for harder sanctions. It has also been argued that there may be productive combinations of collaborative and confrontational tactics — i.e., hybrids. We found that many supposed confrontational and collaborative hybrids were, in fact, dislocated in time and space. Many so-called “inside-outside” strategies, therefore, seem to be a potential mischaracterization. We also found, as Fung and Wright (2003) argued nearly two decades ago, that adversarial forms of engagement cannot easily be redeployed for collaborative purposes. It is widely argued that supposedly ‘weaker’ forms of citizen engagement are less effective than those with ‘strong enforceability (McGee and Gaventa, 2011).’ We found no compelling evidence to support this contention. A quarter of cases reviewed were collaborative for certain periods or in certain locations. On average, these were slightly more successful when compared with periods or locations when imposing sanctions was a key strategic emphasis. So, soft power can also be powerful. Rather than one approach necessarily being superior (confrontational, collaborative, or hybrid) however, we argue that the best approach is likely to be the one most appropriate to the context. While we were unable to identify strong trends of contextual factors which enabled social and formal sanctions to play a role in enhancing service delivery, we were able to identify several conditions which we believe offer the greatest promise. These conditions were: (i) supportive leaders who played a role as champions; opening doors or accompanying civil society efforts; (ii) high capacity and legal authority of oversight agencies; (iii) competitive elections, which provided windows of opportunity for CSOs to combine political and social accountability efforts, and; (iv) vulnerable public servants and service providers already in relatively precarious situations and are thus easy targets. Overall, our study finds that sometimes sanctions can be effective, but punishment is not the answer to all the world’s problems. Given these limitations, we recommend that it is time to reconsider “carrots” and enquire further into the enabling conditions for bureaucrats and service providers. Relatedly, scholars, evaluators, and program teams should look more closely at service providers’ or civil servants’ motivations and take context into account more seriously. To uncover these contextual and motivational features, we believe that scholars, evaluators, and prprogrameams should also make better use of theory-based and participatory methods. And perhaps most importantly, donors and practitioners should carefully consider and mitigate the potential for backlash from sanctions-based approaches.