Social accountability has become one of the most interesting themes for public organizations, referring both the services constructing ways and the effects that services produce themselves, with a special focus on relationship between organization and its context of reference. Reflection on social responsibility and accountability has a particular meaning for public organizations, for it’s in their essence being socially responsible, and their actions and objectives are to consider mainly for their impact on community, on socio-economical and cultural context in which they operate. Starting from this point of view this work examines the specific case of health agencies in Emilia-Romagna Region, with a specific attention to the process to realize the mission balance, institutionally defined as a process and an instrument of social accountability.