In theory, country coordinating mechanisms (CCMs) are a great idea. CCMs provide a forum for relevant stakeholders in a country to discuss the gaps in the national response to AIDS, TB and malaria, develop proposals for the Global Fund to address these gaps, nominate  principal recipients (PRs) to implement the programmes should the proposals be approved, and oversee implementation.

In practice, of course, there have been numerous problems with the ways CCMs are structured and how they operate. Perhaps there is another way to do what CCMs do that does not involve CCMs. But I don’t know what that other way would be, and I suspect that it would present as many challenges as the system we have now. So, let’s concentrate our efforts on trying to make CCMs work better.

The relationship among the Global Fund Secretariat, the PR and the CCM is a difficult one to manage. The CCM submits a proposal to the Secretariat. If the proposal is successful, the Secretariat signs a contract with the PR to implement the grant. The PR is accountable to the Secretariat for implementing the grant properly, which means that the Secretariat is required to monitor implementation. Yet, the CCM is also expected to monitor implementation. In a sense, the PR has two bosses. This arrangement was bound to cause problems, and it has.

I call the relationship among the Secretariat, the CCM and the PR the “tricky triangle.” Up to now, the Global Fund has not done a very good job of managing this tricky triangle.

The first thing the Global Fund needs to do is to acknowledge the fact that the relationship among the Global Fund Secretariat, the PR and the CCM is an unusual one, and one that needs to be managed. When the Global Fund speaks about these things in public or in its publications, it glosses over the problems. If one doesn’t acknowledge a problem, then one has little chance of successfully managing the problem.

The second thing that the Global Fund needs to do is take steps to mitigate the problems.

In terms of understanding how the relationship is supposed to work, most people seem okay with the CCM’s role at the front end (proposal development and PR nomination), but they have problems understanding the back end (CCM oversight of grant implementation). (Not that there aren’t problems with the front end; but that’s a topic for another day.)

The Global Fund Secretariat needs to reach out to PRs to explain why it is important that the CCM play an oversight role; and why it is important that the PR keep the CCM fully up-to-date on progress in implementation, including bringing to the CCM’s attention any problems the PR is encountering. The PR needs to see the CCM as a resource that can help the PR, not as an interfering busybody. This requires educating the PR, not just once but repeatedly over the life of a grant. It also requires that the Global Fund periodically evaluate the state of the relationship between the PR and the CCM.

Similarly, the CCM needs to understand exactly what its role is in grant oversight, and needs to work to develop a good relationship with the PR. The Global Fund Secretariat needs to educate the CCM about these things.

Another problem is the fact that often CCMs are ill equipped to perform their oversight role. Granted, progress has been made on this front as a result of training provided by organisations like Grant Management Solutions, but we don’t know how effective this has been, especially given that there is a lot of turnover on CCMs.

The CCM is a committee made up of volunteers, all of whom have day jobs. The Global Fund has to be very careful about setting expectations for the CCM that it is simply not able to meet.

One potential solution to this problem is to invest significantly more resources in CCM secretariats so that they can perform much of the oversight work required. Perhaps the Global Fund should consider funding a specialist M&E position on each CCM secretariat?

I don’t pretend to have all the answers. In conjunction with its partner organisations, including civil society, the Global Fund should rigorously evaluate how CCMs are functioning, analyse what the problems are, and then devise some solutions.

CCMs don’t report to the Global Fund Secretariat. But the CCMs exist only because the Fund requires it. CCMs are a critical component of the Global Fund architecture at country level. The Fund has to be prepared to invest the necessary resources to make CCMs work.