Governance, coordination, and accountability in public health emergency preparedness and response: A scoping review.

Public health emergency preparedness depends not only on technical capacity but also on strong governance, coordinated multisector action, and clear accountability. However, evidence on how these systems function across different contexts remains fragmented. This scoping review synthesized global evidence on governance structures, coordination mechanisms, and accountability frameworks in public health emergency preparedness and response. Peer-reviewed and grey literature published between 2000 and 2025 was systematically searched in PubMed, Web of Science, Scopus, Embase, and CINAHL, as well as organizational and institutional websites. Eligible sources addressing governance, coordination, or accountability were charted and thematically analyzed to map institutional arrangements, coordination practices, and accountability systems. Seventy-seven sources met the inclusion criteria, comprising 67 primary studies and 10 grey-literature documents. Most studies were published after 2010, with strong representation from global, Asian, and African contexts. The evidence included conceptual and theoretical work, empirical studies, reviews and framework analyses, and policy-oriented guidance. Four interlinked themes emerged: governance architecture, legal foundations, and the distribution of authority, including centralized and decentralized arrangements; institutional roles and coordination mechanisms; accountability failures and system fragmentation; and reform approaches and enabling conditions. Clear legal mandates, functional intersectoral coordination bodies, and routine performance reviews were reported alongside stronger preparedness, whereas weak accountability, overlapping mandates, fragmented information systems, and political inertia were reported alongside delayed and poorly coordinated responses. Effective public health emergency preparedness was described in the literature less in relation to resources alone than to the strength and integration of governance, coordination, and accountability systems. Stronger preparedness was reported alongside adaptive governance, institutionalized multisector coordination, transparent oversight, and continuous learning embedded in policy and practice.