The document outlines how accreditation, or the external evaluation, of health care facilities or organizations interact with the health system, including health service supply and demand, and how they link to wider quality initiatives. It considers links to financial and legal systems and the involvement of stakeholders, health workers, patients, the public and communities in the design and implementation of these programmes. The paper also builds a systems view of accreditation as a quality improvement intervention, highlighting complexity and some of the widespread considerations and assessments required to understand the attributes, value, and potential impacts of accreditation in any given setting.