Securing independence in global health oversight-the OPEN framework.

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 4 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 3 so-called independent monitoring bodies: the Global Polio Eradication Initiative's Independent Monitoring Board, the Global Preparedness Monitoring Board, an 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.