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GFO Issue 99



Bernard Rivers

Article Type:

Article Number: 6

ABSTRACT A summary is provided of three areas of “CCM Advocacy Report: Making Global Fund Country Coordinating Mechanisms Work Through Full Engagement of Civil Society,” a report recently published by the International Treatment Preparedness Coalition (ITPC)

Note: In GFO Issue 96, we reported on an October 2008 publication by the International Treatment Preparedness Coalition (ITPC) that is based on case studies of CCMs that ITPC conducted in seven countries. The report, entitled “CCM Advocacy Report: Making Global Fund Country Coordinating Mechanisms Work Through Full Engagement of Civil Society,” can be accessed at The main finding is that civil society has made important contributions on CCMs, but its engagement is seriously limited by several factors that require immediate attention at the national level and by the Global Fund. In the following article, we summarize three areas of the report.

Topic 1: Problems with Community Sector Representation on CCMs

There are significant problems with the selection process for community sector representatives on CCMs and with the quality and extent of that representation. Usually, these problems are identified more frequently by representatives of community sector organisations not directly represented on CCM than by existing CCM representatives. Examples are as follows:


With respect to the Argentina case study, the report says that

  • Many new groups of young people, adolescents, women and sexual minorities are not represented on the CCM.
  • People in the community “see a need for more democratic mechanisms, such as periodic elections, the rotation of responsibilities, greater accountability, and diversification of and consultation with the wide variety of represented population groups.”
  • The initial selection of community sector representatives was made in 2002 (before the Global Fund required that the selection process be run by the sector itself and be open and transparent) and subsequent changes have only occurred when members have resigned.

Interviewers conducting the case study asked about what mechanisms would improve representation of the community sector. For the most part, the answers depended on whether the interviewees participate in the CCM. The report says that “[t]hose that participate in the CCM report that representation is democratic and say it is unnecessary to make it more inclusive. Those who do not participate in the CCM say that because of the scarce number of organizations that currently make up the NGO Forum [which is represented on the CCM], and the way representatives are elected and have not rotated since 2002, representation is rendered illegitimate.”

The ITPC report says that the community sector in Argentina tends to understand representation “mainly in terms of defending their sector’s territorial interests and not in terms of building a national project toward which all stakeholders contribute their perspectives and support.”


Of the 20 respondents interviewed for the case study, about half said that the selection process for community sector members was unfair. They cited the lack of representation of most at-risk populations, and a lack of concern with the diversity of representation of civil society organisations (e.g., networks versus individual implementation agencies).


The ITPC report says that the selection of community representatives in India is “perceived as fair but non-inclusive.” Although there is an electronic voting system, and voting is done over the Internet, a lack of understanding of the role of civil society on the CCM hampers participation. The report says that “this is particularly true for community-based organizations (CBOs), since eligibility to vote depends on very elaborate capacities and qualifications developed by the CCM which can make it difficult for many CBOs to participate.”


Respondents from Jamaica indicated that community sector representatives on the CCM are not elected or selected by the constituencies they represent, but are generally appointed because of their sub-recipient status and selected by the executive of the National AIDS Committee. The report says that “[i]n order to ensure that civil society members on the CCM represent their constituencies more effectively, mechanisms for obtaining feedback from these constituents – the private sector, sex workers, youth, and others – should be improved.”

Respondents unanimously agreed that civil society’s ability to effectively take part in discussions and decision-making on the CCM and the working groups is limited by the quality of its representation on these bodies. Reasons offered for the lack of quality representation from civil society included that representatives do not understand the technical jargon of CCM documents, attend CCM meetings inconsistently, and do not understand their role on the CCM. With respect to the last point, the ITPC report says that representatives often appear to consider CCM meetings “just another HIV meeting” rather than as a mechanism that is accountable to them, and for which they should be accountable to other civil society organizations.

Other civil society sectors

The report said that that “[i]t is striking that, outside of the community sector, the legitimacy of representation of other sectors is not questioned” – when, for example, only one university is represented or only one scientific society is represented, even though there are many others that are involved in the response to the epidemic.

Topic 2: Poor Communication Hampers the Work of Community Sector Representatives on CCMs

The report identified poor communications as a barrier not only to the functioning of CCMs, but also to the effectiveness of the community representatives on the CCMs.

With respect to communications from CCMs to its members, respondents in Argentina indicated that “there is a lack of communication strategies and few established mechanisms for communicating.”

Respondents in Cambodia said that civil society representatives have uneven access to information, which makes proper participation in the Global Fund process difficult. They also said that some representatives “struggle with language barriers and are unable to digest the massive amounts information they receive from the central level.”

The ITPC report said that in India, civil society representatives do not receive information about CCM activities far enough in advance of CCM meetings to allow them to participate effectively.

The report also said that there are several civil society organizations in India doing good work, “but they do not have adequate information about the CCM, the benefits of participation in the CCM, or even its existence in India.

According to the ITPC report, civil society representatives in Uganda do not have access to the information needed to make meaningful and influential contributions to debates.

In both India and Uganda, the issue of Internet access was raised. The report points out that information tends to be disseminated via email in these countries, but that many people have no or inconsistent email access.

With respect to communications between community sector representatives and their constituents, the report says that, in some cases, there is little communication to the constituencies (e.g., Cameroon), and in other cases information is circulated to the community sector, but largely within a member’s own network or unevenly among other networks and organizations (e.g., Argentina).

In Cambodia, language is a major barrier. The ITPC report says that most organizations working at the grassroots level have difficulty digesting the information they receive because it is mostly in English.

The report says that in India, almost all respondents agreed that there are no systems or procedures for civil society representatives to use for reporting back to their constituencies. The report also says that the discussions, meetings and consultations about Global Fund proposals are mostly restricted to Delhi; and that, consequently, organisations based in other cities are at a disadvantage.

The report notes that “[d]evelopment of back-and-forth communication linkages with their constituencies might help civil society representatives to overcome non-engagement in CCM meetings because they would be able to obtain information from their constituencies, and the resulting discussions and decisions could be reported back to them.”

Topic 3: Participation of Community Representatives on CCMs is Uneven at Best

In the seven case studies that formed the basis of the report, ITPC found some examples of strong community participation on CCMs. However, it found more instances where effective participation was lacking.

How the participation of community representatives was categorised often depended on to whom one talked. Representatives of governments and development agencies tended to have a rosier view than did the community representatives themselves.

The ITPC report says that on the Argentina CCM, the community sector “enjoys true participation and a significant impact” on decision-making. The report says that this is due to the relatively large number of members from the community sector and their consistent attendance at meetings. The report contrasts the active participation of community representatives with the “the passive role of other members of the CCM.”

In India, the report says that “[w]hile government and some multilateral respondents said they believe that civil society members are treated as equal partners in the CCM, most others view civil society representatives as unequal. This perception is attributed to their unwillingness or inability to question powerful government representatives who maintain control over decision-making and resources.”

The report adds that even when civil society representatives have raised issues, “they are generally perceived as ineffective in influencing decision-making processes at the CCM.”

The ITPC report says that most respondents interviewed in Cambodia agree that although the Global Fund’s basic principles assure all members an equal vote with equal opportunity for expression, it is a government-led process. The report says that “[i]n Cambodian culture – especially in formal meetings – power relationships and the culture of hierarchy limit discussions and decision-making. The large number of government representatives may inhibit CSO representatives from voicing their issues – particularly controversial ones.”

With respect to Cameroon, the ITPC report says that in general the performance and effectiveness of community representatives “are limited by lack of technical capacity, lack of coordination, and a lack of respect by representatives from government and international NGOs.” The report says that, according to some CCM members interviewed, “many civil society participants are weak representatives because they do not strongly advocate for civil society at CCM meetings. The opinions of the government and developmental partners predominate over those of civil society representatives, who are not considered by academics and government representatives as qualified to serve as equals.”

Most of the people interviewed for the Jamaican case study said that civil society representation on the CCM is “for the most part tokenistic and ceremonial, and that civil society members are not seen as equal partners by other CCM members.” The report explains that this may be partly because “the PR is viewed as possessing superior knowledge, skills, and understanding and therefore is deferred to when its suggestions are discussed and voted on.” The report adds that the agenda of CCM meetings is normally driven by the PR and not by the full CCM membership.

The ITPC reports notes that in Jamaica, for the most part, some government representatives and the PR “saw things entirely different from all other interviewees.” The former viewed civil society as well-represented and included, while the others described the sector’s inclusion as limited and ceremonial.

In its report, the ITPC says that in Uganda, while civil society participates in proposal development, and while “vocal civil society representatives on the CCM have successfully questioned and influenced some key decisions,” the involvement of civil society in the CCM is generally weak. The report says that “[b]ecause they come from a young and relatively immature civil society in general, Uganda’s civil society representatives are treated as – and naturally feel – inferior when they sit in CCM meetings with donor representatives and high-ranking government officials.”

The ITPC report says that a major impediment to civil society participation is that the CCM in Uganda has been mainstreamed into the government’s existing structures. It goes even further, stating that “[t]he CCM in Uganda is not just dominated by government officials; it is largely government-controlled and government-directed.”

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