Accounting and Accountability in Resource Risk Management Control Systems: What Can Public Health Care Environments Learn From the COVID-19 Pandemic?

Abstract

The COVID-19 pandemic presented unprecedented global challenges, significantly affecting healthcare sectors worldwide and raising profound concerns about preparedness for future crises. The outbreak placed substantial strain on health systems, often revealing critical inadequacies in resources, governance and existing management control and accountability mechanisms, leading to service disruptions and exacerbating societal inequalities. This highlighted the complexity of managing resources and risks during systemic health emergencies and underscored the urgent need for more resilient, equitable and accountable approaches within global health governance. This thesis critically examines the interplay of resource allocation mechanisms, risk management control systems (RMCS) and accountability mechanisms within major international health organisations (IHOs) and associated public health systems during the 2019–2024 pandemic period. Employing a critical realist philosophical stance, the research utilises qualitative content analysis of 620 publicly available documents from ten key IHOs. The research identifies critical resource risks, evaluates management strategies and examines the role and limitations of specific non-financial and financial accounting and control tools employed within RMCS during the pandemic response. Contingency theory and resource dependence theory serve as primary analytical lenses for the interpretation of the context-dependency of system effectiveness and the management of crucial external resource dependencies. The research finds that traditional RMCS and accounting frameworks—often siloed, reactive and focused primarily on financial controls—proved insufficient for the systemic, interconnected and dynamic nature of the pandemic crisis. The central argument derived from the synthesised findings is that achieving effective pandemic resilience demands a fundamental paradigm shift towards RMCS and associated management accounting systems and control practices that are simultaneously anticipatory—embedding equity considerations and systemic risk analysis into pre-crisis planning—and dynamically adaptive—enabling transparent, accountable and stakeholder-responsive decision-making during crises to mitigate fragmentation and injustice. This study contributes an empirically grounded, theoretically informed analysis of the complex interplay between risks, strategies and control tools in global health emergencies. It offers critical insights for the development of more integrated, adaptive and equitable RMCS for future pandemic preparedness and response.