Global Fund Releases Report on CCMs

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Global Fund Releases Report on CCMs

 

In an interim report entitled " A Report on the Country Coordinating Mechanism

Model, " the Global Fund has released results from 40 case studies it

commissioned on the operations of 19 CCMs. The report, which is undated, is

available at

www.theglobalfund.org/documents/publications/other/CCM/CCM_report.pdf.

 

The case studies were conducted in eight thematic areas: partnership and

leadership; governance and civil society participation; CCM oversight practices

for grant implementation; CCM Secretariat; principal recipient and sub-recipient

selection; conflict of interest; CCM-PR-LFA communications; and harmonization

and alignment.

 

By the end of this year, the Global Fund plans to release in-depth reports on

each of these thematic areas. The Fund also plans to produce a final version of

this report, in which it will add one-page summaries of the lessons learned, and

key recommendations in each of the eight thematic areas.

 

The purpose of the case studies was to describe the " range of [CCM] models and

experiences gained since the inception of the Global Fund. " The list of CCMs

selected for the case studies was based, in part, on work already underway for

the Five-Year Evaluation of the Global Fund; and, in part, on the

Secretariat & apos;s experience and knowledge of developments in CCM practices and

management.

The methodology involved (a) a review of relevant Global Fund documents; (

in-depth interviews with stakeholders in-country; and © a focus group

discussion in each country with some key CCM constituencies.

 

The list of CCMs included in the study is as follows:

Africa: Ethiopia, Kenya, Malawi, Mali, Mozambique, Nigeria, Tanzania, Zambia and

Zimbabwe.

Asia: Cambodia, India, Sri Lanka.

Eastern Europe and Central Asia: Bulgaria, Romania and Tajikistan.

Latin America and the Caribbean: Honduras, Jamaica, Peru and CRN+ (Caribbean

Regional Network of Persons Living with HIV/AIDS). (CRN+ is actually an RCM, not

a CCM.)

 

Not all case studies covered all eight thematic areas.

 

The following are some of the main findings of the report, divided by thematic

area.

 

Partnership and leadership

 

Based on case studies conducted in Honduras, Malawi, Nigeria, Peru and Zambia,

the report concludes that the CCM partnership model – with its requirements

for multi-stakeholder participation and equality of voice – is a successful

one and has improved the quality of health programmes in these countries. The

report says that CCMs " generally mediate competing interests successfully " and

that, in some countries, the CCM model has led to " a redefinition of the

relationship between government and civil society. " (However, see Commentary

article below.)

 

The report cites as examples, the " strong leadership and outreach demonstrated

by the Peruvian Ministry of Health, " and the fact that in Honduras, " working

together as equal partners with the government had an empowering effect on civil

society. "

 

The report provides a list of both the positive and negative leadership

characteristics that have been exhibited by CCM chairs.

 

Positive characteristics found in some CCM chairs include the following:

Experienced facilitator and promoter of change

Enjoys CCM members & apos; respect and has a longstanding relationship with the

mechanism

Sound conflict resolution skills and able to mediate between different

stakeholders

Enjoys a high measure of respect and acceptance by the government

Accountable and transparent

Ability to galvanize, mobilize and enthuse CCM partners

Displays a high level of commitment to the fight against AIDS, TB and malaria

Excellent communication skills

Results-oriented approach

Solid meeting management skills

Well organized (ensures minutes and documents distributed on time, handles

agenda well, prioritizes)

Ability to work under pressure

Keeps information flowing between CCM members

 

Negative characteristics found in some CCM chairs include the following:

Does not manage participation and work within multidisciplinary teams, e.g. does

not ensure sufficient civil society participation

Is not clear about CCM responsibilities or those to be performed by PR,

sub-recipient and LFA

Does not lead with much enthusiasm or motivation

Misses CCM meetings, frequently prioritizing government responsibili�ties over

CCM responsibilities [applies only to Chairs from government]

Dominates meetings, often insisting on own " agenda " rather than facili�tating

consensus.

 

In the conclusion of this section, the report says that despite the positive

trends, " civil society still needs strengthening in the many countries where

government dominates the public health arena to the exclusion of a civil society

too weak to engage effectively. "

 

The recommendations call for (among other things) making funds available to CCMs

for capacity building to improve CCM participation on CCMs, and for civil

society consultations with its constituencies.

 

Governance and civil society participation

 

Based on case studies conducted in Cambodia, Ethiopia, Honduras, India, Kenya,

Romania, Tajikistan, and Tanzania, the Global Fund found that in many countries

the voice of civil society in CCMs is weak; that the participation of civil

society representative is not always meaningful; and that civil society

leadership is often not well informed about the latest developments.

 

The report identifies areas where capacity building is required, and where there

are structural obstacles to strengthening civil society participation. The

report says that " challenges to communications between civil society

representatives on CCMs and their constituencies were reported in all [19]

countries where case studies were carried out. "

 

The report provides a list of useful CCM governance tools and protocols.

 

The report identifies as a best practice the use of alternates – i.e., " an

arrangement by which a constituency selects an alternate to stand in for the

primary representative at those meetings she or he is unable to attend.

Alternates are also allowed to vote on behalf of the CCM members they replace. "

The report says that the system of alternates was found to be effective in

Cambodia, India and Tanzania and that the " use of alternates underlines the

importance of CCM meeting attendance and delivers the message that members are

there on behalf of their constituencies and not their own personal interests. "

The report adds that India and Cambodia have developed clear guidelines on the

use of alternates.

 

One of the recommendations in this section calls for the establishment (where

feasible) of a CCM website " which should, at a minimum, contain the following

information: CCM membership, terms of reference and other governance tools

including Global Fund governance documents; CCM meeting schedule and agendas;

CCM decisions; information on CCM member organizations and representatives; and

information about grant implementation as well as PR and sub-recipient

activities. "

 

CCM oversight practices for grant implementation

 

Based on case studies conducted in Kenya, Tajikistan, Tanzania, Ethiopia,

Zambia, Bulgaria and Peru, the study concluded that " [o]f all the CCM roles and

responsibilities, oversight is probably the least well understood " ; that CCMs

" are not yet fully comfortable with the oversight role assigned to them " ; and

that there are serious obstacles in communications between the various CCM

stakeholders. "

 

Nevertheless, the report says, there are some good practice models emerging. The

report describes several examples, including the oversight tools and process

developed by the CCM in Ethiopia; and the process put in place by the CCM in

Bulgaria to monitor grant implementation at each quarterly CCM meeting.

 

CCM Secretariat

 

Based on case studies conducted in a number of the countries included in this

study, the Global Fund concluded that in most countries " CCM secretariats are

either non-existent, not fully operational or considerably understaffed. " The

report says that a week CCM secretariat has a " negative impact " on overall CCM

performance. (It should be noted that the CCM case studies were commissioned and

completed prior to the implementation of the new CCM funding policy which is

described in " CCM Funding Policy FAQ " at

www.theglobalfund.org/documents/ccm/CCMFundingPolicyFAQ_en.pdf.)

 

The report cites the example of the CCM in India, where " with just one member of

staff, the CCM secretariat is under-resourced and unable to provide adequate CCM

coordination support. "

 

The report describes the ingredients of a successful CCM secretariat, based on a

best practices example from Cambodia.

 

One of the recommendations in the report calls on donors to assists CCM

secretariats to develop detailed budgets and workplans with clearly defined

outputs.

 

Principal Recipient and sub-recipient selection

 

The report says that there has been a " substantial evolution " in PR and

sub-recipient selection; that the process has become more formalized, more

inclusive and more transparent; but that this is still " a work in progress. " The

report says that CCMs are " beginning to discover for themselves the merits of an

open and transparent approach to PR and sub-recipient selection. "

 

The report describes various methods of PR and SR selection currently in use. It

also provides examples of best practice – including the criteria used by the

CCM in Ethiopia for PR selection, and the process used by the CCM in Kenya for

the selection of SRs.

 

One of the recommendations in this section of the report calls for the

establishment of PR and SR selection processes and tools.

 

Conflict of interest

 

Based on case studies conducted among CCMs in Kenya, Jamaica and Zimbabwe, the

Global Fund concludes that, in general, conflict of interest (COI) issues have

not been adequately addressed; that CCM members are often not aware of the

CCM & apos;s COI policies; and that the policies are not sufficiently practical.

The Fund observed that often COI policies address only the limited circumstance

of the chair or vice-chair of the CCM being from the same entity as the PR. The

report says that COI policies should address the full range of potential COIs

" generated by the increasing numbers of CCM members who are also SRs. "

 

Despite these conclusions, the report cites Jamaica as an example of a CCM that

has a " fully operation COI management plan, " and describes the Jamaica plan in

some detail.

 

CCM-PR-LFA communications

 

Based on case studies conducted in Nigeria, Peru and Zambia, the report

concludes that communications among the LFA, PR and CCM are of poor quality and

that, to a large extent, this is due to a poor understanding of the role of the

LFA. The report says that at the very least the LFA should regularly attend CCM

meetings as an observer and use its attendance to clarify its role.

 

Harmonisation and alignment

 

Based on case studies conducted in Cambodia, Mozambique, Nigeria and Tanzania,

the report describes examples of two different possible CCM approaches to

harmonisation and alignment – one, in Tanzania, where the CCM serves as a

national coordinating mechanism overseeing grants for AIDS, tuberculosis and

malaria from a variety of funders; and another, in Mozambique, where the role of

the CCM is for the most part limited to preparing proposals and requests for

continued funding and submitting them to the Global Fund.

 

www.aidspan.org/gfo

 

Dr.Ashok Rau

Executive Trustee/CEO

Freedom Foundation-India, Nigeria, and Botswana

(Centers of Excellence- Substance Abuse & HIV/AIDS)

Head Office: 180, Hennur Cross, Bangalore - 560043, India

Senior Research Fellow, TheTerry Sanford Institute of Public Health,Duke

University(USA)

Visiting Faculty, Yale University (USA)

Adjunct Faculty, Drexel University College of Medicine (USA)

Phone (O)

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