Explaining contestations of global health partnerships’ accountability: how political science fosters public health understanding and impact.

In past five years several global health public-private partnerships (PPPs) have been confronted with criticism on their functioning, achievements, conduct, or externalities. Evaluation studies in the health sciences, however, often fail to foster a deeper understanding of the underlying explanatory mechanisms. Using analytical frameworks by Bovens (2006) and Grant and Keohane (2005), we ask how contestation of accountability in global health PPPs can be explained towards developing a global health partnership accountability framework. We conducted a scoping literature review, entering a search string for accountability, public-private partnerships, and health into the databases SCOPUS, Web of Science and MEDLINE. Additionally, we analysed documents and held an expert interview informing an exploratory case study focused on an accountability event within the Global Stop Tuberculosis Partnership (STBP). The scoping review yielded 35 eligible articles from 334 records. 16 articles were published with a disciplinary focus on Public Health and Medicine (46%) while other papers represent a mixture of Political Sciences, Sociology and Economic and Business sciences. While we study global partnerships, only 8 articles (23%) include Non-Western based authors. Instead, 77% of the papers included Western based authors and 67% of all authors were located in the Anglosphere. The majority of included studies were empirical (54%), with 16 qualitative and three mixed-methods studies. Other articles were non-empirical: eight conceptual studies (23%), four literature review studies (11%) and four commentaries (11%). Authors studying PPPs often conceptualized accountability broadly and tied this to hierarchical and democratic accountability. However, at the global level, such political accountability is largely absent. The interdependency between the partners and their dual roles as actor and forum within the same PPP, do not fit with their frameworks´ clear separation between actor and forum. In PPPs we encounter a mixture of bureaucratic, legal, social, audit, fiscal, and soft accountability mechanisms. In 2020, newspaper allegations for misconduct at the Stop TB Partnership exemplified public reputational accountability, which sparked the Board to subject the partnership to audit accountability. The audit lead the Board to enforce mission accountability of all partners as a cornerstone of the STBP and a Value Charter for a safe and equitable work environment implemented in the STBP Board and Secretariat as soft accountability mechanisms. Thus, PPPs' accountability landscape is dynamic, shaped by different normative considerations and by interdependence among partners. This study highlights the necessity for rethinking accountability in global health PPPs due to the limitations of existing structuralist frameworks. Using political science informed accountability frameworks helped to identify, categorise, and interpret varying forms and combinations of accountability manifestations in global health PPPs. This allows us to understand that generalized technical approaches and solutions to impaired accountability structures and procedures as often favoured by health sciences have limited applicability in global health partnerships. Their highly interdependent, dynamic, and normative dimensions requires a shift focus to global governance mechanisms that warrant a hybrid accountability of procedural, interactional, distributive and recognitional justice under their commonly agreed mission.