The Romanow and the Kirby reports both identified public accountability as a key component of health care reform. Romanow recommended creation of a health council, while Kirby supported the appointment of a health commissioner. Both argued in favour of annual reports on the progress of system reform and public health care spending. During negotiations on the 2003 First Ministers’ Accord on Health Care Renewal, all of the provinces except Alberta and Quebec agreed to support creation of a health council “to monitor and make annual public reports on the implementation of the Accord, particularly its accountability and transparency provisions”. The Health Council of Canada was appointed in 2003–2004 and has produced annual reports and background papers that provide Canadians with examples of innovative renewal projects; identify key areas for change, such as primary and home care, aboriginal health and health human resources; and provide advice to governments and the public on how to enhance and accelerate reform.