A concept in flux: questioning accountability in the context of global health cooperation

Publisher: Globalization and Health 2014, 10:73; Carlos Bruen, Ruairí Brugha, Angela Kageni and Francis Wafula

Accountability in global health is a commonly invoked though less commonly questioned concept. Critically reflecting on the concept and how it is put into practice, this paper focuses on the who, what, how, and where of accountability, mapping its defining features and considering them with respect to real-world circumstances. Changing dynamics in global health cooperation – such as the emergence of new health public-private partnerships and the formal inclusion of non-state actors in policy making processes – provides the backdrop to this discussion.

In mapping some defining features, accountability in global health cooperation is shown to be a complex problem not necessarily reducible to one set of actors holding another to account. Clear tensions are observed between multi-stakeholder participatory models and more traditional vertical models that prioritise accountability upwards to donors, both of which are embodied in initiatives like the Global Fund. For multi-constituency organisations, this poses challenges not only for future financing but also for future legitimacy.