Based on experiences from your own country, what should be the right size of any CCM to effectively discharge its responsibilities? Who determines how big or small a CCM should be and what is the basis of such decisions?

• CCM size should not be related to the population. We need more a manageable CCM with pro-active, knowledgeable people. The size should be big enough to foster a diversity of ideas and ensure fair representation, but at the same time, it must remain workable. Here in Afghanistan, the CCM is huge, which makes the simplest of tasks very difficult. We are planning to hire a consultant to help downsize the CCM.
  
  
• What do consider as huge for a CCM? In Azerbaijan, for two years our CCM consisted of 45 members - most of them passive members who did not understand their role in the CCM. Today we have we have 35 members, which is on the increase. In addition, we established an Advisory Board within the CCM to make it more manageable and effective. An Advisory Board has enabled our CCM to engage in long discussions with fewer, yet active, members.
  
  
• In Yemen, the CCM is two years old and has 26 members, who are relatively passive. One of the problems we have is that we do not know how to effectively share information because we do not understand our roles and responsibilities. I would be interested to know more about Vusalya’s role in the CCM.
  
  
• As CCM Secretary, I organize the CCM meetings and its Agenda, calling CCM meetings quarterly. In between these meetings I keep in contact with CCM members as well as the Grant Project Implementation Unit. My activities include defining the main issues for the CCM, drafting meetings’ minutes and sharing them among members for their comments, and finally with the Chair. When there is an urgent matter, I call on the Advisory Board.
  
  
• The structure of the CCM described by Dr Mohammad Fareed is indeed very interesting. We, too, wanted to establish an Executive Committee within the CCM, but the members were not able to reach an agreement on the word “Executive”, as it refers to decision-making – a level higher than the CCM itself. It was therefore changed to “Advisory Board”.
  
  
• The CCM of Afghanistan has about 34 members. We have an Executive Committee, Monitoring Committee, Advocacy Committee, Technical Committees to coordinate between PR and SR for the three diseases, and Temporary Committees to develop proposals and review new ones. We are currently looking for a qualified consultant to help us review the structure of our CCM. 
  
  
• Having a CCM which is limited in size makes it easier to find knowledgeable, committed people, and fewer compromises have to be made. Every country will eventually choose a number that suits its own reality. The critical issues are therefore representation and manageability. Where CCM size is important, it is not as important as its composition and performance, but can be linked to it. Composition should reflect the need and scope within a country. For example, for smaller populations, the requirement of representation can cause problems when a CCM has to include members that have no interest or commitment to the cause. It takes solid leadership at the CCM level to make a difference in the fight against the three diseases; it is worth remembering that countries are not only accountable to their donors, but also to their beneficiaries. 
  
  
•  In response to Dolores from Salomon Island post, Bonnet Mkhweli from the Global Fund Secretariat referred to the Global Fund Guidelines on the Purpose, Structure, Composition and Funding of Country Coordinating Mechanisms and Requirements for Grant Eligibility. These guidelines state that a CCM should determine the details of its functioning, including organizational structure, election procedures, frequency of meetings and terms of references. The Global Fund encourages that CCMs should remain of a manageable size in order to work and discharge responsibilities effectively. It is important to emphasise that size is not an eligibility requirement for CCMs. It terms of composition the only requirement on CCM membership that can make a CCM not eligible for funding is failure to show membership of People living with HIV/AIDS, TB and/or Malaria. One member is sufficient to meet this requirement. 
  
  
• Clearconscience from Cameroon questions the independence of the CCM in each country and if this policy is suitable to African countries. He questions how these results in guaranteeing that people living with the diseases are part of the CCM and states that 90% of the population of the communities in the rural areas of Africa has never benefit from Global Fund funded projects.
  
  
• In response to Clearconscience from Cameroon post, Bonnet Mkhweli from the Global Fund Secretariat explained that there are many successful and well functioning CCMs in Africa that have received Global Fund financing. He further explained thatall CCMs are required to show evidence of membership of people living and/or affected by the disease before they can be funded. The Global Fund has systems and procedures and human resources for monitoring the use of the funds as per the grant agreement signed with each country. In addition there is a Local Fund Agent, an organisation appointed by the Global Fund in each country to monitor and verify implementation and use of the funds as per the detailed plans included in a grant agreement signed between the Global Fund and the principal recipient of the funds in each country. There is also further information about which populations are benefiting from Global Fund resources, the funds that have been provided, and how that money has been used. This can be viewed in the Global Fund website by selecting a country.
  
  
• The CCM topic is very relevant at this stage of the Global Fund’s development. Because of their critical and central role in the Global Fund funding mechanism, more attention and efforts are needed at this level. I support the idea of downsizing CCMs in order to make them more effective and functional in many countries. Representation of all sectors is something that we need to advocate and promote continuously, but we have to acknowledge that in some cases it is difficult to achieve a comprehensive oversight of Global Fund-supported programs at country level through overcrowded CCM meetings. I see an effective CCM being advised by a team of local experts in different areas of programming, implementing, finance and reporting. The second aspect to emphasize is the need for CCMs to develop contextually adapted and tailored policies and procedures. However there's still an open question for the type of CCM required for large/populated and small countries. Discussions on cost implications of the CCM mechanism should also start among the stakeholders as there's now an opportunity for these national bodies to receive financial support from the Global Fund and other local donors.
  

Contributions by:
English: Dr Mohammad Fareed (2) (3), Vusalya G. Bakirova (2) (3), Yusef Alhadri, clearconscience, Bernard Mendy, dolores, Mr Ousmane Amadou SY

Good idea with high level of interest ballancing is equality and conventional  wisdom not at all with limitaion now figure your mind why be area of represntatives without accurate solution focus can we blame CCM Size or who reponsible with caim decission

How can we support this goal rather than figure print idea fight this global epidemic campaign  Contribute to idea solution

Keeping the records straight Geneva Convention  CCM Boards Member Solution and  respect

Cordinator MSF Foundation

Global Health

Meek

I totally agree that each country should be given the authority by Global Fund to be able to determine size of their CCMs.  However, we did this last year and we were told that we would not be eligible for funding because the Global Fund has a list of members which each country needs to abide to.  So, we have had to include members who have no interest or commitment to the cause just to meet funding eligibility.  How do we put this across to the GF? They need to know that their requirements for CCM are unrealistic for smaller populations/nations and needs to be reviewed so that the CCMs are functioning properly.  As individuals working on the ground and out in the field to deliver Global fund initiatives, we are also accountable to our beneficiaries, not just to our donors.

The size of the ccm is not important, but the composition and the performance of the ccm in any country.

How can we quarantee the performance to address the need. Even if the number of ccm in each country is reduced to 8 or less does not quaranteed the effective functioning of the ccm or will be more effective.

My suggestion is that the composition of the ccm in any country should be focused on the need, scope among others.
I will like to see other members of this forum comment on this point.

I have read through the varying comments on this important topic and wish to share the following:

It is true that size matters but representation is also equally key to the success of CCM objectives. Gambia has a CCM membership covering all sectors except for TB and Malaria! We are looking at how to get at least TB represented. Malaria we consider that CCM members are victims and are therefore representatives.

The Gambia CCM size is 30 and we meet every two months and the meetings are conducted well and we cover our agenda which includes review of each PRs performances and confirmation that all CPs have been met or not and why and what action is being taken to close them as a matter of urgency.

Minutes are circulated to the members before meetings and each meeting allows members to air their views. I take it that it takes solid leadership and focus at the CCM level to make the difference

For your information we still have not got a CCM Secretariat