Structured Abstract
| Document Title: | Country Coordinating Mechanisms : A Synthesis and Analysis of Findings from CCM Case Studies, Tracking Study, GNP+ and Other Surveys. April 2004 |
| Institution: | Governance and Partnership Committee |
| Study commissioned by: | Governance and Partnership Committee |
| Objectives: |
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| Methods: | The analysis is based on CCM case studies from 17 countries, a tracking study of CCMs in four countries, two multi-country studies of NGO involvement in CCMs, a multi-country study of the involvement of PLWHA, an ILO review of private sector involvement, and two studies of faith-based organisations' integration into Fund processes, together with feedback from regional meetings and from Secretariat staff. This paper is preparatory to the submission to the GF Board of a policy paper outlining options for strengthening guidance provided to countries on their CCMs. The paper briefly outlines the main Fund Guidelines on CCMs and the framework for the analysis, before summarising the main findings and analyses from the case studies, surveys and meeting reports. |
| Results: | The main findings are presented and organised according to the following headings (see original Executive Summary):
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Executive summary
BackgroundThis paper responds to a request from the Governance and Partnership Committee for a comprehensive analysis of the early experiences of Country Coordinating Mechanisms. It is preparatory to the submission to the Global Fund Board of a policy paper that will provide options for strengthening the guidance provided to countries on their CCMs.
The analysis is based on CCM case studies from 17 countries, a tracking study of CCMs in four countries, two multi-country study of NGO involvement in CCMs, a multi-country study of the involvement of People Living with HIV/AIDS, an ILO review of private sector involvement, and two studies of faith-based organisations' integration into Fund processes, as well as feedback from regional meetings and from Secretariat staff.
The paper reviews briefly the main Fund Guidelines on CCMs as the framework for the analysis, followed by a summary of the main findings and analysis from the case studies, surveys and meeting reports.
Summary of Global Fund Guidelines related to CCMs
The Fund requires CCMs to function as public-private partnerships that coordinate the development of proposals and oversee implementation of Fund-supported activities. Only in exceptional circumstances will the Fund accept Coordinated Country Proposals other than from a CCM. The Fund will receive proposals from sub-national CCMs in large countries, or regional (inter-country) CCMs.
The Fund recommends a list of stakeholder groups to be CCM members. In its composition of members, the CCM should aim for gender balance. The members should represent their constituencies, with whom they should have regular consultations and give feedback. The CCM should be a consensus group promoting true partnership with equality in decision-making and all members should be involved in proposal development and implementation. It should disseminate information about the Fund to all interested parties.
The Chair and Vice-chair should represent different communities. The CCM should determine the details of its own functioning, including terms of reference and election procedures as well as mechanisms for minimising conflicts of interest. The CCM is responsible for the selection of one or more Principal Recipients and should oversee implementation and monitoring and evaluation of the approved grant. Monitoring at country level will be linked to the Fund's M&E system at global level.
The PRs must keep the CCM informed about implementation progress. Before the end of the two-year grant period, the CCM will assess implementation and request the Secretariat for continued funding. The decision for continued funding will be based on an independent impartial assessment of progress, including an assessment of the CCM.
The Fund supports programmes that build on, complement and coordinate with existing programmes. The CCM should ensure consistency between Fund assistance and programmes in support of national priorities. The Fund's grants should be additional to existing resources.
Summary of synthesis of findings and analysis
Establishment and composition of CCMs as a public private partnership
CCMs were set up quickly to meet proposal submission deadlines for Round 1 with members being mainly nominated by ministries of health. Membership has evolved over time in most CCMs to include representatives from the major stakeholder groups recommended by the Fund though there is still only marginal representation of people living with the diseases. Membership, however still tends to be dominated by the government. Few CCMs were following the Fund guidelines on ensuring a gender balance.
Representation and participation in CCMs
While the CCMs have increased the opportunities for government-civil society dialogue, members are not equals in decision-making. Proposal preparation is often so rushed that meaningful participation is impossible, and systems are not yet established for a participative approach to decision-making and for overseeing implementation. Ineffective communications undermine participation, with a small number of exceptions. In addition, lack of funds to meet travel costs limit the involvement of stakeholders from outside capital cities.
Limited or no participation of members' constituencies in CCMs was a problem in all but two CCMs covered in the studies. This was due to lack of selection procedures for members, problems of ineffective communications, lack of resources for networking. Participation in CCMs of those outside capital cities was sparse. Even large countries with devolved administrative and political structures have not as yet set up sub-national CCMs, which meant that most interested parties, governmental and non-governmental, were excluded from Fund processes
Members from small, informal organisations were less skilled in the protocol of meetings and were more likely to face language difficulties. The purpose of involvement by people affected by the diseases was little understood, limiting their effective participation. Institutional cultures and the need to maintain working relations limit debate and opposition from CCM members to government control of decision making in some CCMs.
CCM Governance
Most CCM chairs are from the Ministry of Health and in some countries the Vice Chairs were also from MoH despite guidance that they should be from different constituencies. Few CCMs have developed PR selection criteria resulting in some cases in lack of transparency in PR selection. CCM secretariats vary in style and strength, but are almost universally under-resourced, which contributes to poor communications and rushed proposal preparation. By now, a small number of CCMs has terms of reference and rules of procedure and others are in the process of developing them. More CCMs are now creating subcommittees, technical panels to delegate tasks to improve efficiency.
Conflicts of interest exist in many forms, including where Chairs and Principal Recipients coincide. Stakeholders were conscious of the risks but action to minimise conflicts of interest have yet to be taken except in very limited cases.
Working relations between CCMs and PRs are becoming more complex as implementation expands. Only two studies indicated PRs reporting to CCMs as they are obliged to do. Neither the Fund guidelines nor the grant agreements contain any requirements or recommendations on CCM action with regard to PR reports. This is important because the PRs have a direct legal relationship with the Fund but not with the CCM. Consequently, the CCM appears to have no formal authority with regard to overseeing the PRs.
Harmonisation
Studies did not reveal any major issues related to harmonisation with national strategies. In a couple of countries good coordination was reported in relation to national strategies. There was mention of coordination with a Sector Wide Approach mechanism and a joint inter-agency committee responsible for the health sector functioning as the CCM but, otherwise, there was little formal harmonisation with other coordination mechanisms. Coordination is, however, improving as CCMs become more experienced. Together with other agencies, the Fund has put out an M&E toolkit as part of its efforts to harmonise M&E of fund supported activities with that of national programmes and other donors. Countries have requested for sharing of early experiences in harmonisation.
Global Fund guidelines and procedures
Previous sections have commented on the quality and utility of parts of the Fund's guidelines. Issues identified in the case study documentation and surveys related to: lack of clarity in Fund Guidelines leading to difficulties in understanding and interpreting them; their non-availability in local languages and their general lack of accessibility. Some stakeholders in many countries have not seen the guidelines. A minority welcomed the room for flexibility in the current guidelines, while others wanted more specificity. Some CCM members reported frustration with the complex and changing grant-application procedures. The proposal guidelines and forms were the subject of much frustration and criticism.
The support needs of CCMs
Areas that stakeholders cited most frequently as requiring technical support included communication with members' constituencies, strengthening CCM secretariat, CCM governance, and capacity building for CCM members, PRs and SRs, especially NGOs, CBOs and People living with the diseases that are likely to be SRs. Other areas included team-building for CCMs, resolving language problems, and help with running costs such as meeting travel costs. The technical support needs are likely to increase as implementation expands. CCMs acknowledged the support they receive from multilateral and bilateral partners; however, currently they acquire that support in uncoordinated and unsustainable ways, and many are unaware of all the sources of support that are available. The Fund, based on lessons learned, now allows for a proportionate percentage of its grants to be used for technical support. Early experience and lessons learned could also be used as a basis to facilitate together with partners a coordinated and sustainable access to technical support for CCMs and implementers
