When preparing their proposals for Round 10, applicants will need to work closely with community

organisations and actors to identify which community system strengthening interventions need to be funded. This is one of the key messages contained in “Community Systems Strengthening Framework,” an 81-page document released by the Global Fund when it released its Round 10 documents on 20 May 2010.

The CSS Framework was developed by the Global Fund in collaboration with a range of other organisations. Feedback on a draft of the CSS Framework was obtained through meetings, workshops and an online consultation.

The CSS Framework document says that the goal of CSS is “to achieve improved health outcomes by developing the role of key affected populations and communities, and of community based organisations, in the design, delivery, monitoring and evaluation of services and activities related to prevention, treatment, care and support of people affected by HIV, tuberculosis, malaria and other major health challenges.”

According to the Framework, CSS is “an approach that promotes the development of informed, capable and coordinated communities and community based organisations, groups and structures.”

The CSS Framework document says that while community organisations and networks have a “unique ability to interact with affected communities,” in order to have real impact on health outcomes “they must have effective and sustainable systems in place to support their activities and services.” The focus of the Framework, therefore, is on strengthening community systems for scaled-up, quality, sustainable community based responses. This includes strengthening community groups, organisations and networks, and supporting collaboration with other actors and systems, especially health, social care and protection systems.

The CSS Framework document provides definitions of key terms, including “community systems” and “key affected populations.” The report acknowledges that it is difficult to come up with a single or fixed definition of the term “community,” but says that “broadly, communities are formed by people who are connected to each other in distinct and varied ways…. Community members may be connected by living in the same area or by shared experiences, health and other challenges, living situations, culture, religion, identity or values.”

The CSS Framework is organised around six core components of CSS:

1. Enabling environments and advocacy – including community engagement and advocacy for improving policy, legal and governance environments.
2. Community networks, linkages, partnerships and coordination.
3. Resources and capacity building – including human resources with appropriate personal, technical and organisational capacities, financing (including operational and core funding) and material resources (infrastructure, information and essential medical and other commodities and technologies).
4. Community activities and service delivery.
5. Organisational and leadership strengthening – including management, accountability and leadership for both organisations and community systems.
6. Monitoring and evaluation, and planning – including M&E systems, situational assessments, evidence-building and research, learning, planning and knowledge management.

For each core component, one or more service delivery areas (SDAs) are recommended (similar, but not identical, to the SDAs that the Global Fund has traditionally used). For each SDA, a rationale for doing programming in that area is provided; examples of activities are listed; and one or more CSS-specific indicators are recommended and described in detail. There are 27 such indicators, developed as part of the consultation process for the development of the CSS Framework.

The CSS Framework document also includes a chapter describing a 12-step approach to developing a system for CSS interventions.

CSS and the Global Fund

In a chapter devoted to CSS in the context of the Global Fund, the Framework document points out that the Global Fund encourages applicants to routinely include CSS interventions in proposals, based on analysis of existing resources and the gaps and weaknesses that need to be addressed. The CSS Framework document encourages applicants to consider CSS as an integral part of assessments of disease programmes and health systems, and to ensure that they identify those areas where the full involvement of the community is needed to improve the scope and quality of service delivery, particularly for those hardest to reach.

Applicants may include CSS-related interventions in their disease-specific proposal or under the HSS cross-cutting section of the proposal form. The CSS Framework document says that HIV, TB or malaria proposals should not only include CSS interventions specific to the disease being applied for, but also general CSS interventions, wherever possible.

The Framework document says that because CSS particularly targets affected communities, CSS interventions should be harmonized across the three disease components whenever possible, and overlap should be avoided. This means that HIV, TB and malaria programmes need to coordinate their efforts.

The CSS Framework document recommends that applicants take the following steps before and during the proposal development process:

• Create an enabling environment for the participation of all stakeholders in the development of the proposal.
• Read the Global Fund proposal form and guidelines thoroughly and consider how, in every part of the proposal, communities can be strengthened.
• Gather together all relevant experts, stakeholders and sectors and determine a system by which each can engage in proposal development (either through a proposal development committee, technical working groups or through organised consultations).

The “Community Systems Strengthening Framework,” May 2010, is available at www.theglobalfund.org/documents/civilsociety/CSS_Framework.pdf.