Thus, a spatiotemporal account highlights both overlooked links and unexpected disconnections. Similarly, not just researchers but also practitioners are struggling to develop a comprehensive understanding of IOs since they experience them only partially and in specific settings. However, there is also the constant danger that they develop a self-referential life of their own and become disconnected from other processes. These focal times and spaces provide an important coordination mechanism and ease the general flow of knowledge вЂ“ within IOs and between IOs and their environment. This practical challenge illustrates that there are focal times and spaces, which are linked to the cyclical and sited character of global health governance. Both practitioners and ethnographers have to be in specific spaces at particular times. This experience overlaps with the lived realities of practitioners and spotlights aspects that are otherwise easily overlooked.

First of all, it shows that ethnography induces researchers to experience international organizations (IOs) and global governance as spatiotemporal phenomena. These trends are discussed in the context of three case studies of significant political, social and health relevance, namely HIV/AIDS, the 2014 Ebola outbreak and antimicrobial resistance.Дrawing on a long-term political ethnography of sites of global health governance, the paper makes methodological and substantive contributions. Second, global health actors have often been able to harness the opportunities offered by three important pathways of change, namely: (1) a significant degree of organizational learning and active feedback loops between epistemic and practice communities (2) a highly polycentric system of governance and (3) the increased role of political leadership as a catalyst for governance innovation. First, developments that are normally associated with gridlock in multilateral cooperation, such as institutional fragmentation and growing multipolarity, have transformed, rather than gridlocked, global health governance. The remarkable degree of innovation that characterizes global health governance is the result of two interrelated conditions.

In order to understand the mechanisms that have made these developments possible, this article draws on the concept of gridlock, as well as on the additional theoretical strands of metagovernance and adaptive governance, to conceptualize how global health gover-nance has been able to adapt despite increasingly difficult conditions in the multilateral order. Global health governance is in many ways proving more innovative and resilient than other sectors in global governance.

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