Let’s Be Creative About Solving the Problems of CCMs

Author:

David Garmaise

Article Type:

Article Number: 2

ABSTRACT Despite the best of intentions, writes David Garmaise, the piecemeal approach to reforming CCMs isn't working. It is time to try something that is more holistic and that is country-based.

Since the piecemeal approach isn’t working, we should try something that is more holistic and that is country-based

by David Garmaise

Since the piecemeal approach isn’t working, we should try something that is more holistic and that is country-based

by David Garmaise

Why is it that relatively few CCMs are using the money the Global Fund makes available for the operations of CCMs? The Global Fund budgets $8 million a year for this; yet, in 2010, only $1.5 million was spent.

During the consultations on the CCM Guidelines, Dr Brian Brink, who works for a company called Anglo American, and who is the private sector board member on the Global Fund Board, compared CCMs to the board of directors of a company. He said that both rely on a strong management arm to run the day-to-day affairs of the organisation, and to present options to the board when major policy decisions are required. The management arm of the CCM is the CCM Secretariat. Yet, most CCM Secretariats are poorly staffed. Why is this? One would think that if CCMs were really taking their responsibilities seriously, they would have established very strong secretariats.

Just about everyone associated with the Global Fund agrees that there are problems with the way many country coordinating mechanisms (CCMs) operate. These problems have been documented in reports, have been raised countless times during question and answer periods at regional and international meetings, and have spread by word of mouth.

The problems range from inadequate involvement of non-government sectors in selecting their representatives on the CCM, to CCM meetings being government-dominated, to CCMs being asked to rubber stamp proposals prepared by ministries of health, to CCMs not performing their oversight role, and to CCMs failing to deal with serious conflicts of interest.

The piecemeal approach to solving the problems of CCMs, which is what we have seen up to now, is not going to work. What we need is a holistic approach that is, in the main, country-based.

The piecemeal approach – Part one

The Global Fund Secretariat tried to deal with the problems of CCMs by coordinating a process to revamp the CCM Guidelines. To its credit, the Secretariat consulted widely with all stakeholder groups, listened to what people said at the consultation meetings, and produced draft new guidelines that would have helped to address some of the problems. Unfortunately, the draft guidelines were considerably watered down by the Global Fund Board and its Portfolio Implementation Committee (PIC). (See GFO commentary.)

The new CCM Guidelines contain a number of standards and recommendations. The Guidelines state that the standards and recommendations will be used by the Global Fund

“to form the basis of information to appraise overall CCM performance. Standards and recommendations within the CCM Guidelines will inform the development of CCM performance frameworks with CCMs and the Global Fund Secretariat, in the context of the CCM Funding Policy.”

(The wording of the last sentence in this quote is an example of what happens when you try to write something by committee!)

In discussions that took place at PIC meetings when the guidelines were being drafted, it was suggested that access to funding for the operations of CCMs ought to be adversely affected by persistent and unjustified failure to adopt the standards and recommendation in the CCM Guidelines. However, this language did not make into the final draft.

The piecemeal approach – Part two

The Secretariat is now consulting with stakeholders on the development of a performance framework for CCMs. The idea is that the framework would contain a set of criteria or indicators against which the performance of CCMs could be measured. The proposed performance framework will be presented to the Board for approval at its first meeting of 2012 (probably in April or May).

The performance framework may become a useful tool to improve the effectiveness of CCMs. But there are a lot of questions that need to be answered concerning how the performance framework will be used and whether there will be any sanctions imposed on CCMs who do not measure up – questions such as:

• Who will evaluate the performance of the CCMs and how often will they be evaluated?
• Is the Secretariat the best entity to conduct the evaluations? Does the Secretariat have the resources?
• Since the CCM “represents” the country, would it not be preferable if some entity within the country conducted the evaluations? But who could do this?
• If a CCM is shown to be not performing well, what remedial actions will be taken and who will undertake them?
• Will there be penalties for persistent under-performance?

The holistic approach

If the Global Fund really wants to address the shortcomings of CCMs, it should borrow a page from its own guidance to countries concerning the development of proposals, and conduct (or commission) a gap analysis first to document where CCMs are weak. And the Fund should proceed from there to design programmes to address the gaps.

In conducting the gap analysis, the Global Fund should be thinking along the following lines:

1. What are the main weaknesses in the way CCMs are structured and how they operate?

2. What do we think should be done to address these weaknesses?

3. Which weaknesses do we think can be best addressed by making changes to the minimum requirements for CCMs?

4. Which weaknesses can be best addressed through the Global Fund issuing better guidance?

5. Which weaknesses could be best addressed in other ways?

6. What are these other ways?

7. What is the Global Fund’s role in making these other ways happen?

The “other ways” mentioned above should include, as a starting point, having individual CCMs evaluate themselves and develop action plans to address any weaknesses identified. Let’s give CCMs a chance – and some tools – to solve their own problems.

However, this will not work for all CCMs, especially those that are government-dominated. Trying to address shortcomings in the operations of CCMs in countries where there is a culture of government predominance is a major challenge. We should not fool ourselves into thinking that CCMs in these countries can be reformed overnight. Nevertheless, we should be trying to come up with creative ways to address the problems in these countries.

There is no easy solution to the problems of CCMs, no “one size fits all” approach, no magic wand that Geneva can wave. Since every country and every CCM is different, we should be thinking in terms of a country-based approach to reforming CCMs. This would entail conducting separate evaluations and developing separate actions plans for each CCM.

Where it makes sense to do so, the action plans can be developed by the CCMs. In countries where that approach would not be effective, stakeholders not represented on the CCM would need to play a leading role. Either way, there will be a need for support from the Global Fund Secretariat, from the Fund’s partner organisations (Stop TB, UNAIDS, World Health Organisation, Roll Back Malaria, etc.) and from technical assistance providers such as Grant Management Solutions and the technical support hubs of UNAIDS and the International HIV/AIDS Alliance.

Being country-based and country-led is a core principle of the Global Fund; let’s apply that principle to building more effective CCMs.

David Garmaise (david.garmaise@aidspan.org) is a senior analyst with Aidspan. The new CCM Guidelines are available on the Global Fund website here. Information on the CCM Funding Policy is available here.

Why is it that relatively few CCMs are using the money the Global Fund makes available for the operations of CCMs? The Global Fund budgets $8 million a year for this; yet, in 2010, only $1.5 million was spent.

During the consultations on the CCM Guidelines, Dr Brian Brink, who works for a company called Anglo American, and who is the private sector board member on the Global Fund Board, compared CCMs to the board of directors of a company. He said that both rely on a strong management arm to run the day-to-day affairs of the organisation, and to present options to the board when major policy decisions are required. The management arm of the CCM is the CCM Secretariat. Yet, most CCM Secretariats are poorly staffed. Why is this? One would think that if CCMs were really taking their responsibilities seriously, they would have established very strong secretariats.

Just about everyone associated with the Global Fund agrees that there are problems with the way many country coordinating mechanisms (CCMs) operate. These problems have been documented in reports, have been raised countless times during question and answer periods at regional and international meetings, and have spread by word of mouth.

The problems range from inadequate involvement of non-government sectors in selecting their representatives on the CCM, to CCM meetings being government-dominated, to CCMs being asked to rubber stamp

Since the piecemeal approach isn’t working, we should try something that is more holistic and that is country-based

by David Garmaise

Why is it that relatively few CCMs are using the money the Global Fund makes available for the operations of CCMs? The Global Fund budgets $8 million a year for this; yet, in 2010, only $1.5 million was spent.

During the consultations on the CCM Guidelines, Dr Brian Brink, who works for a company called Anglo American, and who is the private sector board member on the Global Fund Board, compared CCMs to the board of directors of a company. He said that both rely on a strong management arm to run the day-to-day affairs of the organisation, and to present options to the board when major policy decisions are required. The management arm of the CCM is the CCM Secretariat. Yet, most CCM Secretariats are poorly staffed. Why is this? One would think that if CCMs were really taking their responsibilities seriously, they would have established very strong secretariats.

Just about everyone associated with the Global Fund agrees that there are problems with the way many country coordinating mechanisms (CCMs) operate. These problems have been documented in reports, have been raised countless times during question and answer periods at regional and international meetings, and have spread by word of mouth.

The problems range from inadequate involvement of non-government sectors in selecting their representatives on the CCM, to CCM meetings being government-dominated, to CCMs being asked to rubber stamp proposals prepared by ministries of health, to CCMs not performing their oversight role, and to CCMs failing to deal with serious conflicts of interest.

The piecemeal approach to solving the problems of CCMs, which is what we have seen up to now, is not going to work. What we need is a holistic approach that is, in the main, country-based.

The piecemeal approach – Part one

The Global Fund Secretariat tried to deal with the problems of CCMs by coordinating a process to revamp the CCM Guidelines. To its credit, the Secretariat consulted widely with all stakeholder groups, listened to what people said at the consultation meetings, and produced draft new guidelines that would have helped to address some of the problems. Unfortunately, the draft guidelines were considerably watered down by the Global Fund Board and its Portfolio Implementation Committee (PIC). (See GFO commentary.)

The new CCM Guidelines contain a number of standards and recommendations. The Guidelines state that the standards and recommendations will be used by the Global Fund

“to form the basis of information to appraise overall CCM performance. Standards and recommendations within the CCM Guidelines will inform the development of CCM performance frameworks with CCMs and the Global Fund Secretariat, in the context of the CCM Funding Policy.”

(The wording of the last sentence in this quote is an example of what happens when you try to write something by committee!)

In discussions that took place at PIC meetings when the guidelines were being drafted, it was suggested that access to funding for the operations of CCMs ought to be adversely affected by persistent and unjustified failure to adopt the standards and recommendation in the CCM Guidelines. However, this language did not make into the final draft.

The piecemeal approach – Part two

The Secretariat is now consulting with stakeholders on the development of a performance framework for CCMs. The idea is that the framework would contain a set of criteria or indicators against which the performance of CCMs could be measured. The proposed performance framework will be presented to the Board for approval at its first meeting of 2012 (probably in April or May).

The performance framework may become a useful tool to improve the effectiveness of CCMs. But there are a lot of questions that need to be answered concerning how the performance framework will be used and whether there will be any sanctions imposed on CCMs who do not measure up – questions such as:

• Who will evaluate the performance of the CCMs and how often will they be evaluated?
• Is the Secretariat the best entity to conduct the evaluations? Does the Secretariat have the resources?
• Since the CCM “represents” the country, would it not be preferable if some entity within the country conducted the evaluations? But who could do this?
• If a CCM is shown to be not performing well, what remedial actions will be taken and who will undertake them?
• Will there be penalties for persistent under-performance?

The holistic approach

If the Global Fund really wants to address the shortcomings of CCMs, it should borrow a page from its own guidance to countries concerning the development of proposals, and conduct (or commission) a gap analysis first to document where CCMs are weak. And the Fund should proceed from there to design programmes to address the gaps.

In conducting the gap analysis, the Global Fund should be thinking along the following lines:

1. What are the main weaknesses in the way CCMs are structured and how they operate?

2. What do we think should be done to address these weaknesses?

3. Which weaknesses do we think can be best addressed by making changes to the minimum requirements for CCMs?

4. Which weaknesses can be best addressed through the Global Fund issuing better guidance?

5. Which weaknesses could be best addressed in other ways?

6. What are these other ways?

7. What is the Global Fund’s role in making these other ways happen?

The “other ways” mentioned above should include, as a starting point, having individual CCMs evaluate themselves and develop action plans to address any weaknesses identified. Let’s give CCMs a chance – and some tools – to solve their own problems.

However, this will not work for all CCMs, especially those that are government-dominated. Trying to address shortcomings in the operations of CCMs in countries where there is a culture of government predominance is a major challenge. We should not fool ourselves into thinking that CCMs in these countries can be reformed overnight. Nevertheless, we should be trying to come up with creative ways to address the problems in these countries.

There is no easy solution to the problems of CCMs, no “one size fits all” approach, no magic wand that Geneva can wave. Since every country and every CCM is different, we should be thinking in terms of a country-based approach to reforming CCMs. This would entail conducting separate evaluations and developing separate actions plans for each CCM.

Where it makes sense to do so, the action plans can be developed by the CCMs. In countries where that approach would not be effective, stakeholders not represented on the CCM would need to play a leading role. Either way, there will be a need for support from the Global Fund Secretariat, from the Fund’s partner organisations (Stop TB, UNAIDS, World Health Organisation, Roll Back Malaria, etc.) and from technical assistance providers such as Grant Management Solutions and the technical support hubs of UNAIDS and the International HIV/AIDS Alliance.

Being country-based and country-led is a core principle of the Global Fund; let’s apply that principle to building more effective CCMs.

David Garmaise (david.garmaise@aidspan.org) is a senior analyst with Aidspan. The new CCM Guidelines are available on the Global Fund website here. Information on the CCM Funding Policy is available here.

proposals prepared by ministries of health, to CCMs not performing their oversight role, and to CCMs failing to deal with serious conflicts of interest.

The piecemeal approach to solving the problems of CCMs, which is what we have seen up to now, is not going to work. What we need is a holistic approach that is, in the main, country-based.

The piecemeal approach – Part one

The Global Fund Secretariat tried to deal with the problems of CCMs by coordinating a process to revamp the CCM Guidelines. To its credit, the Secretariat consulted widely with all stakeholder groups, listened to what people said at the consultation meetings, and produced draft new guidelines that would have helped to address some of the problems. Unfortunately, the draft guidelines were considerably watered down by the Global Fund Board and its Portfolio Implementation Committee (PIC). (See GFO commentary.)

The new CCM Guidelines contain a number of standards and

Since the piecemeal approach isn’t working, we should try something that is more holistic and that is country-based

by David Garmaise

Why is it that relatively few CCMs are using the money the Global Fund makes available for the operations of CCMs? The Global Fund budgets $8 million a year for this; yet, in 2010, only $1.5 million was spent.

During the consultations on the CCM Guidelines, Dr Brian Brink, who works for a company called Anglo American, and who is the private sector board member on the Global Fund Board, compared CCMs to the board of directors of a company. He said that both rely on a strong management arm to run the day-to-day affairs of the organisation, and to present options to the board when major policy decisions are required. The management arm of the CCM is the CCM Secretariat. Yet, most CCM Secretariats are poorly staffed. Why is this? One would think that if CCMs were really taking their responsibilities seriously, they would have established very strong secretariats.

Just about everyone associated with the Global Fund agrees that there are problems with the way many country coordinating mechanisms (CCMs) operate. These problems have been documented in reports, have been raised countless times during question and answer periods at regional and international meetings, and have spread by word of mouth.

The problems range from inadequate involvement of non-government sectors in selecting their representatives on the CCM, to CCM meetings being government-dominated, to CCMs being asked to rubber stamp proposals prepared by ministries of health, to CCMs not performing their oversight role, and to CCMs failing to deal with serious conflicts of interest.

The piecemeal approach to solving the problems of CCMs, which is what we have seen up to now, is not going to work. What we need is a holistic approach that is, in the main, country-based.

The piecemeal approach – Part one

The Global Fund Secretariat tried to deal with the problems of CCMs by coordinating a process to revamp the CCM Guidelines. To its credit, the Secretariat consulted widely with all stakeholder groups, listened to what people said at the consultation meetings, and produced draft new guidelines that would have helped to address some of the problems. Unfortunately, the draft guidelines were considerably watered down by the Global Fund Board and its Portfolio Implementation Committee (PIC). (See GFO commentary.)

The new CCM Guidelines contain a number of standards and recommendations. The Guidelines state that the standards and recommendations will be used by the Global Fund

“to form the basis of information to appraise overall CCM performance. Standards and recommendations within the CCM Guidelines will inform the development of CCM performance frameworks with CCMs and the Global Fund Secretariat, in the context of the CCM Funding Policy.”

(The wording of the last sentence in this quote is an example of what happens when you try to write something by committee!)

In discussions that took place at PIC meetings when the guidelines were being drafted, it was suggested that access to funding for the operations of CCMs ought to be adversely affected by persistent and unjustified failure to adopt the standards and recommendation in the CCM Guidelines. However, this language did not make into the final draft.

The piecemeal approach – Part two

The Secretariat is now consulting with stakeholders on the development of a performance framework for CCMs. The idea is that the framework would contain a set of criteria or indicators against which the performance of CCMs could be measured. The proposed performance framework will be presented to the Board for approval at its first meeting of 2012 (probably in April or May).

The performance framework may become a useful tool to improve the effectiveness of CCMs. But there are a lot of questions that need to be answered concerning how the performance framework will be used and whether there will be any sanctions imposed on CCMs who do not measure up – questions such as:

• Who will evaluate the performance of the CCMs and how often will they be evaluated?
• Is the Secretariat the best entity to conduct the evaluations? Does the Secretariat have the resources?
• Since the CCM “represents” the country, would it not be preferable if some entity within the country conducted the evaluations? But who could do this?
• If a CCM is shown to be not performing well, what remedial actions will be taken and who will undertake them?
• Will there be penalties for persistent under-performance?

The holistic approach

If the Global Fund really wants to address the shortcomings of CCMs, it should borrow a page from its own guidance to countries concerning the development of proposals, and conduct (or commission) a gap analysis first to document where CCMs are weak. And the Fund should proceed from there to design programmes to address the gaps.

In conducting the gap analysis, the Global Fund should be thinking along the following lines:

1. What are the main weaknesses in the way CCMs are structured and how they operate?

2. What do we think should be done to address these weaknesses?

3. Which weaknesses do we think can be best addressed by making changes to the minimum requirements for CCMs?

4. Which weaknesses can be best addressed through the Global Fund issuing better guidance?

5. Which weaknesses could be best addressed in other ways?

6. What are these other ways?

7. What is the Global Fund’s role in making these other ways happen?

The “other ways” mentioned above should include, as a starting point, having individual CCMs evaluate themselves and develop action plans to address any weaknesses identified. Let’s give CCMs a chance – and some tools – to solve their own problems.

However, this will not work for all CCMs, especially those that are government-dominated. Trying to address shortcomings in the operations of CCMs in countries where there is a culture of government predominance is a major challenge. We should not fool ourselves into thinking that CCMs in these countries can be reformed overnight. Nevertheless, we should be trying to come up with creative ways to address the problems in these countries.

There is no easy solution to the problems of CCMs, no “one size fits all” approach, no magic wand that Geneva can wave. Since every country and every CCM is different, we should be thinking in terms of a country-based approach to reforming CCMs. This would entail conducting separate evaluations and developing separate actions plans for each CCM.

Where it makes sense to do so, the action plans can be developed by the CCMs. In countries where that approach would not be effective, stakeholders not represented on the CCM would need to play a leading role. Either way, there will be a need for support from the Global Fund Secretariat, from the Fund’s partner organisations (Stop TB, UNAIDS, World Health Organisation, Roll Back Malaria, etc.) and from technical assistance providers such as Grant Management Solutions and the technical support hubs of UNAIDS and the International HIV/AIDS Alliance.

Being country-based and country-led is a core principle of the Global Fund; let’s apply that principle to building more effective CCMs.

David Garmaise (david.garmaise@aidspan.org) is a senior analyst with Aidspan. The new CCM Guidelines are available on the Global Fund website here. Information on the CCM Funding Policy is available here.

recommendations. The Guidelines state that the standards and recommendations will be used by the Global Fund

“to form the basis of information to appraise overall CCM performance. Standards and recommendations within the CCM Guidelines will inform the development of CCM performance frameworks with CCMs and the Global Fund Secretariat, in the context of the CCM Funding Policy.”

(The wording of the last sentence in this quote is an example of what happens when you try to write something by committee!)

In discussions that took place at PIC meetings when the guidelines were being drafted, it was suggested that access to funding for the operations of CCMs ought to be adversely affected by persistent and unjustified failure to adopt the standards and recommendation in the CCM Guidelines. However, this language did not make into the final draft.

The piecemeal approach – Part two

The Secretariat is now consulting with stakeholders on the development of a performance framework for CCMs. The idea is that the framework would contain a set of criteria or indicators against which the performance of CCMs could be measured. The proposed performance framework will be presented to the Board for approval at its first meeting of 2012 (probably in April or May).

The performance framework may become a useful tool to improve the effectiveness of CCMs. But there are a lot of questions that need to be answered concerning how the performance framework will be used and whether there will be any sanctions imposed on CCMs who do not measure up – questions such as:

• Who will evaluate the performance of the CCMs and how often will they be evaluated?
• Is the Secretariat the best entity to conduct the evaluations? Does the Secretariat have the resources?
• Since the CCM “represents” the country, would it not be preferable if some entity within the country conducted the evaluations? But who could do this?
• If a CCM is shown to be not performing well, what remedial actions will be taken and who will undertake them?
• Will there be penalties for persistent under-performance?

The holistic approach

If the Global Fund really wants to address the shortcomings of CCMs, it should borrow a page from its own guidance to countries concerning the development of proposals, and conduct (or commission) a gap analysis first to document where CCMs are weak. And the Fund should proceed from there to design programmes to address the gaps.

In conducting the gap analysis, the Global Fund should be thinking along the following lines:

1. What are the main weaknesses in the way CCMs are structured and how they operate?

2. What do we think should be done to address these weaknesses?

3. Which weaknesses do we think can be best addressed by making changes to the minimum requirements for CCMs?

4. Which weaknesses can be best addressed through the Global Fund issuing better guidance?

5. Which weaknesses could be best addressed in other ways?

6. What are these other ways?

7. What is the Global Fund’s role in making these other ways happen?

The “other ways” mentioned above should include, as a starting point, having individual CCMs evaluate themselves and develop action plans to address any weaknesses identified. Let’s give CCMs a chance – and some tools – to solve their own problems.

However, this will not work for all CCMs, especially those that are government-dominated. Trying to address shortcomings in the operations of CCMs in countries where there is a culture of government predominance is a major challenge. We should not fool ourselves into thinking that CCMs in these countries can be reformed overnight. Nevertheless, we should be trying to come up with creative ways to address the problems in these countries.

There is no easy solution to the problems of CCMs, no “one size fits all” approach, no magic wand that Geneva can wave. Since every country and every CCM is different, we should be thinking in terms of a country-based approach to reforming CCMs. This would entail conducting separate evaluations and developing separate actions plans for each CCM.

Where it makes sense to do so, the action plans can be developed by the CCMs. In countries where that approach would not be effective, stakeholders not represented on the CCM would need to play a leading role. Either way, there will be a need for support from the Global Fund Secretariat, from the Fund’s partner organisations (Stop TB, UNAIDS, World Health Organisation, Roll Back Malaria, etc.) and from technical assistance providers such as Grant Management Solutions and the technical support hubs of UNAIDS and the International HIV/AIDS Alliance.

Being country-based and country-led is a core principle of the Global Fund; let’s apply that principle to building more effective CCMs.

David Garmaise (david.garmaise@aidspan.org) is a senior analyst with Aidspan. The new CCM Guidelines are available on the Global Fund website here. Information on the CCM Funding Policy is available here.