If the CCM begins to function soon in Burma / Myanmar then it is time to catch up with Global Fund thinking on them ...
[him] moderator
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In an interim report entitled “A Report on the Country Coordinating Mechanism Model,” the Global
Fund has released results from 40 case studies it commissioned on the operations of 19 CCMs. The
report, which is undated, is available at www.theglobalfund.org/documents/publications/other/CCM/CCM_report.pdf.
The case studies were conducted in eight thematic areas: partnership and leadership; governance
and civil society participation; CCM oversight practices for grant implementation; CCM Secretariat;
principal recipient and sub-recipient selection; conflict of interest; CCM-PR-LFA communications; and
harmonization and alignment.
By the end of this year, the Global Fund plans to release in-depth reports on each of these thematic
areas. The Fund also plans to produce a final version of this report, in which it will add one-page
summaries of the lessons learned, and key recommendations in each of the eight thematic areas.
The purpose of the case studies was to describe the “range of [CCM] models and experiences gained
since the inception of the Global Fund.” The list of CCMs selected for the case studies was based, in
part, on work already underway for the Five-Year Evaluation of the Global Fund; and, in part, on the
Secretariat’s experience and knowledge of developments in CCM practices and management. The
methodology involved (a) a review of relevant Global Fund documents; (b) in-depth interviews with
stakeholders in-country; and (c) a focus group discussion in each country with some key CCM
constituencies.
The list of CCMs included in the study is as follows: Africa: Ethiopia, Kenya, Malawi, Mali, Mozambique, Nigeria, Tanzania, Zambia and
Zimbabwe. Asia: Cambodia, India, Sri Lanka. Eastern Europe and Central Asia: Bulgaria, Romania and Tajikistan. Latin America and the Caribbean: Honduras, Jamaica, Peru and CRN+ (Caribbean Regional Network of Persons Living with HIV/AIDS). (CRN+ is actually an RCM, not a CCM.)
Not all case studies covered all eight thematic areas.
The following are some of the main findings of the report, divided by thematic area.
Partnership and leadership
Partnership and leadership
Based on case studies conducted in Honduras, Malawi, Nigeria, Peru and Zambia, the report
concludes that the CCM partnership model – with its requirements for multi-stakeholder participation
and equality of voice – is a successful one and has improved the quality of health programmes in
these countries. The report says that CCMs “generally mediate competing interests successfully” and
that, in some countries, the CCM model has led to “a redefinition of the relationship between
government and civil society.” (However, see Commentary article below.)
The report cites as examples, the “strong leadership and outreach demonstrated by the Peruvian
Ministry of Health,” and the fact that in Honduras, “working together as equal partners with the
government had an empowering effect on civil society.”
The report provides a list of both the positive and negative leadership characteristics that have been
exhibited by CCM chairs.
Positive characteristics found in some CCM chairs include the following: Experienced facilitator and promoter of change Enjoys CCM members’ respect and has a longstanding relationship with the mechanism Sound conflict resolution skills and able to mediate between different stakeholders Enjoys a high measure of respect and acceptance by the government Accountable and transparent Ability to galvanize, mobilize and enthuse CCM partners Displays a high level of commitment to the fight against AIDS, TB and malaria Excellent communication skills Results-oriented approach Solid meeting management skills Well organized (ensures minutes and documents distributed on time, handles agenda well,
prioritizes) Ability to work under pressure Keeps information flowing between CCM members
Negative characteristics found in some CCM chairs include the following: Does not manage participation and work within multidisciplinary teams, e.g. does not ensure sufficient civil society participation Is not clear about CCM responsibilities or those to be performed by PR, sub-recipient and
LFA Does not lead with much enthusiasm or motivation Misses CCM meetings, frequently prioritizing government responsibilities over CCM
responsibilities [applies only to Chairs from government] Dominates meetings, often insisting on own “agenda” rather than facilitating consensus.
In the conclusion of this section, the report says that despite the positive trends, “civil society still
needs strengthening in the many countries where government dominates the public health arena to
the exclusion of a civil society too weak to engage effectively.”
The recommendations call for (among other things) making funds available to CCMs for capacity
building to improve CCM participation on CCMs, and for civil society consultations with its
constituencies.
Governance and civil society participation
Based on case studies conducted in Cambodia, Ethiopia, Honduras, India, Kenya, Romania,
Tajikistan, and Tanzania, the Global Fund found that in many countries the voice of civil society in
CCMs is weak; that the participation of civil society representative is not always meaningful; and that
civil society leadership is often not well informed about the latest developments.
The report identifies areas where capacity building is required, and where there are structural
obstacles to strengthening civil society participation. The report says that “challenges to
communications between civil society representatives on CCMs and their constituencies were
reported in all [19] countries where case studies were carried out.”
The report provides a list of useful CCM governance tools and protocols.
The report identifies as a best practice the use of alternates – i.e., “an arrangement by which a
constituency selects an alternate to stand in for the primary representative at those meetings she or
he is unable to attend. Alternates are also allowed to vote on behalf of the CCM members they
replace.” The report says that the system of alternates was found to be effective in Cambodia, India
and Tanzania and that the “use of alternates underlines the importance of CCM meeting attendance
and delivers the message that members are there on behalf of their constituencies and not their own
personal interests.” The report adds that India and Cambodia have developed clear guidelines on the
use of alternates.
One of the recommendations in this section calls for the establishment (where feasible) of a CCM
website “which should, at a minimum, contain the following information: CCM membership, terms of
reference and other governance tools including Global Fund governance documents; CCM meeting
schedule and agendas; CCM decisions; information on CCM member organizations and
representatives; and information about grant implementation as well as PR and sub-recipient
activities.”
CCM oversight practices for grant implementation
Based on case studies conducted in Kenya, Tajikistan, Tanzania, Ethiopia, Zambia, Bulgaria and
Peru, the study concluded that “[o]f all the CCM roles and responsibilities, oversight is probably the
least well understood”; that CCMs “are not yet fully comfortable with the oversight role assigned to
them”; and that there are serious obstacles in communications between the various CCM
stakeholders.”
Nevertheless, the report says, there are some good practice models emerging. The report describes
several examples, including the oversight tools and process developed by the CCM in Ethiopia; and
the process put in place by the CCM in Bulgaria to monitor grant implementation at each quarterly
CCM meeting.
CCM Secretariat
Based on case studies conducted in a number of the countries included in this study, the Global Fund
concluded that in most countries “CCM secretariats are either non-existent, not fully operational or
considerably understaffed.” The report says that a week CCM secretariat has a “negative impact” on
overall CCM performance. (It should be noted that the CCM case studies were commissioned and
completed prior to the implementation of the new CCM funding policy which is described in “CCM
Funding Policy FAQ" at www.theglobalfund.org/documents/ccm/CCMFundingPolicyFAQ_en.pdf.)
The report cites the example of the CCM in India, where “with just one member of staff, the CCM
secretariat is under-resourced and unable to provide adequate CCM coordination support.”
The report describes the ingredients of a successful CCM secretariat, based on a best practices
example from Cambodia.
One of the recommendations in the report calls on donors to assists CCM secretariats to develop
detailed budgets and workplans with clearly defined outputs.
Principal Recipient and sub-recipient selection
The report says that there has been a “substantial evolution” in PR and sub-recipient selection; that
the process has become more formalized, more inclusive and more transparent; but that this is still “a
work in progress.” The report says that CCMs are “beginning to discover for themselves the merits of
an open and transparent approach to PR and sub-recipient selection.”
The report describes various methods of PR and SR selection currently in use. It also provides
examples of best practice – including the criteria used by the CCM in Ethiopia for PR selection, and
the process used by the CCM in Kenya for the selection of SRs.
One of the recommendations in this section of the report calls for the establishment of PR and SR
selection processes and tools.
Conflict of interest
Based on case studies conducted among CCMs in Kenya, Jamaica and Zimbabwe, the Global Fund
concludes that, in general, conflict of interest (COI) issues have not been adequately addressed; that
CCM members are often not aware of the CCM’s COI policies; and that the policies are not
sufficiently practical. The Fund observed that often COI policies address only the limited
circumstance of the chair or vice-chair of the CCM being from the same entity as the PR. The report
says that COI policies should address the full range of potential COIs “generated by the increasing
numbers of CCM members who are also SRs.”
Despite these conclusions, the report cites Jamaica as an example of a CCM that has a “fully
operation COI management plan,” and describes the Jamaica plan in some detail.
CCM-PR-LFA communications
Based on case studies conducted in Nigeria, Peru and Zambia, the report concludes that
communications among the LFA, PR and CCM are of poor quality and that, to a large extent, this is
due to a poor understanding of the role of the LFA. The report says that at the very least the LFA
should regularly attend CCM meetings as an observer and use its attendance to clarify its role.
Harmonisation and alignment
Based on case studies conducted in Cambodia, Mozambique, Nigeria and Tanzania, the report
describes examples of two different possible CCM approaches to harmonisation and alignment – one,
in Tanzania, where the CCM serves as a national coordinating mechanism overseeing grants for
AIDS, tuberculosis and malaria from a variety of funders; and another, in Mozambique, where the role
of the CCM is for the most part limited to preparing proposals and requests for continued funding and
submitting them to the Global Fund.
Issue 95: 26 September 2008
www.aidspan.org/gfo
