Hybrid accountability in global health public-private partnerships: a literature and case study

Abstract Background Recent global health public-private partnerships (PPPs) offer novel approaches to public health issues, yet they lack clear public accountability. Hence, it remains unclear how accountability is organised and practiced. This research examines accountability in global health PPPs, how it is manifested, and derives lessons for developing an accountability framework. Methods The study utilized both a scoping literature review, examining the databases SCOPUS, Web of Science and MEDLINE, which yielded 35 eligible articles from 334 records, and an exploratory case study focused on an accountability event within the Global Stop Tuberculosis Partnership (STBP), incorporating a document analysis and an expert interview to enhance insights from the literature review. Results Authors studying PPPs often conceptualized accountability broadly and favoured a view tied to hierarchical state-led governance and democracy. However, at the global level, this political accountability is largely absent. In PPPs, it is replaced by a mix of bureaucratic, legal, social, audit, fiscal, and rather soft accountability mechanisms. Also, PPPs' accountability landscape is dynamic, shaped by different normative considerations and by the interdependence among partners. In 2020, the allegations for misconduct at the STBP exemplified public reputational accountability, followed by audit accountability leading to an enforced soft accountability to STBPs' mission & purpose. Conclusions This study highlights the necessity for rethinking accountability in global health PPPs due to the limitations of existing structuralist frameworks. A new hybrid accountability framework is proposed. It considers a strong accountability focus on PPPs' purpose, their processual dynamics, and normative aspects. Lastly, it is recommended to further investigate the trade-off between transparent accountability mechanisms and the practical necessity for confidential backstage processes in PPPs. Key messages • Exploring a hybrid accountability framework in global health PPPs beyond only static accountability snapshots, helps to understand PPPs’ true dynamic, purpose-driven and individualized accountability. • Without regulatory mechanisms and state governance, individual action and new collaboration become essential, requiring soft accountability mechanisms as increased trust and cooperation among partners.