Social accountability has become one of the most interesting themes for public organizations, referring to both the constructing ways and the effects that services produce themselves with a special focus on relationship between an organization and its context of reference. Reflection on social responsibility and accountability has a particular meaning for public organizations, for its in their essence, being socially responsible. Their actions and objectives are to be considered mainly for their impact on community and the socio-economic 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 specific attention to the process to realize the mission balance, institutionally defined as a process and an instrument of social accountability.