The Global Fund Board will decide on the future of the Country Coordinating Mechanism (CCM) Evolution project at the 42nd Board meeting to be held in mid-November. The decision will rely partly on the Global Fund CCM Hub’s findings from the CCM evolution pilot project, conducted in 18 countries for a year. A presentation by the Global Fund CCM Hub (the Secretariat department managing CCM-related work) in a CCM Dialogue Forum held recently previewed some initial findings of this pilot project. The CCM Hub noted that the project has amplified community voices in terms of strategic oversight, and built the capacity of the civil society representatives on CCMs. Beyond strategic engagement, the project has helped transform the CCM into a leaner institution better aligned to grant and national priorities.
The Eastern Africa National Networks of AIDS and Health Service Organizations (EANNASO) – with the support of the CCM Plus project - funded by the GIZ Backup Health - (which is described later in this article) – convened the CCM Dialogue Forum, for the third year in a row, on 30th September and 1st October 2019 in Nairobi, Kenya. The Forum aimed, among other things, to take stock of the achievements, challenges and lessons learned in civil society participation in CCMs. It also aimed to review progress, and advise on measures to strengthen various projects supporting civil society engagement within CCM and Global Fund processes.
Participants were representatives of civil society and communities on CCMs, and representatives of CCM Secretariats, from both Anglophone and Lusophone (Portuguese-speaking) African countries. Participants welcomed the CCM Evolution findings on strategic engagement as they shared their own country experiences. They noted gaps in the representation and engagement of their constituencies in the CCM’s processes, which they attributed to the lack of a transparent process for the selection of representatives to the CCM, lack of coordination among civil society and community groups, lack of adequate resources to support constituency engagement, and limited knowledge of the Global Fund structures, among others.
Projects supporting constituency engagement within the CCM
The Forum highlighted two main projects currently supporting meaningful participation and engagement of civil society and community groups within both CCM and Global Fund processes: the CCM Evolution pilot – which is a Global Fund initiative – and the CCM Plus project, which is an initiative by EANNASO.
CCM Evolution initiative and pilot
The CCM Evolution initiative focuses on four main areas, one of which is strategic engagement. Under the intervention, the project seeks to promote proactive representation and enhanced quality of engagement of CCM civil-society constituencies in key CCM processes. The other three focus areas are (2) the CCMs’ internal functioning, (3) oversight of the grants, and (4) linkages with other national governance bodies. The pilot, which started in September 2018 and will run through the end of 2019, targeted different types of CCMs – those under transition preparedness, those from challenging operating environments (COEs), or ‘standard’ CCMs (those that that do not fall into the two other categories) – from 18 countries. Five of the pilot countries were represented at the meeting – Lesotho, Malawi, Mozambique, Tanzania and Uganda.
In a March 2019 update to the Strategy Committee, the CCM Hub reported most progress in the interventions oversight – one of the four focus areas - that includes hiring of oversight officers, creating tools to track co-financing commitments, and strengthening CCM Oversight Committees to engage with other national health governance structures. Progress was less apparent for the other three focus areas.
A mid-term GFO analysis of the CCM Evolution project in four African countries – Burundi, Niger, Tanzania and Uganda – had found mixed results. Tanzania and Niger showed some early signs of success: for instance, the Tanzania Coordinating Mechanism (TCM) noted that they had started focusing on fundamental and strategic issues like grant performance, risk management and co-financing, unlike in the past where they would only focus on the PR’s implementation challenges. On the other hand, Burundi and Uganda had experienced significant delays initiating project activities.
During the EANNASO meeting, the CCM Hub noted that, moving forward, civil society and community representatives need to improve on the quality of their engagement within the Global Fund and national processes; and leverage the strengths of the different civil society groups/platforms and other actors including the private sector. CCMs also need to increase the use of community-generated and validated data to inform processes and decisions, added the CCM Hub.
Participants noted that the CCM evolution initiative needs to consider the country context. They commended the CCM Evolution project for providing countries with an opportunity to assess their own weaknesses and gaps and come up with solutions. However, the participants noted that most of the improvements realized in the CCM Evolution pilot were due to the additional funding made available through the project and emphasized the need for the Global Fund to increase funding allocations to CCMs, particularly for constituency engagement. The participants also recommended that the project address engagement between the Country Team and the CCM, particularly its civil society and community representatives. They noted that Country Teams often sideline the CCM until there are issues with grant implementation. The participants further recommended that the Country Teams should meet with civil society and communities when on country missions.
CCM Plus project
The CCM Plus project seeks to strengthen the participation and engagement of civil society and community groups in CCM processes and overall Global Fund process in five countries: Malawi, Nigeria, Tanzania, Uganda and Zambia – three of which are part of the CCM Evolution pilot.
At the start of the project, in August 2019, EANNASO conducted baseline assessments for the five countries and found weak involvement of civil society and community groups in the CCM oversight process, mainly due to a lack of community-level data. Civil society and community groups also did not prepare adequately for the Global Fund funding-request development process and as a result could not engage meaningfully in it. In most of the countries, civil society and community groups lacked proper coordination mechanisms.
For this project, the five countries are implementing different activities based on their country context. One key component of the project is the development of community-based monitoring systems in order to collect community-level data, for instance on service delivery, to inform the oversight process. For instance, the Zambian Youth Platform has created a youth-friendly Social Accountability Framework to monitor successes and challenges related to Global Fund-supported services and to use the findings to influence the national strategies around health, rights and the needs of adolescents and young people. The civil society organizations implementing the project in Tanzania and Uganda have also mapped out CBM systems and are identifying ways of how these can be integrated into the CCM oversight processes.
According to EANNASO, the project has supported civil society to organize and coordinate themselves prior to and post CCM meetings, to develop coordination mechanisms among civil society and community groups, to develop constituency communication plans, and orient further constituency representatives on Global Fund and other relevant in-country processes.
Civil society and community groups share their experiences
In this section of the article, we mention the key issues highlighted by participants during the CCM Dialogue Forum, in relation to participation and engagement in the CCM and Global Fund processes. We also include insights from previous analysis.
Poor representation and engagement in CCM and Global Fund processes
Civil society and community groups are still not engaging and participating meaningfully in CCM and Global Fund processes due to poor representation and limited constituency engagement. Often, the civil society and community representatives have limited understanding of the Global Fund’s processes and of their roles within the CCM, as they receive little or no orientation upon joining the CCMs. These representatives often do not leverage the diverse strengths of the different civil society and community groups. In addition, limited funding, as well as in-fighting and lack of coordination among civil society and community groups, all limit meaningful engagement. (Communities include people living with or affected by the three diseases, and key and vulnerable populations.)
Often, the civil society and community representatives have limited understanding of the Global Fund’s processes and of their roles within the CCM, as they receive little or no orientation upon joining the CCMs.
Participants recommended open and transparent selection of the civil society and community representatives to CCMs, and performance monitoring of these representatives by their constituencies. EANNASO noted that through the CCM Plus project, some of the countries are already developing Terms of Reference (ToRs) for civil society and community representatives, and communications plans to guide constituency engagement. Participants also recommended that new representatives undergo comprehensive orientation and induction programs as well as mentorship from the previous representatives. The constituencies need to hold their representatives accountable by requiring feedback and progress updates, despite limited funding to support constituency engagement. For instance, one representative explained that the CCM pays for only two constituency engagements per year whereas there are four CCM meetings per year.
According to the participants, constituency engagement is best done before (for the representatives to capture key issues from the constituencies) and after (for the representatives to provide feedback to their constituencies) each quarterly CCM meetings. Currently, the Global Fund requires that at least 15% of the CCM’s annual budget supports constituency engagement for non-governmental sector activities, including civil society and key population groups. Participants emphasized the need for innovation in mobilizing more resources for constituency engagement or identifying cheaper alternatives for the CCM representatives to engage with their constituencies, such as through social media.
Independent and well-equipped CCM Secretariats are critical
Participants noted that ‘CCMs are only as good as their Secretariat’. CCMs require Secretariats with adequate staff and the right skill set. Currently, CCM Secretariats usually have one or two members of staff. The Evolution project funded the hiring of oversight officers who provide technical support to the CCM and enhanced the use of dashboards – an Excel-based oversight tool used to monitor grants. The CCM Secretariat also needs adequate funding to support its administrative functions and constituency engagement. The participants suggested that CCMs seek additional support from the government or other development partners such as PEPFAR and GIZ to complement limited funding from the Global Fund.
Leaner composition at the expense of broad representation
CCMs have broad representation including government, private sector, civil society, persons living with or affected by the three diseases, and technical partners. Other representatives include media and academia. In recent years, most CCMs have become leaner. The participants expressed concerns that key populations are likely to be the biggest losers in this regard, with reduced representation within the CCMs. CCMs therefore need to balance the trade-off between efficiency and adequate representation of key and vulnerable populations.
Need for civil society and communities to position themselves strategically
In most countries represented in the meeting, civil society and community representatives make up the majority of the CCM’s membership. In fact, in some countries such as Zambia and Ghana, the CCM chairs are from civil society. They, therefore, have the potential to influence and drive decisions within the CCM. However, the participants noted that CCMs are often not proactive, particularly in tracking co-financing commitments by the governments and identifying the need for reprogramming and acceleration plans, and monitoring the reprogramming process. The participants also noted that civil society and community groups often do not participate in all stages of the grant cycle including the country dialogue, funding development process, grant making and grant oversight, and therefore lose out on the opportunity to influence discussions and decisions at these stages.
The participants also emphasized the need for civil society and communities to invest in community-based monitoring systems to collect data on programming and service delivery at the community level, to feed back to the CCM, and to use this information to hold implementers accountable.
- From GFO Issue 354, 17 April 2019, “Global Fund Country Coordinating Mechanism evolution initiative: Mid-term lessons from Tanzania, Niger, Uganda and Burundi”
- From GFO Issue 352, 20 March 2019, “Global Fund country coordinating mechanisms are good; they could be better”
- The Global Fund’s Country Coordinating Mechanism website page.