This is exactly the point. There are two kinds of accountability here. One kind of accountability is that if there are strings attached to funding, the federal government is making sure that the provincial government is doing what the federal government wants. The primary mechanism of accountability that's lacking is for voters and constituents, who expect to see the delivery of those services, to actually judge the results.
There's a difference between being accountable to a federal government that can pick any of its own criteria when it wants to judge where provincial spending is going.... It is not the same kind of accountability when you have the average citizens at the local level, who do not feel that the operating of their system is sufficient.