Since the 2004 World Development Report articulated the theoretical linkages between governance and service delivery, the United States Agency for International Development (USAID), the World Bank, and other key donors have promoted embedding social accountability concepts within sector-specific programs. In the interest of leveraging these investments, this paper builds on existing research to pinpoint key concerns for linking social accountability inputs to various types of outcomes. It also describes key concerns for program managers as they try to assess the effectiveness of social accountability programs. I argue that assessing social accountability efforts requires considering a variety of different inputs, contextual factors, study design limitations, and operational concerns. Additionally, the recent emphasis on experimental designs has given program managers more knowledge about what works in specific contexts, but we are often still in the dark about why interventions work. To address this limitation, program managers can use qualitative methods, including causal pathway analysis, to enrich experimental or observational data. Finally, I find that the divide between research that discovers new interventions and programs that implement known “best practices” will only shrink, and program managers must be ready to propose evaluation approaches that respond to the needs of donors and governments seeking to implement social accountability programs.