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This chapter describes the contemporary search for a universal metric in global health as an answer to the problem of accountability in the past sixty or so years of international health development. Randomized controlled trials are seen as the gold standard for doing global health work and for providing accountability. This form of counting emerges from several shifts in personnel in the global health world but also as a possibility because of earlier efforts to count things, notably the qaly and the daly. How the rct differs from and continues to provide evidence of success or failure in health efforts is explored in relation to other opportunities that arrive with global health that have tethered market-based economics to the work of health care. These have implications for new forms of sovereignty orchestrated in and through global health.

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