Mediating multiple accountabilities: variation in formal and perceived accountability among international and domestic actors in the health sector in Peru

Based on a comparative case study of bilateral and multilateral donors, this article examines individual and institutional accountabilities among donor officers, implementing agencies, government officials and intended beneficiaries. It explores how multiple accountability demands interact, the extent to which they conflict, and how development actors mediate among them when they do. Institutionally there was substantial alignment of objectives and little goal conflict between international donors and the state; however, there was poor harmonisation across the many donors and numerous projects they were pursuing. There was greater variation within rather than between bilateral and multilateral donor chains, with perceived accountability differing more based on individuals’ positions within their organisation than by the type of organisation for whom they worked. Most informants cited multiple entities to whom they felt accountable. They more frequently acknowledged outward accountability when there existed formal accountability mechanisms, although intended beneficiary groups were conceptualised in different ways.