Chasing Accountability in Global Health

Abstract The story of United Nations (UN) efforts to create an independent mechanism to foster greater accountability across global health is one of high hopes, missed opportunities and, ultimately, planned project failure. The creation of the UN Secretary-General’s Independent Accountability Panel on Women’s, Children’s and Adolescents’ Health (IAP) in 2016 was born out of the idea that accountability was the missing link to achieve progress on the Sustainable Development Goals related to women’s, children’s, and adolescents’ health. The IAP produced four reports before it was dissolved in 2020. Subsequently, other independent accountability mechanisms have been proposed, such as for antimicrobial resistance. In this paper, I draw on my experience as a member of the IAP to examine the context for the creation of the IAP and share four lessons as to why meaningful accountability has been so elusive in global health and how future efforts might benefit from these insights. These lessons relate to the need for (1) normative grounding; (2) institutional legitimacy; (3) genuine independence; and (4) conceptual clarity with respect to the meaning of accountability. I conclude by arguing that the deeply neoliberal and colonial architecture of global governance for health constrains possibilities for transformative accountability. In telling this story, I do not pretend to represent the views of other IAP members, who may have very different reflections.