This article aims to understand the inversion of roles between the state and citizens, by exploring its historical roots and current implications for processes of social accountability in Mozambique, particularly in the health sector. This is a practice-based reflection grounded in the evidence collected through the implementation of Community Scorecards in the health sector in 13 districts of Mozambique. The evidence has revealed a transfer of responsibilities from local governance institutions and service providers to the communities; diluting the frontiers between the state and citizens’ duties and rights, resulting in the inversion of roles. This inversion results in the minimisation of the state’s performance of its duties and accountability in the health sector to respond to local communities’ needs, allegedly due to the lack of financial resources. It also leads to the overburdening of local communities, who assume the responsibility of meeting their own demands, risking participation fatigue.