Making Global Fund Country Coordinating Mechanisms Work through Full Engagement of Civil Society

This International Treatment Preparedness Coalition (ITPC) report looks at the functioning of the Country Coordinating Mechanism (CCM) in seven countries - Argentina, Cambodia, Cameroon, India, Jamaica, Romania, and Uganda - with a particular focus on civil society (CS) engagement in CCMs. Research teams sought to understand whether and how CS has had meaningful involvement in the design and monitoring of Global Fund-supported programming, and, ultimately, how CS can be most effective in improving delivery of Global Fund-supported services.

Findings and recommendations are provided through a chapter for each country. Overarching findings, discussed in the Executive Summary include:

• "CS members have made notable contributions in several CCMs, for example by making the social realities of people living with HIV/AIDS (PLWHA) much more real for other members and fighting to restore subsidies for HIV treatment and diagnostics." However, CS CCM members generally have limited influence compared to government representatives due to not being considered equals by other members, not having appropriate knowledge or expertise (including knowledge about their roles as CCM members), being reluctant to challenge leadership, and not having confidence in their own skills. Argentina and Romania are exceptions, "in part because of the CS members’ active engagement (sometimes in contrast with the passivity of other sectors), their ready access to information, and their recognition by other members as equal partners."
  
• Among the reasons why CS members are less effective are:
  • Lack of coordination among CS representatives can undermine the ability to present a united front in discussions in the full CCM, and can decrease CS credibility with other sectors, particularly if CS members tend to represent only their organisational interests.
    
  • Improved communication among CS members is called for so that they regularly receive information about the CCM and the Global Fund.
    
  • There is a need for CS members to have more opportunities to improve a range of technical skills and capacities. Priority training topics include: medical information and disease-fighting strategies; structure, function, and procedures of the CCM and Global Fund; members’ roles and mission on the CCM; high-level advocacy and negotiation skills; skills for communicating with constituencies; programme management and logistics; monitoring and evaluation; and government budgeting, financing, and legislative processes.
    
  • CS representatives need to come together in forums outside of the CCM to coordinate their work, to identify strategic priorities, and to define an advocacy agenda.
    
  • Conflicts of interest among CS need mitigation - CS representatives’ agencies sometimes receive funds from a Global Fund-supported programme.
  •  In some countries, vulnerable groups still need better representation - either through membership in the CCM or better defence through CS members.

Recommendations include the following:

1. The Global Fund should:
   • ...along with UN agencies and donors, do more to promote capacity building for civil society members of CCMs.
     
   • ...empower CCMs to play the appropriate strategic performance monitoring and programme implementation oversight role expected of them.
   • ...issue guidance, including a checklist and tools, to increase the awareness of CS representatives about their multiple roles on CCMs.
     
   • ...develop a sample set of key performance indicators for CS representatives to promote accountability and help CS monitor the performance of its representatives.
     
   • ...help fund independent CCM secretariats and voice strong support for participation of all stakeholders.
     
   • ...provide case studies and guidance to the CS sector on how their representatives can have maximum positive impact on CCMs, build needed capacity, address conflict of interest, and stand up to other forceful interests, including government CCM representatives.
     
2. United Nations (UN) agencies, including the Joint United Nations Programme on HIV/AIDS (UNAIDS), should help convene civil society on neutral ground outside of CCM meetings to support efforts of civil society to identify strategic priorities and should disseminate information and provide technical support to enable civil society to play a more effective role in CCM deliberations.
   
3. CCM leadership should provide resources and support to enable the full participation of CS representatives and their ongoing communication with constituencies; ensure that all members of the CCM are engaged in oversight of grant implementation; and make information accessible in a timely fashion in all languages necessary.
   
4. CS representatives and organisations should seek funding to ensure that members have access to capacity development opportunities; communicate with the CS sector and health care consumers, including grassroots and underserved communities, on a regular basis; address potential conflicts of interest openly by being transparent about financial involvements and by creating mechanisms for health consumers to assess how they are represented, what work is being done, and what improvements in representation can be made.