Over the past decade, the Government of Tanzania has paid increasing attention to accountability in its nutrition policies. This has coincided with the introduction of truly innovative efforts to advance and monitor government action towards and accountability for nutrition at subnational level. A multisectoral nutrition scorecard (MNS) has been rolled out across all districts in the country, with quarterly updates on district performance. Moreover, a Nutrition Compact instrument was introduced to incentivise senior civil servants within regional and district administrations to advance efforts to promote nutrition. This paper explores how the government has used these initiatives to give accountability a particular form and meaning, pertinent to context. The paper analyses a series of policy documents and complements analysis this with field-based interviews with local officials across five regions. We find that the MNS and Compact are designed predominantly for internal purposes of government. This renders ‘accountability tools’ largely in the service of a centralised state, advancing vertical accountability. Such a narrow framing and design inhibits the potential of these instruments for galvanising social accountability, whereby citizens can hold public service providers and subnational government actors to account directly.Irish Aid, Government of Ireland