ABSTRACT Top-level design and campaign-style governance have reshaped the dynamics of central-local relations in China during the Xi Jinping era. With an empirical focus on targeted poverty alleviation—a politically charged national agenda in China—this article examines three types of pair-making mechanisms, including the fixed-point paired support mechanism (FSM), the horizontally-twinned support mechanism (TSM), and the subnational peer-to-peer support mechanism (PSM), which are instrumental in both centralizing power and decentralizing responsibilities. Under the current leadership, these pair-making mechanisms have become more politicized, institutionalized, penetrative, and action-focused, with an expanded toolkit for enforcing accountability. They establish a nuanced, comprehensive duty system that transcends hierarchical, regional, and sectoral boundaries, collectively giving rise to a novel form of top-down accountability, conceptualized in this research as ‘designated accountability’. By engineering these pairs, central power has burgeoned. Not only can it prompt various parties to fulfill bureaucratic functions better, but it can also designate and impose tasks beyond their official roles, holding them accountable and ultimately claiming credit for achievements. Designated accountability not only provides fresh insights into new central-local dynamics and broader political implications in the Chinese context but also holds the potential to add to the general theory of political accountability.