PartnersGF - 2004-06-26

An Open Letter to the GFATM Board
HDN eForum Moderation Team
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Re: Perspectives and Recommendations on Country Coordination Mechanisms [CCMs] from the PartnersGF eForum discussions


Dear GFATM Board Members

Prior to the launch of the PartnersGF eForum earlier this year, Health & Development Networks (HDN) received assurances from senior GFATM officials that this feedback from on-line discussions is welcomed by the Global Fund, and that our collective voices will be heard - and acted upon.

In the opening statement welcoming members to the PartnersGF e-forum discussion (16 March 2004), the Global Fund Board members affirmed that: "Synthesis of online discussions shall be used (along with feedback gathered through various regional consultations) as the basis for the Partnership Forum event in Bangkok – which in turn will generate specific recommendations to guide the Global Fund Board."

On behalf of the participants of the first on-line discussion, the following recommendations are submitted to the Board of the Global Fund for consideration at GFATM Board meeting to be held in Geneva on 28th and 29th June 2004. This meeting is the first opportunity for the opinions and views from PartnersGF participants to be presented to and discussed by the Board. This first step in providing feedback to the GFATM will be important in setting the tone in this continuous process of dialogue and consultation between the GFATM and a wide range of stakeholders through PartnersGF. The recommendations are intended for the Global Fund Board delegates, international institutions and other participants in the Global Fund mechanism.

In the summary accompanying these recommendations (separate posting, to follow), HDN has attempted to capture the main themes of concern, interests and consequent recommendations from the PartnersGF discussion on Country Co-coordinating Mechanism (CCMs). Where possible, verbatim contributions from eforum members have been incorporated (i). Otherwise, HDN has paraphrased yet sought to preserve the integrity of the voices.

While we gratefully acknowledge one anonymous contribution from a member of the CCM, we are appalled by the lack of commitment and engagement from CCM members and Global Fund Board delegations as shown by the absence of their contributions on this forum. We hope both CCM members and GF Board delegations will show maturity, commitment and engagement to improving our lives by carrying out their functions diligently, including speaking with constituency members on this forum.

We hope we have succeeded in this endeavour and invite participants to confirm if this summary reflects your contributions, as well as reflects the essence of the discussion to date.

The HDN Moderation Team takes this opportunity to thank all participants for their contributions and participation and looks forward to their continued involvement.

HDN Moderation Team
Email: info@hdnet.org

[Note: This letter and attachments were sent to: Helene Gayle, Chairperson, GFATM Partnership Forum Working Group; and Dianne Stewart, Board Relations, GFATM Secretariat - Friday 25th June 2004]

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Recommendations from PartnersGF Discussion 1: Country Coordination Mechanisms

Preamble
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One of the most important features of the Global Fund for AIDS, Tuberculosis and Malaria (GFATM) is that it was established as a broad partnership, aimed at bringing together the various constituencies involved in fighting these diseases. The Country Coordination Mechanism (CCM) is the main way that this goal is intended to be achieved.

CCMs are essentially national stakeholder committees convened to develop and put forward shared national GF proposals for addressing the three diseases covered by the GFATM – and for jointly executing the plans they propose.

The underlying idea behind the CCM approach is that only through country-driven, coordinated and multi-sector approaches - involving ALL relevant partners - will additional resources have a significant impact on the reduction of infections, illness and death from the three diseases.

The goals of this first PartnersGF discussion were to bring together as many views as possible about the progress made by CCMs over the past two years, and to potentially condense these into a set of suggestions or recommendations about CCM composition and operations for consideration by the Global Fund Board and Secretariat.

Recognizing that "no one size recommendation fits all," we developed these recommendations on the understanding that within different contexts common foundations exist. It is to the formation and strengthening of these foundations that need substantive and sustained efforts to maximize the impact of the Global Fund in our countries and communities.

The full text of this on-line discussion can be read at:

www.theglobalfund.org/en/about/forum


Country Coordinating Mechanisms [CCMs]
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A. Composition

In many instances, ministries of health led the development of CCMs, with UN agencies support. It is not surprising to find that CCM composition to date reflects, in part, the pre-existing national collaborative structures and ministerial partnerships and leaderships. While valuable to CCM operations, this composition lacks the scope the three diseases individually and collectively demand.

1. It is recommended that:

Access to GFATM resources by CCMs be conditional on the composition of the CCM having an agreed balance in stakeholder representation;

(a) From agencies and organizations working on HIV/AIDS, Tuberculosis and Malaria based on the following:

A maximum of
- 10 government officers from the relevant ministries,
- 5 UN/bilateral,

A minimum of:
- 4 NGO/community-based,
- 1 private sector,
- 1 religion/faith-based,
- 1 academic /educational,
- 1 Red Cross/Crescent,
- 1 person living with GF diseases,
- 2 Media representatives,

And:
- 1 international NGO.

(b) reflecting geographical balance, and

(c) including the participation of representatives from vulnerable groups especially women, young people, children and drug users;

2. It is further recommended that:

Access to GFATM resources by CCMs also be conditional on the introduction of an electoral or nomination arrangement based on equal voting /consensus rights that promote continuity while protecting this composition of the CCMs as recommended above.

B. Representation

Despite the fairly encouraging range and numbers of individuals or organizations that already make up CCMs, their simple presence on the CCM is not effective representation unless members' constituencies have been involved in their selection, are able to consult with them and logistical and capacity building support is provided to facilitate their participation in CCMs’ activities.

3. It is recommended that:

(a) Explicit guidelines on the nomination and election of constituency representatives on CCMs be issued as soon as possible, and

(b) An agreed level of resources be made available for constituency development and functioning, including training in (locally-identified) leadership skills of constituency representatives.

C. Operations

Apparently, CCMs are instrumental in developing proposals and subsequent requesting of funds. Combining CCMs' oversight roles with executive functions of Principal Recipients (PR), Sub Recipients (SR) and service providers compromise the CCM-PR-SR-Service Providers chain of accountability as there will be considerable potential for conflicts of interest to arise. Even if Local Fund Agencies (LFAs) perform their functions optimally, the breakdown in this chain invalidates the accounting - accountability requirement in program performance.

4. It is recommended that:

(a) Guidelines and/or country level memoranda of agreement be developed in collaboration with relevant stakeholders spelling out the delegation of powers and responsibilities and conflicts of interest

(b) The effective and efficient function of the CCMs be resourced and supported through the delivery of governance education of the CCM vis-a-vis PR-SR and LFA

(c) Procedural policies and regulations be developed for the procurement of all programme funded goods with particular reference to drugs, test kits, reagents, etc.

D. Partnerships/Co-ordination

Partnerships and co-ordination mechanisms in the GFATM mechanisms present opportunities and challenges for innovation against the concerned diseases; opportunities because comparative advantages of the different partners can be garnered against the three diseases; and challenges because these partnerships have not always lent themselves to effectively working together.

5. It is recommended that the Global Fund:

(a) Help leverage technical support and non-grant resources to support full functioning of CCM Secretariats including support in conducting, monitoring and impact evaluation of GFATM-funded programs and services.

(b) Facilitate an independent media institution to produce a series of investigative articles in the public media on CCM partnerships, processes and GFATM funded services and programs, and

(c) Develop guidelines on the roles and functions of the different partners such as the private sector in CCMs and provide resources to generate debate and activities within CCMs on how partnerships can be optimized.


Endnote:

(i) Please refer to PartnersGF eForum at:

http://eforums.healthdev.org/read/?forum=PartnersGF


Chiang Mai, Thailand
Friday, June 25th 2004