lessons learned from project to strengthen country coordinating mechanisms

7/30/2019 Lessons Learned from Project to Strengthen Country Coordinating Mechanisms

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CSAT: lessons learned from efforts to strengthen CCMs

CCMs: The Global Funds model for promoting transparency, accountability and multi-

stakeholder involvementBy establishing Country Coordinating Mechanisms CCMs as a required entry point for countries

wishing to access funding, the Global Fund to fight AIDS, Tuberculosis and Malaria has sought to put

into practice the principle, long held in the movement to fight AIDS in particular, of greater

involvement of people directly affected in programs that concern them. In the ten years of its

existence, the Global Fund has gradually strengthened the requirements related to the proportion of

civil society representatives on CCMs, the processes by which members are selected, and to the

management of conflicts of interest for CCM members who are also involved in implementation of

Global Fund programs. The Global Fund continues to turn down requests for funding from countries

with CCMs that do not meet the criteria, and is currently developing an enhanced performance

framework, which will aim to ensure that as well as fulfilling basic eligibility requirements, CCMs will

play a stronger role in overseeing programs. Few if any donors providing funding at such a large

scale have comparable policies aimed at promoting transparency, accountability and multi-

stakeholder involvement, with a view to increasing the impact of their programs.

Efforts to make CCMs more effective: what has worked

Country actors from government and civil society, technical partners, and advocacy and technical

support organizations have invested considerable effort in supporting CCMs to meet the eligibility

criteria and to coordinate and oversee Global Fund grants at country level.

ICASO, through the CSAT (Civil Society Action Team) initiative, has itself been involved in CCMstrengthening work since 2007, through three modes: guidance to country-level civil society

organizations on how to organize and advocate as a sector within the HIV response (for instance,

through the Coordinating with Communities guide1); short-term training and technical support in

response to requests for capacity building or crises within CCMs; and structured, ongoing financial

and technical support designed to strengthen community sector advocacy and communications

related to the Global Fund at country level.

Through these efforts, a number of strategies have emerged that have proved useful in improving

community sector engagement in CCMs, such as:

Support to transparent election processes for community sector CCM members, along withclarification of roles and improved rotation and alternate member policies, and

development of CCM charters. Also includes training and orientation for CCM members.

Establishment ofstrong, visible community sector focal points, which are not necessarilymembers of the CCM themselves but who can play the role of ensuring communication and

1Available in multiple languages in the following locations:http://www.icaso.org/files/coordinating-

with-communities-book-a;http://www.icaso.org/files/coordinating-with-communities-book-b;

http://www.icaso.org/files/coordinating-with-communities-action-cards;

http://www.icaso.org/files/coordinating-with-communities-workshop-facilitation-notes
http://www.icaso.org/files/coordinating-with-communities-book-ahttp://www.icaso.org/files/coordinating-with-communities-book-ahttp://www.icaso.org/files/coordinating-with-communities-book-ahttp://www.icaso.org/files/coordinating-with-communities-book-ahttp://www.icaso.org/files/coordinating-with-communities-book-bhttp://www.icaso.org/files/coordinating-with-communities-book-bhttp://www.icaso.org/files/coordinating-with-communities-book-bhttp://www.icaso.org/files/coordinating-with-communities-action-cardshttp://www.icaso.org/files/coordinating-with-communities-action-cardshttp://www.icaso.org/files/coordinating-with-communities-workshop-facilitation-noteshttp://www.icaso.org/files/coordinating-with-communities-workshop-facilitation-noteshttp://www.icaso.org/files/coordinating-with-communities-workshop-facilitation-noteshttp://www.icaso.org/files/coordinating-with-communities-action-cardshttp://www.icaso.org/files/coordinating-with-communities-book-bhttp://www.icaso.org/files/coordinating-with-communities-book-ahttp://www.icaso.org/files/coordinating-with-communities-book-a


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consultation with the broader sector; regular information sharing through newsletters,

websites and blogs.

Availability of advice and support from the Global Fund Secretariat. This support has beenprimarily provided through the now disbanded civil society team, and it is unclear how such

support will be provided under the new Secretariat configuration.

Support to broader civil society convening at national level, for instance in Jamaica the CivilSociety Forum of Jamaica

2which now includes over 100 agencies island-wide working with

people living with HIV and key affected populations, including women, people with

disabilities, and people who inject drugs.

Linking CCM work with broader civil society advocacy, for instance in Cameroon, PositiveGeneration

3has targeted CCM members as one of the audiences for the data generated

from its community level treatment access monitoring work, using access to the CCM to

create awareness of problems in treatment access at local level, both in Global Fund

supported projects and in those supported by other funding sources.

Persistent challenges in community sector engagement in CCMs

Although there have been clear improvements in the composition and functioning of CCMs in many

countries, civil society organizations, and key population organizations in particular, continue to

report that they have little or no impact within CCMs. The recent ITPC-ICASO report, Global Fund

Country Coordinating Mechanisms: a Prescription for Change in a Time of Peril4, describes a number

of common problems still faced by CCMs: limited capacity of civil society organizations to operate

effectively within the CCM environment; poor communication between CCM members and the

constituencies they represent; continued non-transparency in member selection; lack of meaningful

involvement of key populations; and continued domination of CCMs by government representatives.

ICASOs experience of working with CCMs, and with national civil society actors in general, suggests

that the fact that the community sector continues to face these challenges needs to be understood

as part of broader national contexts, for instance:

Legal frameworks and policies in the country, in particular those that marginalize orcriminalize populations affected by AIDS, tuberculosis and malaria, or that limit the role of

civil society.

The range of other forums where decisions and policies on AIDS, tuberculosis and malariaare formed including national strategy and policy planning processes, but also including

informal processes where senior government officials, donors and technical agencies are

influential.

The fact that CCMs are not policy making entities in their own right, but that they are madeup of individuals each of whom has an institutional position or identity, and some of whom

have far more institutional power than others. (Experience has shown, for instance, that

where community sector actors have successfully influenced CCMs, this has often required a

2The Civil Society Forum of Jamaica is a local coalition advocating for the greater inclusion of civil society organisation in

decision making in the Jamaican health sector.http://www.cvccoalition.org/downloads/CSFbooklet.pdf3

Positive Generation is a grass roots network of people living with HIV based in Yaound, Cameroon(http://camerounaids.org/).4http://www.csactionteam.org/?file=175
http://www.cvccoalition.org/downloads/CSFbooklet.pdfhttp://www.cvccoalition.org/downloads/CSFbooklet.pdfhttp://www.cvccoalition.org/downloads/CSFbooklet.pdfhttp://camerounaids.org/http://camerounaids.org/http://camerounaids.org/http://www.csactionteam.org/?file=175http://www.csactionteam.org/?file=175http://www.csactionteam.org/?file=175http://www.csactionteam.org/?file=175http://camerounaids.org/http://www.cvccoalition.org/downloads/CSFbooklet.pdf


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considerable amount of preparatory work with individual CCM members in advance of any

CCM decision).

The artificial nature of civil society and key population group constituencies, and theexpectation or requirement that civil society organizations should have common positions or

agreements on issues related to AIDS, tuberculosis or malaria while the reality is that

organizations from civil society often have divergent and even antagonistic viewpoints.

The generally marginalized status of the community sector and the lack of recognition ofthe roles it can play in implementing and monitoring programs.

In other words, although in many countries CCMs provide an entry point for community sector

organizations to engage with policy and decision makers, the ability of the sector to have an

influence is to some extent determined by the structures that exist outside of the CCM.

In addition, the tendency of CCMs to focus on relatively abstract concepts such as grant

performance indicators, spending rates, and CCM and PR adherence to Global Fund conditions,

often leaves little space for representatives of affected communities to assess and raise practical

problems faced in the delivery of programs despite the fact that these are the issues that

community sector representatives are uniquely qualified to comment on. Community sector

organizations often avoid speaking out about problems as they feel it may jeopardize their

relationships with PRs and other CCM members. To make matters worse, when community sector

representatives do not provide input, they are seen as nave or lacking relevance and this gives a

negative perception of their role.

Toward a more comprehensive approach to CCM support

The conclusion that ICASO draws from its experience, and from its understanding of the experiences

of other organizations involved in CCM support work, is that the standard model of CCM

strengthening should be accompanied by efforts to strengthen civil society convening and advocacy

more broadly. It is also essential that CCMs provide a space for discussion of the issues that are

most relevant to community sector actors. ICASO offers a number of recommendations that should

be considered by community sector actors and their supporters in taking forward this important

work:

Continue to provide core support to community sector engagement in CCMs: support toelections, training on roles, and communications in particular. The provision of financial

support to a national level community sector organization not necessarily a CCM member

to act as communications facility for the sector is also a sound investment.

Enable convening of the community sector beyond the specific context of the Global Fund,so that plans for advocacy and engagement with the CCM can be developed based on the

broader agendas of the sector. At the same time, the community sector should not be

required to adopt consensus positions on every issue the diversity of views within the

sector should be acknowledged and accepted.

Enable the sector to effectively assess progress of their advocacy engagement work, tounderstand what can and cannot be achieved through CCM-focused work, and to develop

plans to advocate beyond the CCM where necessary.


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Support good quality community level monitoring of AIDS, tuberculosis and malariaprograms, including of aspects related to stigma, human rights and gender equity, so as to

provide reliable, credible data to inform advocacy within CCMs and other relevant forums.

Enable CCM members in particular those from the community sector to define what theCCM should monitor and how, rather than focusing only on top-level grant data and periodic

site visits (such visits cannot be expected to provide a reliable picture of overall program

performance).

Ensure national networks are linked to regional and global networks, to ensure the flow ofinformation and the provision of additional technical support and mentoring where

necessary.

Ensure linkages between CCM and other national level activism and advocacy, for instanceby using the CCM as a forum for channeling and discussing information about broader

national program barriers and failures.

lessons learned from project to strengthen country coordinating mechanisms

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