The Country Coordinating Mechanism (CCM) evolution initiative aims to strengthen CCMs’ performance in four areas: their internal functioning, oversight of the grants, engagement between the CCM and its constituency members, and linkages with other national governance bodies. The Global Fund Secretariat announced in September 2018 that it had invited 18 countries to be part of the pilot phase of this initiative for a year. (See our report on the Board approval of the initiative in GFO 336, 12 May 2018.)

The CCM evolution pilot phase is slated to run from “September 2018 through the end of 2019,” according to the Global Fund website. As this pilot phase reaches its mid-point, we take stock of its early implementation challenges, successes, and lessons learned. The Global Fund will decide on the future of this CCM evolution initiative at the end of the year.

Information for this article comes from countries’ presentations at the African Constituency Meetings in March 2019 and subsequent interviews with the executive secretaries of the CCMs in Tanzania, Uganda, and Burundi, the CCM chair in Niger, as well as Global Fund CCM Hub staff.

CCM evolution in four African countries

Information from four African countries suggests mixed results: two countries (Tanzania and Niger) show early signs of success, while in Uganda and Burundi, “it is a bit too early to measure [anything],” according to their respective CCM representatives.

The Global Fund divided the 18 participating CCMs into three contextual groupings: standard, transition preparedness, and challenging contexts. The Global Fund also ranked countries according to three maturity levels. The first level is “functional,” which indicates that the CCM applies basic governance principles; the intermediate level is “engaged,” and the third level is “strategic,” which means the CCM engages at the national level and tackles long-term sustainability issues. The evolution project’s aim is to advance countries along these progressive levels of maturity.

Tanzania and Uganda have standard CCMs while Burundi and Niger are classified as challenging contexts. The maturity levels in these four countries ranged at the baseline from “working towards functional” in Burundi and Niger to “functional” in Tanzania and Uganda. In practice, the Secretariat had to add “nuances” to the initial three classifications to account for situations where the country CCM does not meet all the criteria for a specific level.

The CCM evolution process begins with the Secretariat selecting consultants, through a competitive process designed to account for quality and costs, who are assigned to different countries. Those consultants start by conducting baseline evaluations in the four areas specified for strengthening – namely functioning, oversight of the grants, engagement between the CCM and its constituency members, and linkages with other institutions. Then they establish with the CCM a workplan detailing activities needed to improve the CCM’s performance in these areas. The workplan is then costed and submitted to the CCM Hub, which has to approve the activities and any associated budget. The CCM leads the activities specified in the workplan.

In all four countries, the CCM evolution initiative focused on the oversight function of the CCM, funding technical assistance for it as well as the position of an “oversight officer”. This area was very important from the perspective of the CCM Hub, which explained that oversight was highlighted by the Global Fund Strategy Committee before the committee put forward the CCM Evolution Initiative to the Global Fund Board.

Some countries in this first half of the project also addressed improving the internal functioning of the CCM (Niger and Burundi) as well as engaging their constituencies. All have addressed the question on and linking with other national governance bodies. For example, in Burundi, the CCM evolution evaluated links between the CCM and other coordination platforms in health. Such an exercise is especially important when the government is not the principal recipient, as is the case in Burundi (the PR is the United Nation Development Agency for both the HIV/TB and malaria grants).

Early signs of success in Tanzania and Niger

The oversight officer’s role in the CCM is to support a proactive CCM oversight committee. In Tanzania, early signs of success are apparent in the new way the Tanzania Coordinating Mechanism (TCM) oversees the grants. The TCM oversight committee now concentrates its attention on fundamental and strategic issues like grant performance, risk management, and co-financing commitment, using data; in the past, the oversight committee focused only on PRs’ implementation challenges, such as ‘where is the money, equipment, drugs, human resources and other [similar] issues,” according to Dr Rachel Makunde, the TCM executive secretary.

Such a change requires more time from all those involved: the quarterly oversight committee now schedules a full day meeting with the PRs and other stakeholders instead of just two to three hours, as happened in the past.

In Niger, the CCM has improved its internal functioning. The CCM has been restructured, with stronger leadership, and a pool of experts to support the CCM. The membership was reduced from 28 to 21, with reduced representation for both government and civil society organizations. The restructuring aimed to improve performance while maintaining adequate representation. The new CCM representation is more aligned with the epidemiology of the country: it now has a representative of the mining industries and civil society organizations active in the humanitarian sector. The CCM has developed new framework documents that received input from all the stakeholders, including civil society and technical partners.

Initiative’s short duration and funding issues present challenges

The main challenge of this CCM evolution initiative is its short duration: one year.  This tight timeline makes even small delays consequential. All four countries experienced a delay in implementing this project for several reasons: the end-of-year holiday season, the length of time necessary for the Secretariat to approve the CCM evolution activities and associated budget, and the timely availability of the consultants. For instance, it took about six weeks for the CCM hub to approve the workplan and give feedback on the approved budgets for Uganda and Burundi. While this duration is not excessive in normal circumstances, it represents about 10% of the total duration of the project.

The second challenge is the overall level of funding, as well as which activities were funded for the CCM evolution pilot phase. In Uganda, the CCM Hub funded about one third of the costed activities recommended after the baseline evaluations by the consultant; among those unfunded activities were the installation of a dashboard to improve oversight of the grants. The CCM Hub explained that one of the important elements of this CCM evolution pilot is that the PRs provide actionable data to the CCMs, which can be used for oversight. In that context, the CCM Hub estimated that the CCM dashboard was beyond the scope of this initiative.

The approved budget favored international consultants’ remunerations over other local activities. A Secretariat presentation to the Board indicates that most of the CCM evolution activities are geared towards technical assistance, and training of the CCM members. However, the CCM Hub explained to the GFO that the CCM evolution budget globally is balanced with respect to expenses on technical assistance, guidance and other tools needed for CCM activities.

For Tanzania (and other countries not included in this article), CCM evolution activities were fully funded the German development agency (GIZ). In Niger and Burundi, some of the activities were co-funded by the GIZ, and the French Ministry of Cooperation and Development (through the 5% initiative), respectively. The CCM Hub explained that it is looking into more sustainable and local funding options for the initiative’s full roll-out.

In-country keys to success

In Tanzania and Niger, the initiative obtained strong buy-in from high-level authorities. This high-level support is complemented on the ground by the commitment of the CCM’s leadership and permanent secretariat. In addition, in Tanzania, open and trusting relationships between the CCM Secretariat, the Oversight Committee and consultants have facilitated continuous consultations.

Country context also matters. For instance, success in Tanzania lies partly with an early start and a particular desire for change: a couple of months before the country was invited to join this initiative, the then-CCM chair had initiated a series of actions to improve the TCM performance. The TCM went to a retreat to discuss and agree on what was then called “Business Unusual” or a new way of running the CCM business both at the Secretariat and the membership levels. In this case, the CCM evolution initiative supported an existing desire to change. (GFO reported in October 2018 on the TCM aspiration “to become a best-practice model for the Global Fund’s CCM evolution initiative”.)

In Niger, the implementation of the project coincided with the renewal of the CCM membership, which comes with training and capacity building for new members.  Since the implementation of the CCM evolution intiative, Niger has updated its CCM framework document. (The Secretariat provides a framework that can be customized) and has adopted other legal documents such as the framework for engagement of civil society.

Finally, an important key to success is the support of other partners.  We described how the GIZ and the 5% initiative funded – totally or in part – the CCM evolution project in several countries; they also provide other in-kind assistance as members of the CCM.

Suggestions from the field

Most CCM representatives we talked to find that just one year for the project is insufficient, even if this is considered a pilot phase. They suggest adding at least a few months to this pilot phase to be able to obtain results, especially considering the delays in implementation. They also insisted on timely adherence to the workplan by all (CCM, CCM Hub, and consultants) and the timely disbursement of funds.

Another suggestion is that the CCMs’ input be considered for the selection and deployment of international consultants, although the CCM Hub asserts that CCMs are asked whether they have an objection to the selected consultant. The consultants, even though they are recruited by the Secretariat, should also share their reports with the CCMs in good time. Better yet, the CCMs suggested that when possible, a local consultant be added to the international team so the CCM can continue working with the local consultant after the pilot phase ends.

The Secretariat told the GFO that the Global Fund Board will decide in November 2019 if the CCM evolution project will continue and be extended to other countries. In the meantime, the Hub is encouraging all CCMs – not just those participating in the pilot – to continue to look for ways to strengthen their performance. Their intent is to strengthen the strategic engagement of CCMs – not only their compliance – given the critical role CCMs play in ensuring inclusive decision-making about Global Fund grants.

Further reading:

• From GFO 343, 3 October 2018, “Tanzania National Coordinating Mechanism aspires to become best-practice model for Global Fund’s CCM evolution initiative”
• The Global Fund’s Country Coordinating Mechanism website page.