“Published in 2020 at The Lancet Volume 396, this article written by Gita Sen analyses the critical accountability crisis impeding the health-related Sustainable Development Goals for women, children, and adolescents. Drawing on the 2020 Independent Accountability Panel (IAP) report, it details how progress—already 20% off track pre-pandemic—has been severely reversed by COVID-19, which disrupted essential health services and increased gender-based violence, risking millions of unintended pregnancies and reversals in survival gains.

The article argues that accountability is the cornerstone of an effective response. It centres on the IAP’s framework of four interdependent pillars: Commit (to roles), Justify (with evidence and rights), Implement (through Monitor–Review–Remedy–Act cycles), and Progress (via continuous advancement). The failure of any single pillar collapses the entire system.

To address this, three core actions are advanced: (1) Invest in data systems for vital registration and equity tracking; (2) Institutionalise accountability through formal mechanisms that link evidence to remedial action, countering the 20–40% waste in health spending; and (3) Democratise accountability to ensure community voices trigger concrete responses. It concludes that accountability is a non-negotiable “must-have” that must be permanently embedded to fulfil rights for all.”