The role and evolution of the Country Coordinating Mechanisms are the subject of important discussions at the Global Fund Board
Christian DjokoArticle Type:
Article Number: 6
During the 50th Board meeting held this week, the Secretariat presented an important document describing the importance of Country Coordinating Mechanisms in the Global Fund partnership. It shows how CCMs support actors on the ground to implement the new 2023-2028 Strategy. This article reflects this. While the role of CCMs is essential, there is also room for improvement, as highlighted by the findings of the Office of the Inspector General audit.
During the 50th meeting of the Global Fund Board held on 14, 15 and 16 November, the Secretariat presented a document describing the role of Country Coordinating Mechanisms (CCMs) in the Global Fund partnership, particularly in the context of Grant Cycle 7 (GC7). The CCMs support stakeholders in the field to implement the 2023-2028 Strategy and ensure inclusive dialogue and effective oversight of Global Fund grants.
Since 2018, additional support has been provided through the CCM Evolution Strategic Initiative (SI). The Board paper describes the institutional design and organizational reconfiguration that CCMs are undergoing. It also highlights the progress made under this initiative and the main findings of the Office of the Inspector General (OIG) audit of the CCMs (see our article on the OIG CCM audit here) which we also describe in more detail later in this article.
CCMs at the heart of GC7 implementation
First and foremost, CCMs are designed to be democratic approaches to the development, implementation and co-management of Global Fund grants. As shown in Figure 1 below, CCMs play a crucial role in the process of developing and submitting funding proposals, as well as in grant supervision and implementation.
Figure 1. CCMs and the Global Fund model: their role throughout the grant cycle
Beyond GC7, the role of CCMs has been strengthened (democratic process) and expanded (inclusion) as part of the Global Fund’s Strategy 2023-2028. By accelerating the evolution of CCMs and community-led platforms, the Global Fund hopes to strengthen inclusive decision-making, oversight and evaluation of all its processes. It is one of the many factors, among others, that the Global Fund believes will lead to the achievement of one of the major objectives under Strategy 2023-2028, namely: “Maximizing the engagement and leadership of the most affected communities so that no one is left behind”. In other words, through the inclusion of civil society, key populations and people living with the diseases CCMs are called upon to provide decisive support in achieving the Global Fund’s new priorities, subject to meeting a number of criteria.
The CCM Evolution Strategic Initiative was a mechanism to bolster CCM performance
It should be noted that OIG’s 2016 audit found that CCM oversight of Global Fund-supported programmes was weak. Significant issues were identified in the implementation of CCM policies and procedures. In response to this review, the Board approved the CCM Evolution SI in May 2018. This initiative aims to improve collaboration between the partnership and relevant countries and regions (Figures 2 and 3).
Figure 2. Adapted CCM Evolution SI to support GC7 priorities
Figure 3. Support to CCMs to deliver the Strategy’s new priorities
CCM development and strengthening
On closer inspection we can see that, for the Global Fund, it is not enough to give CCMs the space or opportunity to participate in the decision-making processes surrounding its governance and investments. It is also necessary to equip them to be able to fulfil their mission optimally and effectively. With this premise in mind, the Global Fund has produced a series of briefing notes, seminars, workshops and webinars on the grant cycle lifespan in its entirety for GC7. With a view to supporting communities in CCM engagement, the Global Fund has put financial support in place, but above all there are a wide range of Strategic Initiatives to provide extra support. Figure 4 gives a brief overview of who is involved and their role.
Figure 4. Strategic Initiatives support for Community, Rights and Gender (CRG) to strengthen CCM engagement
According to the Board document, the CCM Evolution SI shows encouraging results. A survey carried out by the OIG among 1,000 CCM respondents (in November 2022) showed that:
- 81% of CCMs think the SI’s activities are relevant and address the needs of CCMs;
- 82% say the CCM Evolution SI is contributing to improvements and the increased maturity of CCMs; and
- 85% believe gains from the CCM Evolution SI will be sustained beyond the end of the SI.
That said, the Baseline Gap Analysis used with 93 CCMs identified some priority intervention areas.
Figure 5. Baseline gap analysis shows areas for focus interventions
In more detail, Figure 6 presents a global overview of the state of CCM Evolution based on data relating to four key areas (positioning, engagement, oversight, and operations) of support for the Global Fund’s interventions.
Figure 6. CCM Evolution as of July 2023
Key findings of the recent OIG’s CCM audit
Nearly 100 CCMs have benefited from the CCM Evolution SI due to end in December 2023. The success of the SI in increasing the maturity of CCMs and optimally support the implementation of the Global Fund’s Strategy was the focus on the OIG audit. The evaluation found that the CCMs that participated in the pilot phase improved their operations, but not all the gains were sustained and not all planned activities were implemented. Some of these delays were due to the COVID-19 pandemic and other competing priorities.
More importantly, while it is true that the catalytic effect has not been assessed and hat there have been improvements in CCM policies and processes since 2016, the audit findings do indicate that:
- The significant delays in implementing SI interventions in many of the participating countries will hamper the catalytic potential of increasing the level of CCM maturity;
- Certain aspects of the SI’s management need to be improved if the objectives are to be achieved;
- The management of technical assistance (TA) provided to CCMs needs to be improved to ensure the quality of activities and their timely implementation; and
- The effectiveness of the CCM cluster is hampered by system deficiencies and a lack of guidance for bodies operating in unique or challenging contexts.
Figure 7 provides a slightly more detailed summary of the findings of the OIG audit.
Figure 7. OIG CCM Audit: key findings and actions
Further CCM Evolution
Transitioning from SI to OPEX at the end of 2023
For the future, the OIG and the Global Fund Secretariat recommend a number of actions:
- SI funding ends in December 2023; increase CCM operating expenses (OPEX) to continue CCM Evolution in 2024-25;
- Support the completion of activities and sustain gains beyond 2023, e.g., covering the costs of Oversight Officers (in High Impact and Core portfolio countries);
- Target new support in 2024-25 at gaps identified in the CCM Evolution endline evaluation and with partners; and
- Reinforce performance standards and identify TA needs through annual process;
M&E framework strengthened
- A Theory of Change developed and added to standard SI process after the CCM Evolution SI was approved;
- Logical Framework added – not required in SI process but retrofitted to capture outcomes; and
- M&E Roadmap – adding in new evaluation element and continuing beyond the SI’s end in 2023.
Next Steps and Strategy Committee (SC) input sought (back in July 2023)
More specifically, the Secretariat plans to :
- Continue and complete CCM Evolution activities in 2024-25, pending OPEX availability; and
- Increasingly target activities and support towards priority countries with the lowest scoring areas/biggest gaps.
The Secretariat will also keep the SC informed by:
- Incorporating an annual CCM performance update report into the Secretariat-SC update on Country Funding (+CCMs), Portfolio Optimization and SIs (from Oct 2024); and
- Contributing to Committee thematic discussions (e.g., on resilient and sustainable systems for health (RSSH), CRG, health financing) around CCM engagement.
In addition, the Secretariat intends to organize bi-annual CCM partner meetings and contribute to Technical Advice & Partnerships (TAP) and CRG partner meetings on CCM issues.
Comments from stakeholders
This was a passionate topic for the majority of stakeholders who commented on the paper and also made recommendations.
In general, stakeholders felt that the detailed account of the CCM Evolution SI’s progress and challenges are relevant, and indeed invaluable, for planning and implementation. They also recognize that CCMs are important for achieving the 2023-2028 Strategy’s objectives but they believe that CCMs’ operations needs to be adapted to each national context through a differentiated approach and better integrated into national or regional structures. In countries subject to an Additional Safeguard Policy (ASP), it is necessary to define clear criteria for activating the ASP and the Challenging Operating Environments (COE) policy as well as an exit strategy in partnership with the Global Fund and the country.
Some stakeholders also believe that it is important to strengthen the role of civil society and communities in CCMs and to better integrate the data collected through community monitoring into CCM oversight processes. This, they say, is a question of effectiveness and inclusion.
On the topic of efficiency, some people highlighted the shift in CCM funding from one-off or limited investment/grants (SIs) to operational expenditure (OPEX) and stressed the importance of allocating realistic and sufficient resources to ensure the continued funding of the oversight function. They highlighted the challenges of representation and power imbalances within CCMs and proposed the introduction of a CCM Ombudsman to resolve grievances.
Last but not least, stakeholders presented a range of inequalities and pitfalls surrounding the participation of women in decision-making bodies, particularly in the CCM structure and meetings. Indeed, they were deeply surprised at the absence of any mention of these concerns in the CCM Strategic Evolution SI. To address these disparities, some stakeholders proposed:
- Establish clear quotas and guidelines to ensure the substantial representation of women. It is also recommended that sustainable resources be provided for capacity building programs and mentoring opportunities to help women engage actively and technically in these forums. It was pointed out that many women are voluntarily involved in these processes, but unpaid/unrecognized engagement can be a barrier to clear and meaningful participation;
- Invest in the collection and analysis of sex- and gender-disaggregated data to understand women’s specific health needs. This data-driven approach will enable the development of evidence-based policies tailored to the unique health challenges faced by different gender groups. There is also a need to allocate resources to research that examines the cross-sectional impact of gender, considering factors such as age, ethnicity, origin, education and socio-economic status on health outcomes; and
- Accelerate the implementation of the SI in other priority countries to build CCM capacity and support the Strategy 2023-2028, with a focus on eliminating gender stereotyping and inequalities. Most importantly, stakeholders urged the Global Fund Board and Secretariat to strengthen gender equality by integrating gender perspectives into all facets of the country grant implementation process. They stressed the importance of strengthening women in their diversity and promoting their active participation in CCMs and decision-making spaces to achieve the desired impact and sustainability in the quest to achieve universal health equity.
Board paper GF/B50/11 Country Coordinating Mechanisms (CCMs) will shortly be available on the Global Fund website.