Country Coordinating Mechanisms (CCMs) that took part in the CCM Evolution pilot have demonstrated an enhanced capacity to oversee grants and engage with other national structures and coordination platforms, according to a Secretariat report to the Board, at the Global Fund Board meeting held on 14-15 November. However, the report noted that these CCMs are still falling short in ensuring meaningful engagement of civil society constituencies in key CCM processes, and in improving the CCMs' internal functioning.
The pilot had aimed to strengthen CCM performance in four functional areas: internal functioning, oversight of the grants, engagement between the CCM and its constituency members, and linkages with other national governance bodies in 18 countries. The Secretariat reported improvement in three of these four functional areas – excluding CCM internal functioning.
The report presented the Board with reflections on findings from the CCM Evolution pilot, which started in May 2018 and will run through December 2019, and insights on core principles of an evolved model for CCMs.
This article highlights the key points of this report.
Oversight and linkages top gainers in the CCM Evolution pilot
The Secretariat piloted the CCM Evolution initiative in 18 CCMs representing different types of CCMs at different maturity levels. The CCMs included those from countries preparing to transition from Global Fund financing and from challenging environments. The pilot included a baseline assessment conducted at the beginning of the pilot (between September and December 2018), ten months of implementation and an end-line assessment conducted between August and September 2019.
The Secretariat, at the baseline phase, ranked the pilot CCMs’ performance in each functional area in one of four maturity levels: ‘working towards functional’ (the lowest rating), ‘functional’, ‘engaged’ or ‘strategic’, based on findings from the assessment. The pilot then focused on increasing this maturity level which was measured again towards the end of the pilot.
In what the Secretariat calls the “end-line” assessment, of the three functional areas in which CCMs had grown in maturity, the oversight focus area demonstrated the most progress while CCMs’ internal functioning was the area of least progress.
The Secretariat noted the outcomes for the individual focus areas as follows:
Eighty-eight per cent of the CCMs are now operating at the top two levels of maturity - engaged or strategic – compared to 31% at the baseline, according to the Secretariat. These CCMs now have data-based discussions, use dashboards, and receive support by CCM Secretariat Oversight Officers.
The Secretariat noted that 94% of the pilot CCMs now engage in outreach to other national structures, as compared to an initial 19%. In fact, 56% are now operating at higher levels of maturity. Even though coordination and information sharing among the key bodies have improved, the Secretariat noted that the pilot CCMs are still missing out on opportunities to merge or strategically position themselves into national structures that meet core requirements such as engagement of civil society and communities.
A majority of the CCMs are still operating at lower levels of maturity in this area; only 44% are operating at higher levels of maturity although this is more than double the number of CCMs operating at higher levels of maturity initially (13%). The Secretariat noted that it will prioritize opportunities to enhance meaningful engagement in future phases of CCM Evolution.
Of the four focus areas, CCM functioning made the least progress; none of the CCMs moved into the top two levels of maturity, even though now no CCMs are at the lowest level unlike at the beginning of the pilot. The Secretariat noted that the CCM Secretariats remain the key mechanism to ensure a proper functioning CCM in a sustainable way.
CCM Evolution pilot faced challenges in the design and implementation phases
The Secretariat noted four key challenges in the implementation of the pilot.
First, the assessment tools – for the baseline and end-line assessments - were rooted heavily in compliance components and binary metrics, for instance checking to see if the CCM has specific documents or not. The consultants tried to mitigate this by incorporating qualitative details that provided context to the binary metrics. The Secretariat noted that they are currently refining the assessment tools to ensure that they address key questions and reflect the nuance and context present across – and often within – countries.
Second, the Secretariat said, the pilot relied heavily on the use of consultants for much of the in-country work, which led to a level of risk in quality and to subjectivity, and did not institutionalize some of the learnings. The Secretariat noted that engagement of the Country Team and CCM Hub officers helped mitigate this risk and highlighted the need for their increased engagement in the future.
Third, the Secretariat reported that the pilot overwhelmed the CCMs with interventions from multiple providers, with frequent visits from multiple partners and consultants, following up on interventions to inform subsequent implementation. The Secretariat noted that future phases will prioritise interventions identified at the baseline phase based on greatest interest and need.
Lastly, tight timelines limited the pilot’s realizing more fully developed results. The end line assessment captured approximately 10 months of implementation. As a result, the Secretariat could not assess the relationship between grant performance and CCM maturity; it has planned such an assessment in future phases of the CCM Evolution initiative.
CCM Evolution interventions should be simple, specific and flexible
The Secretariat drew some lessons implementing the pilot interventions and activities as follows:
- The need to adopt a simplified CCM Evolution approach devoid of too many assessment metrics, too many consultants, and overlapping visits from multiple stakeholders to the CCMs;
- Effective CCM Secretariats could be a sustainable way of creating systemic improvements in CCM maturity, as compared to flying in and out technical assistance;
- The need to equip CCMs with the right interventions and incentives; CCMs are likely to change if the specific tools to be adopted and the strategic intent are clear; and
- CCMs do not mature at the same rate, hence the need for flexibility in the approach through differentiation of CCMs.
Strengths of an evolved CCM
The CCM Evolution initiative aims to improve the performance of the CCM. Based on the pilot, the Secretariat described in the report an evolved CCM as one that:
- Conducts active oversight of investments through regular, data-based reviews of grant performance in the context of the national program and in coordination with partners, and identifies opportunities to enhance performance across the diseases and RSSH to ensure the impact of the investments;
- Engages key stakeholders in government and across sectors, diseases, and populations, including civil society and key and affected populations;
- Pursues specific and tangible opportunities to merge into national structures as well as existing and emerging coordination platforms for ongoing multi-sectoral participation in health; and
- Sustains coordination and governance operations while managing conflicts of interest, and providing strategic guidance and preparation of CCM leadership to create shared accountability for investments to end the three diseases.
Secretariat invites the Board to make inputs into CCM Evolution
The Secretariat, through a list of discussion questions, invited the Board to share their overall reflections on the CCM Evolution findings and the outcomes relating to CCM maturity. They also sought, from the Board, recommendations on how to strategically position the CCM within national structures or merge with existing or emerging coordination platforms without compromising on active participation of key and affected populations. The Secretariat also asked the Board for suggestions on key actions that partners can support to ensure meaningful participation in CCMs across populations, sectors and disease programs, and key areas in CCM Evolution that will be the most critical to consider.
During the Board session, several CCM representatives presented the main outcomes of the CCM evolution in their country. Uganda, Cambodia and Costa Rica explained the leverage created by the CCM evolution to better position the CCM at a high decision level, how transitioning counties such as Costa Rica have taken the opportunity of the CCM evolution to promote a better link with the national system, as well as Cambodia, and Uganda presented the work that has been done to partner with the private sector. In all these cases, the CCM evolution has been key to inspire major leadership of the CCM.
The Secretariat will incorporate the feedback from the Committees and the Board, and the lessons from the pilot, to design interventions for the next phase of the CCM Evolution project. The Secretariat plans to differentiate interventions across 115 CCMs globally in the next allocation cycle (2020-2022), starting with 90 countries in 2020, subject to the amount of funding available for catalytic investments.
Board Document GF/B42/10, Evolving CCMs to deliver on the Global Fund Strategy), should be available shortly at http://www.theglobalfund.org/en/board/meetings/42