Securing independence in global health oversight - The OPEN Framework

Abstract The credibility of global health oversight mechanisms relies on their perceived independence. What truly constitutes “independent,” however, remains ill-defined. Using a mixed-methods approach that includes a literature review and 54 key informant interviews, this paper outlines four pillars of independence: Operational, Political, Economic, and Knowledge/Technical. It then proposes a practical tool for evaluating their application - the “OPEN Framework”. We tested this framework by reviewing it against three monitoring bodies: the Global Polio Eradication Initiative’s Independent Monitoring Board, the Global Preparedness Monitoring Board, independent monitoring and accountability body to ensure preparedness for global health crises; and the Independent Accountability Panel for Maternal, Newborn and Child Health. Our findings reveal that, despite intentions of independence, pragmatic constraints and dependencies often compromise autonomy. The paper argues for a shift from rhetorical to operational independence by applying this framework, identifying conflicts of interest, and actively managing them. The OPEN Framework offers a replicable methodology for evaluating, comparing, and enhancing the independence of oversight bodies, thereby fostering stronger accountability and trust in global health governance.