The Aidspan Guide to Building and Running an Effective CCM
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| The Aidspan Guide to Building and Running an Effective CCM |
helb 2016/2017 first year disbursment - Second edition: September 2007
by
David Garmaise
Copyright © September 2007 by Aidspan. All rights reserved.
Table of Contents
Preface 4
List of Abbreviations and Acronyms 6
Chapter 1: Introduction and Background 7
Ten Most Common Problems Faced by CCMs 7
Purpose of This Guide 8
Target Audiences 8
How This Guide Was Put Together 9
Contents of This Guide 9
Note on Terminology 11
Overview of the Global Fund 12
Global Fund Policies and Guidance on CCMs 13
Chapter 2: The Place of the CCM in Country and Global Fund Contexts 15
Country Context 15
Role of the CCM 16
The CCM-Global Fund Relationship 16
The Politics of CCMs 17
Chapter 3: General Governance Issues 18
The CCM as a Board of Directors 18
Using Existing In-Country Coordinating Mechanisms as the CCM 18
Mandate Statement 19
Statement of Roles and Responsibilities 19
Core Principles 21
Relationship to Other Bodies 21
Terms of Reference 22
Incorporation 22
Chapter 4: Structure of the CCM 24
Size 24
Officers 25
Committees 26
Executive Committee 27
Secretariat 28
Chapter 5: CCM Membership 30
Representation from Different Sectors 30
Representation from People Living with the Diseases 31
Representation from Vulnerable Groups 33
Representation from Women 34
Ensuring Gender Expertise 34
Representation from Outside the Capital City 35
Membership: Individuals or Organisations? 35
Responsibilities of Members 36
Expertise Required 37
Commitment, Time and Energy Required 38
Selection Process 38
Sector Groups 40
Selection Criteria 41
How Well Are the Selection Processes Working? 41
Orientation for New Members 42
Other Membership Issues 43
Categories of Membership: Voting, Non-Voting, Observer 43
Do Members Need To Be Approved by the CCM? 43
Length of Terms 44
Failing To Turn Up for Meetings 44
Dealing with Turnover 44
Written Membership Criteria 45
Chapter 6: CCM Operations 46
Importance of Transparency 46
Importance of Government Leadership 46
Decision-Making Process 46
Full Participation of Members in the Deliberations and Work of the CCM 47
CCM Meetings 48
Holding Regular Meetings 48
Notice of Meetings, Advance Documentation, Minutes 48
Support for Member Attendance 49
Attendance by Non-CCM Members 49
Should CCM Meetings Be Open? 49
Language Issues 49
Accommodation 50
Covering CCM Expenses 50
Conflict of Interest 51
Chapter 7: Proposal Development 54
Introduction 54
Importance of Getting a Head Start 55
Designing and Implementing a Proposal Development Process 56
Integration with Other National Processes 57
The Submissions Process 57
Issuing the Call for Submissions 59
Reviewing Submissions 59
A Final Word 60
Selection of PR(s) and SR(s) 60
Putting Together the Final Proposal 63
Chapter 8: Project Implementation 64
Oversight Role of the CCM 64
How Should CCMs Monitor Progress in Project implementation? 66
How Should CCMs Work with PRs to Identify Issues and Develop Solutions? 67
Involving Other Stakeholders 68
The CCM-LFA Relationship 69
Chapter 9: Phase 2 Renewal 70
Chapter 10: Information Sharing and Constituency Communications 72
Sharing Information Inside the CCM 72
Sharing Information Outside the CCM 73
Constituency Communications 73
Means of Communication 74
Dealing with Language Issues 74
Chapter 11: Technical Support and Capacity Building for the CCM 75
Evaluating Needs 75
Sources of Funding 75
Where To Find TS 76
CCM Role in Developing a Broader TS Plan 77
Chapter 12: Evaluating CCM Performance and Problem-Solving Within the CCM 78
Evaluations 78
Problem-Solving 79
Annex I: Sample Terms of Reference 80
Annex II: List of Relevant Documents 91
Preface
This Aidspan publication is one of several free Aidspan guides for applicants and recipients of grants from the Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund). The following is a partial list of the guides that Aidspan has produced:
The Aidspan Guide to Building and Running an Effective CCM – This document (Second edition September 2007)
The Aidspan Guide to Effective Implementation of Global Fund Grants – Volume 1: From Grant Approval to Signing the Grant Agreement (First edition November 2005)
The Aidspan Guide to Understanding Global Fund Processes for Grant Implementation – Volume 2: From the First Disbursement to Phase 2 Renewal (forthcoming; scheduled for publication before the end of 2007) – This is the second volume of “The Aidspan Guide to Effective Implementation of Global Fund Grants” (see previous bullet). The title has been altered. When Volume 2 is published, Volume 1 will be re-issued, with the title changed to match the title of Volume 2.
The Aidspan Guide to Round 7 Applications to the Global Fund (March 2007)
The Aidspan Guide to Developing Global Fund Proposals to Benefit Children Affected by HIV/AIDS (May 2006)
The Aidspan Guide to Obtaining Global Fund-Related Technical Assistance
(First edition January 2004)
Downloads
To download a copy of any of these guides, go to www.aidspan.org/guides. If you do not have access to the web but you do have access to email, send a request to guides@aidspan.org specifying which of the currently-available guides you would like to receive as attachments to an email. Aidspan does not have the resources to produce or distribute printed copies of these guides.
Aidspan
Aidspan is a small NGO that works to promote increased support for and effectiveness of the Global Fund. Aidspan also publishes the “Global Fund Observer (GFO)” newsletter, an independent email-based source of news, analysis, and commentary about the Global Fund. GFO is sent to over 10,000 readers in more than 170 countries. To receive GFO at no charge, send an email to receive-gfo-newsletter@aidspan.org. The subject line and text area can be left blank.
Aidspan and the Global Fund maintain a positive working relationship, but have no formal connection, and Aidspan accepts no grants or fees from the Global Fund. The board and staff of the Fund have no influence on, and bear no responsibility for, the content of this guide or of any other Aidspan publication.
Acknowledgements, Permissions, Feedback
Aidspan thanks its funders for the support they have provided for 2003-2007 operations – the Open Society Institute, the Monument Trust, the John M. Lloyd Foundation, the MAC AIDS Fund, the Foundation for the Treatment of Children with AIDS, Glaser Progress Foundation, Irish Aid, Merck & Co., Anglo American, and four private donors.
Aidspan thanks the members of the advisory committee for this project for their very valuable input:
Aisha Baldeh, Medical Research Council, The Gambia
Mercy Bannerman, Consultant
Matthew Greenall, Consultant
Merle Mendonca, Guyana Human Rights Association
Daniel Meskovic, Coordinator, CCM Secretariat, Serbia
Ren Minghui, Deputy Director-General, Department of International Cooperation
Ministry of Health, China
Benjamin Safari, Catholic Relief Services USCCB, The Gambia
Catherine Severo, Management Sciences for Health
Martin Taylor, Department for International Development (DFID), UK
Wayne van Gemert, WHO TB Control Programme in the Russian Federation
Aidspan also thanks the staff of the Global Fund Secretariat for reviewing a draft of this guide and providing comments.
David Garmaise, author of this guide, can be reached at garmaise@aidspan.org. Bernard Rivers, Executive Director of Aidspan, can be reached at rivers@aidspan.org.
Permission is granted to reproduce, print, or quote from this document , in whole or in part, if the following is stated: "Reproduced from ‘The Aidspan Guide to Building and Running an Effective CCM – Second Edition,’ available at www.aidspan.org/guides."
Readers are invited to email David Garmaise at garmaise@aidspan.org with suggestions for improvements in the next edition of this guide. Also, if you find this guide useful, or if you have appreciated GFO or any other Aidspan guide, please let us know. Feedback of all kinds is always helpful.
List of Abbreviations and Acronyms
The following is a list of the abbreviations and acronyms used frequently in this Guide:
CBO Community-based organisation
CCM Country Coordinating Mechanism
COI Conflict of interest
FBO Religious- or faith-based organisation
GF Global Fund
GFO Global Fund Observer
HSS Health systems strengthening
LFA Local Fund Agent
MOH Ministry of Health
M&E Monitoring and evaluation
NGO Non-governmental organisation
Non-CCM Non-Country Coordinating Mechanism
NSA National Strategy Application
PR Principal Recipient
PRS Poverty Reduction Strategy
RCC Rolling Continuation Channel
RCM Regional Coordinating Mechanism
RO Regional Organisation
SR Sub-Recipient
SSR Sub-Sub-Recipient
SWAp Sector-wide approach
Sub-CCM Sub-National Country Coordinating Mechanism
TB Tuberculosis
TOR Terms of reference
TRP Technical Review Panel
TS Technical support
UNAIDS Joint United Nations Programme on HIV/AIDS
UNDP United Nations Development Programme
Chapter 1: Introduction and Background
This chapter lists the 10 most common problems faced by Country Coordinating Mechanisms (CCMs); describes the purpose of the guide; defines the target audiences; explains how the guide was put together; describes the contents of the guide; and contains a note on terminology. The chapter also provides a brief overview of the Global Fund and the Fund’s policies and guidance concerning CCMs.
Ten Most Common Problems Faced by CCMs
The following list describes ten problems that often arise with CCMs. The problems are not listed in any particular order. The list does not try to capture all problems, and not every CCM encounters all of these problems, but most CCMs face some version of several of the problems listed.
1. Often, the CCM's roles, responsibilities and operating methods are not clearly defined, and are not clearly understood by CCM members or outsiders.
2. Often, the CCM is dominated by government members (and sometimes by international agencies). Civil society and people living with the diseases are under-represented and have little influence.
3. Often, CCM members who are supposed to represent the non-government sectors were not chosen by these sectors and do not properly represent them.
4. Often, CCM members were not involved in choosing the CCM chair or in selecting the Principal Recipient (PR).
5. Often, there is no or insufficient representation from vulnerable populations on the CCM.
6. Often, there is no genuine involvement by all CCM members in the CCM decision-making process. Decisions are made in advance by the CCM chair and a few other CCM members. CCM officers do not share information within and outside the CCM.
7. Often, CCM members are asked to sign a proposal to the Global Fund even though they had no input into its preparation and little prior knowledge of its content.
8. Often, the CCM has not been able to obtain sufficient money, practical resources or expertise to operate effectively.
9. Often, CCM members do not have the capacity to participate effectively on the CCM.
10. Often, CCM members do not know whether projects funded through Global Fund grants are being effectively implemented.
A CCM that experiences all or many of these problems will have a hard time obtaining funding from the Global Fund, If the CCM is able to obtain funding, it will have a hard time ensuring that the projects financed through this funding are performing effectively.
Purpose of This Guide
“The Aidspan Guide to Building and Running an Effective CCM” tries to identify solutions to the problems outlined in the previous section, and to other problems as well. Civil society organisations from one African country told us that in that country:
the Ministry of Health (MOH) views the CCM as just another mechanism for obtaining funding;
the MOH does not see the CCM as a genuine national partner;
the MOH directly or indirectly selects the members of the CCM;
the MOH manages the functions of proposal development and project monitoring with little participation from the CCM;
the non-government sectors are not well represented on the CCM;
the CCM has no say in the selection of the PR; and
information is not shared with CCM members and non-members in a transparent manner.
This CCM is functioning extremely poorly. This guide has been designed as a practical tool to help CCMs such as this one become more effective. Even CCMs that function much better than the one described above can benefit from the advice in this guide.
The Global Fund has produced its own CCM Guidelines. Because they are fairly general in nature, this has led to a wide range of strategies and structures being developed for individual CCMs. The Fund's approach is respectful of local autonomy and of the differences among countries in practices and traditions. However, the lack of specificity in the guidelines creates some challenges. In a number of countries, CCMs are not functioning as well as they should be. Some CCM members in these countries seek more concrete suggestions for addressing issues such as how to ensure that all stakeholders are adequately represented on CCMs, and how to ensure that all CCM members are full and equal partners. This guide attempts to provide these suggestions.
It is worth emphasizing, however, that each CCM is different, that some are working better than others, and that what is a “good practice” for a CCM in one country may not work in another country.
While this guide has been written for CCMs, virtually all of the content applies equally to Sub-National Country Coordinating Mechanisms (Sub-CCMs), and much of the content is relevant to Regional Coordinating Mechanisms (RCMs).
Target Audiences
The primary target audiences for this guide are CCM members, including members from all of the sectors normally represented on a CCM – i.e., government; civil society (academic and educational institutions, NGOs and community-based organisations [CBOs], people living with the diseases, and religious and faith-based organisations [FBOs]); the private sector; and development partners (in-country multi- and bi-lateral development organisations).
Additional target audiences include PRs, Sub-Recipients (SRs) and Sub-Sub-Recipients (SSRs), who may or may not be members of the CCM; and individuals and organisations from the sectors listed above who interact with CCMs, or who have an interest in the operations of CCMs, but are not actually sitting on CCMs.
How This Guide Was Put Together
This guide is an updated version (second edition) of “The Aidspan Guide to Building and Running an Effective Country Coordinating Mechanism (CCM) – First Edition (16 December 2004).” An Advisory Committee was set up to critique the first edition and, for this second edition, to provide input on the outline, to provide additional information on the content and to review a draft of the guide. See the Preface for a list of the members of the Advisory Committee. In addition, the author reviewed the Global Fund’s guidance on CCMs and conducted additional research to obtain information on best and worst practices.
Although a draft of this guide was reviewed by a number of persons, responsibility for the final text resides entirely with Aidspan.
Contents of This Guide
The balance of Chapter 1 includes a note on terminology, a general description of the Global Fund and a discussion of the Fund’s policies and guidance concerning CCMs.
Chapter 2: The Place of the CCM in Country and Global Fund Contexts describes the country context in which the CCM operates and examines the role of the CCM, the relationship between the CCM and the Global Fund, and the politics of CCMs.
Chapter 3: General Governance Issues compares the CCM to a board of directors, explores the use of existing mechanisms as CCMs, discusses the issue of incorporation, and describes the relationship of the CCM to other national bodies. The chapter also provides guidance concerning the mandate, roles, responsibilities and core principles of the CCM.
Chapter 4: Structure of the CCM discusses the size of the CCM, what officers the CCM requires, the use of committees, and the role of the CCM Secretariat.
Chapter 5: CCM Membership discusses representation on the CCM from different sectors (including people living with the diseases), from vulnerable populations (including women) and from outside the capital city. The chapter also discusses the need for gender expertise on the CCM; explores the issue of whether membership should be accorded to individuals or organisations; and discusses the responsibilities of CCM members, the types of expertise the CCM requires, and the commitment, time and energy required. Finally, the chapter outlines the need for CCM members to be accountable to their constituencies; discusses issues concerning how CCM members are selected; describes the need for an orientation process for new members; and discusses a number of other membership issues.
Chapter 6: CCM Operations discusses the need to ensure that the CCM operates in a transparent fashion and allows for the full participation of its members in deliberations and decision-making. It also talks about the importance of government leadership. The chapter looks at a number of issues concerning how CCM meetings should be conducted; describes the need to accommodate the special needs of CCM member; outlines sources of funding for CCM operations; and discusses the need for a conflict of interest (COI) policy.
Chapter 7: Proposal Development explains the Global Fund requirements with respect to proposal development; discusses the steps involved in designing and implementing a proposal development process; and describes the CCM’s role in the selection of PRs and SRs.
Chapter 8: Project Implementation defines the CCM’s role in overseeing project implementation, discusses how the CCM should monitor progress in implementation, and explains how the CCM can work with the PR to identify problems and develop solutions. The chapter also discusses the importance of involving other stakeholders in the oversight process. Finally, the chapter describes the CCM-LFA relationship.
Chapter 9: Phase 2 Renewal reviews the CCM’s role in the Phase 2 renewal process.
Chapter 10: Information Sharing and Constituency Communications describes ways in which the CCM can share information both inside and outside the CCM, and how CCM members can maintain good communications with their constituents.
Chapter 11: Technical Support and Capacity Building for CCMs describes the need for the CCM to evaluate its technical support and capacity building requirements; identifies sources of funding; and discusses where technical support can be obtained.
Chapter 12: Evaluating CCM Performance and Problem-Solving Within the CCM explains how self-assessments and external evaluations can help to improve the functioning of the CCM; and discusses how the CCM can address problems concerning how the CCM operates.
Annex I: Sample Terms of Reference contains a “model” terms of reference (TOR) that CCMs can adapt when they develop their own TOR.
Annex II: List of Relevant Documents contains a list of the documents related to CCMs that are cited in this guide, and provides information on how to obtain copies of the documents.
Throughout the guide, examples have been provided of actions taken by individual CCMs; these examples have been placed in shaded text boxes.
This guide deals extensively with the six minimum requirements that CCMs have to meet. These requirements are outlined in bold in the last section of Chapter 1. As well, some of the chapters and sections begin with extracts from these minimum requirements; the extracts are outlined in bold and are shaded.
Note on Terminology
People Living with the Diseases
In this guide, the term “people living with the diseases” refers to people living with HIV/AIDS, tuberculosis, or malaria.
Sector Classifications
Global Fund documents identify seven sectors that should be represented on CCMs, as follows:
government;
in-country multi- and bi-lateral development partners;
academic and educational institutions;
NGOs and CBOs;
people living with the diseases;
FBOs; and
organisations and companies from the private sector.
In Global Fund documents, and elsewhere, the sectors are often grouped into two classifications: (a) government; and (b) non-government. In this context, “government” is considered to include in-country multi- and bi-lateral development partners. The term “non-government sectors” usually encompasses all sectors other than government and development partners. In this guide, the term “civil society” encompasses all of the non-government sectors with the exception of the private sector. These classifications and groupings are illustrated in the following table:
Table 1.1: Sectors Represented on the CCM
Government
Government
In-country multi- and bi-lateral development partners
Non-Government
Civil Society Academic and educational institutions
NGOs and CBOs
People living with the diseases
FBOs
Private Sector
Stakeholders
The term “stakeholders” refers to organisations and individuals actively working on, or impacted by, the fight against HIV/AIDS, TB or malaria.
Proposals and Submissions
In this guide, “country coordinated proposal” (“proposal” for short) refers to the proposal that a CCM submits to the Global Fund. The term “in-country submission” (“submission” for short) describes the “mini-proposals” that in-country stakeholders may submit to the CCM for possible inclusion in the country coordinated proposal.
Overview of the Global Fund
Author’s Note: Most readers will already be very familiar with the how the Global Fund works, so they may want to skip this section. We have chosen to include it because it provides information on the Global Fund philosophy and on the roles of PRs and LFAs that is germane to the content of this guide.
The effort of the Global Fund to mobilize and disburse new levels of resources against AIDS, TB and malaria has captured the world’s attention. Beyond its significant role in securing and channelling new funding commitments, the Global Fund also acts as a catalyst for improvements in the way that countries and the world fund and implement programmes for public health.
The Global Fund is a multi-billion-dollar international financing mechanism intended to help advance the fight against AIDS, TB and malaria by dramatically increasing the availability of funding for practical health initiatives. Funding is allocated to disease prevention, treatment, and care and support. Funded activities include both piloting of new and innovative projects and scaling up of existing interventions. The objective is to make it easier for affected countries to improve availability of health services, build national capacity, promote behaviour change, conduct operational research and gain access to critical health products, such as medicines to treat HIV/AIDS, TB and malaria.
In its first six rounds of funding, the Global Fund approved 444 proposals, involving potential expenditures of US$4.7 billion over two years.
One of the basic principles of the Global Fund is that it is country-driven (see box). The Fund does not say, “We will give you a grant if you use it in the way that we instruct.” Instead, the Fund in effect says, “What will you do if you receive a grant? What results will you achieve? If we believe that you can indeed achieve those results, if we believe that the results represent good value, and if we have enough money, we’ll give you the grant.”
The Global Fund is primarily designed to work through existing or new multi-sectoral partnerships in developing countries – partnerships known as “Country Coordinating Mechanisms (CCMs).” The CCMs develop and submit grant proposals to the Global Fund. The proposals are reviewed by the Technical Review Panel (TRP), an independent group of experts, which makes recommendations to the Global Fund Board. The final decisions as to which proposals are funded rests with the Board.
Once a grant is approved, the CCM oversees progress in the implementation of the projects financed by the grant. For each grant, the CCM nominates a public or private organisation to serve as Principal Recipient (PR). (There can be more than one PR.) The PR is legally responsible for implementing the grant. The Global Fund Secretariat channels funding for the grant through the PR. The PR usually disburses some of this funding through Sub- Recipients (SRs) and Sub-Sub-Recipients (SSRs).
The PR works with the Global Fund Secretariat to develop a two-year grant agreement that identifies actions to be taken, costs to be incurred and results to be achieved over time. Once the grant agreement is signed, a first disbursement of funds is made to the PR. Over the course of the grant agreement, the PR requests additional disbursements based on demonstrated progress towards the intended results. This performance-based system of grant-making is key to the Global Fund’s commitment to results.
The Global Fund Secretariat also contracts with a Local Fund Agent (LFA) in each country. The role of the LFA is to serve as the Fund's "eyes and ears" within the country, evaluating the financial management and administrative capacity of the nominated PR and monitoring the performance of the PR.
Global Fund Policies and Guidance on CCMs
Over the years, the Global Fund has adopted a number of policies concerning CCMs – a mix of requirements that CCMs have to meet in order for their proposals to be considered for funding and recommendations that the Global Fund suggests CCMs adopt. These policies are described in two main documents:
“Revised Guidelines on the Purpose, Structure and Composition of Country Coordinating Mechanisms and Requirements for Grant Eligibility” (hereinafter “CCM Guidelines”)
“Clarifications on CCM Requirements – Round 7” (hereinafter “CCM Clarifications”)
Throughout this guide, we quote frequently from both documents. (For information on how to obtain these documents, please see Annex II.)
The second document was first drafted at the outset of Round 6 and was revised for Round 7. It is likely that the Global Fund will revise this document for each new round of funding.
Because of the country-driven philosophy of the Global Fund, the Fund was initially reluctant to dictate how CCMs should be run. However, the Fund also believes that multi-sectoral partnerships at country level (and at all levels) are critical to the success of programmes to fight the three diseases. In the first few rounds of funding, many CCMs did not embody this spirit of partnership. As a result, the Fund started to impose certain requirements on CCMs. It began by requiring that there be representation on the CCM from people living with or affected by the diseases. Later, additional requirements were added concerning the selection process for members of the CCM from the non-government sectors, the preparation of proposals, the nomination of the PR, grant oversight and policies to mitigate possible COI.
Today, the Global Fund refers to these requirements as “The Six Minimum Requirements for Grant Eligibility for Country Coordinating Mechanisms.” The six minimum requirements are as follows:
1. CCM members representing the non-government sectors must be selected or elected by their own sector(s) based on a documented, transparent process, developed within each sector.
2. CCMs must show evidence of membership of people living with and/or affected by the diseases.
3. CCMs are required to put in place and maintain a transparent, documented process to solicit and review submissions for possible integration into the country coordinated proposal.
4. CCMs are required to put in place and maintain a transparent, documented process to ensure the input of a broad range of stakeholders, including CCM members and non-members, in the proposal development and grant oversight process.
5. CCMs are required to put in place and maintain a transparent, documented process to nominate the PR and oversee project implementation.
6. When the PRs and chair or vice-chairs of the CCM are the same entity, the CCM must have a written plan in place to mitigate against this inherent conflict of interest.
If a CCM submitting a proposal to the Global Fund does not meet all six minimum requirements, there is a good chance that the proposal will be screened out even before it is reviewed.
The CCM Clarifications document states that
CCM requirements are more than paper formalities. They define a basic set of actions necessary to develop comprehensive proposals and oversee and guide the implementation of resulting grants. The spirit of these requirements is to ensure multi-stakeholder inclusiveness. Frequently, governments have institutional resources that far outstrip those of civil society groups and are therefore able to organize a comprehensive, national proposal without their input. The new requirements help to “level the playing field,” and stems from the GF’s firm belief that wide participation leads to better program results and faster implementation. They encourage the fair participation of all stakeholders and help ensure the voice of civil society and other non-governmental stakeholders.
Chapter 2: The Place of the CCM in Country and Global Fund Contexts
This chapter describes the country context in which the CCM operates; briefly defines the role of the CCM; outlines the relationship between the CCM and the Global Fund; and discusses the politics of CCMs.
Country Context
The CCM does not operate in a vacuum. Some countries have national strategies for one or more of the three diseases, though these strategies are sometimes weak and may not be operationalized with clear budgets. In the case of HIV/AIDS, many countries have implemented the Three Ones, which means that in addition to a national AIDS strategy, there is a national AIDS programme or council (which sometimes takes the form of a multisectoral committee) and a national monitoring and evaluation (M&E) system for HIV/AIDS. Not all national HIV/AIDS programmes or councils are functional, however.
Many countries have Roll Back Malaria Committees and National Steering Committees on TB Control. Some countries, especially whose with cross-border health issues, take part in regional disease strategies.
In addition, some developing countries have developed Poverty Reduction Strategy Papers (PRSPs) or have adopted sector-wide approaches (SWAps).
The CCM has to ensure that its work meshes with these various strategies and bodies. (See “Relationship to Other Bodies” in Chapter 3: General Governance Issues for a discussion about how the CCM can establish formal links with other bodies.) By the same token, the CCM needs to ensure that it does not interfere with these other strategies and bodies.
Role of the CCM
The CCM Guidelines state that
[t]he Global Fund recognizes that only through a country-driven, coordinated and multi-sector approach involving all relevant partners will additional resources have a significant impact on the reduction of infections, illness and death from the three diseases. Thus, a variety of actors, each with unique skills, background and experience, must be involved in the development of proposals and decisions on the allocation and utilization of Global Fund financial resources…
and that to achieve this
…the Global Fund expects grant proposals to be coordinated among a broad range of stakeholders through a Country Coordinating Mechanism (CCM), and that the CCM will monitor the implementation of approved proposals.
The CCM has an internal and an external role. Internally, the CCM must determine the priorities for future proposals through gap analyses, often relying on analyses done by the national programmes or other lead agencies and partners. It is the CCM that must assess the gaps among the three diseases and make the decision on specific themes. Then the CCM must ensure that the funds it is requesting in its proposals will be additional – i.e., not replacing funds which should be provided by the government or simply taking over a programme funded by another donor whose grants have run out. The CCM is responsible externally to the Global Fund to guarantee that the principle of additionality is respected. The responsibility for harmonization of moneys received from the Global Fund with other efforts within the national response to the diseases is an important one, often overlooked by CCMs.
In many countries, CCMs fulfil their role admirably. When the process works, it often works very well. In other countries, however, CCMs are often only of interest because it is not possible (or very difficult) to submit a proposal without one. In these countries, just before a proposal deadline, there is a wave of excitement around the CCM, largely aimed at ensuring that the CCM fulfils whatever conditions the Global Fund has in place for accepting projects. Invariably the process is then rushed and not meaningful. The Global Fund is hoping that some of the measures it has adopted recently will alleviate these problems somewhat. These measures include (a) sticking with one fixed round of funding a year and announcing the application deadlines well in advance; and (b) more ardent application of the six minimum requirements for CCMs.
We should also point out that the responsibility of the CCM is limited, in that it is the PR and not the CCM that is responsible for the execution of the grant.
The CCM-Global Fund Relationship
The CCM Clarifications document states that since the start of the Global Fund
the CCM has been established as a central pillar of the Global Fund’s (GF) architecture to insure country-driven, coordinated, and multi-sector processes for leveraging and effecting
additional resources to reduce morbidity and mortality from HIV/AIDS, TB, and Malaria.
The Global Fund believes that a strong CCM is critical to the success of Global Fund-supported projects. As indicated above, the Fund has established a number of requirements that CCMs have to meet in order to be eligible for funding.
The vast majority of proposals approved by the Fund emanate from CCMs, so obviously the CCM-Global Fund relationship is a critical one. And yet, there is no contractual relationship between the CCM and the Global Fund. While CCMs submit proposals, once they are approved the Fund enters into contracts (grant agreements) with PRs, not CCMs, concerning the implementation of the projects. The CCM is expected to play an oversight role during implementation, but it is the PRs that are accountable for performance.
The CCM-Global Fund relationship takes on greater importance again at the end of the first two years of each grant, at the time of Phase 2 Renewal, because CCMs are responsible for submitting the Requests for Continued Funding. But, once Phase 2 is approved, and the grant agreements with the PRs are extended, the PRs are once again accountable for results.
Once grant agreements are signed, a CCM cannot really stop a project, but it can draw the Global Fund’s attention to any implementation problems it spots.
Thus, the CCM-Global Fund relationship is somewhat convoluted, and is often not clearly understood by the CCMs themselves.
The Politics of CCMs
While most stakeholders that participate in CCMs have a concern for the “greater good,” it must be recognized that these stakeholders are sometimes also influenced by individual prerogatives and preferences. At the end of the day, the Global Fund is about money, and CCMs are largely about who gets the money, and about the relative role of government. The politics of this are of great consequence to how CCMs operate.
But it is not just about money. Most CCMs are likely to be an ideological battleground. Governments are interested in protecting existing national policies. Donors are interested in protecting the investments their governments have made in the Global Fund and in various countries. As well, donors and international partners that have a particular view of the world (e.g., Unicef on breastfeeding; USAID on abstinence and sex work) are likely to promote those views within the CCM. Finally, civil society organisations use CCMs to advance their particular issues.
The different players represented on the CCM all want to see results but do not always agree on the best way of getting there. In the end, therefore, the CCM is a highly political body, and conflicts within this body are inevitable. (This guide tries to identify when these conflicts may arise and to provide guidance on how to mitigate them.)
Chapter 3: General Governance Issues
This chapter explains how the CCM can be viewed as a board of directors; discusses the possible use of existing mechanisms as CCMs; and provides guidance concerning the mandate, roles, responsibilities and core principles of the CCM. The chapter also discusses the relationship of the CCM to other national bodies. Finally, the chapter describes the importance of developing terms of reference, and explores whether or not the CCM should legally incorporate.
The CCM as a Board of Directors
The three principal roles of the CCM are (a) to submit proposals to the Global Fund; (b) to nominate the PR; and (c) to oversee the implementation of projects funded by Global Fund grants. The experience of the first six rounds of funding shows that the first two roles are more easily understood than the third.
With respect to the oversight role, perhaps the best way to approach it is to say that the CCM ought to function similarly to a board of directors in the private sector. The CCM Clarifications document says that
[l]ike a board, the CCM is ultimately responsible for the actions and welfare of the institution, yet it generally does not get involved with day-to-day operations. The CCM sets the essential policy framework, monitors organizational progress towards meeting targets, and reviews fiduciary issues generally within the confines of regularly scheduled meetings. It intervenes in day-to-day operations only in extraordinary circumstances.
Even with respect to its other roles – submitting proposals to the Global Fund and nominating the PR – the CCM can also operate essentially as a board of directors, establishing committees to coordinate the proposal writing process and to identify potential PRs, and then approving (or modifying) the recommendations of these committees.
There are limits to the board of directors analogy – for example, neither the Global Fund nor any other entity can dismiss or sanction CCM members (unlike shareholders in a private company with respect to the company’s directors) – but the analogy may still be a useful one in some countries.
Using Existing In-Country Coordinating Mechanisms as the CCM
Although in most countries, CCMs have been set up as separate entities, it does not have to be done that way. In fact, the Global Fund’s Framework Document, written when the Global Fund was established, says that CCMs should preferably be an already existing body.
Some countries are now finding that multiple coordination mechanisms (especially for AIDS) increase their workload. This may be an argument for these countries to integrate the CCM into another existing mechanism. However, this would present a few challenges. If, for example, the CCM is integrated into an existing HIV/AIDS coordinating body – which has happened in some countries (see box) – how does the coordinating body ensure that the needs of TB and malaria are addressed?
Another challenge is to ensure that the existing coordinating body operates in a fully participatory and democratic fashion (something that CCMs themselves are supposed to do). Governments may have even more power on existing coordinating bodies than they do on CCMs.
Finally, if the CCM is integrated into an existing coordinating body – say, an HIV/AIDS body – there is a danger that the entire national response to HIV/AIDS will be seen as a Global Fund project.
Each country will have to judge for itself whether integration of the CCM with an existing body makes sense. If the CCM is to be integrated, it should be done in a way that maintains the diversity of the CCM, allows the CCM to function with full participation of all relevant sectors, and maintains the focus on all three diseases covered by the Global Fund.
Mandate Statement
Every organisation needs a mandate statement – a statement that describes why the organisation exists. It is important that the mandate statement be developed at a full meeting of the CCM, be agreed upon by the CCM and be clearly understood by all stakeholders. The CCM may want to bring in an outside facilitator to help with the process of developing the mandate statement (and determining the core principles and the roles and responsibilities of the CCM – see below).
Here is what a mandate statement might look like:
The mandate of the CCM is to develop and submit proposals to the Global Fund, and to monitor, evaluate and support the implementation of projects that are initiated by the CCM and financed by the Global Fund.
Statement of Roles and Responsibilities
Once the CCM has worked out its mandate, it should go on to develop a statement of roles and responsibilities which sets out in more detail what the CCM does. If CCM members do not have a clear sense of the roles and responsibilities of the CCM, the CCM is unlikely to function effectively. The CCM’s role statement should be discussed and agreed on at a full meeting of the CCM.
The CCM Guidelines define the role of the CCM as follows:
Coordinate the submission of one national proposal for funding, drawing on the strengths of various stakeholders to agree on strategy, identify financing gaps in achieving the strategy based on existing support, prioritize needs, and identify the comparative advantages of each proposed partner;
Select one or more appropriate organization(s) to act as the Principal Recipient(s) (PR) for the Global Fund grant;
Monitor the implementation of activities under Global Fund approved programs, including approving major changes in implementation plans as necessary;
Evaluate the performance of these programs, including of Principal Recipient/recipients in implementing a program, and submit a request for continued funding prior to the end of the two years of initially approved financing from the Global Fund; and
Ensure linkages and consistency between Global Fund assistance and other development and health assistance programs in support of national priorities, such as PRS or SWAps.
The CCM’s role statement should be consistent with what the CCM Guidelines say, but it does not have to be identical. Some of what is contained in the CCM Guidelines goes beyond defining the CCM’s role and describes how the CCM should carry out its functions.
The CCM Guidelines contain a separate, seven-point description of the responsibilities of the CCM. We do not repeat this description here because the list is really a mix of CCM responsibilities, individual member responsibilities, core principles by which the CCM should operate, and other items already covered elsewhere in the guidelines. (All of the seven points listed in the guidelines are covered in one way or another in this guide.)
As well, it is sometimes difficult to differentiate between what is a role and what is a responsibility. With that in mind, based on what is contained in the CCM Guidelines, and taking into account some of the recent changes in the role of the CCM, we have prepared the following combined statement of how the role and responsibilities of a typical CCM could be described:
Ensure that all relevant stakeholders are represented on the CCM.
Ensure that the CCM is responsive to the needs of its stakeholders.
Ensure that information concerning the CCM and the Global Fund is communicated widely to relevant stakeholders.
Promote linkages and consistency between projects funded by the Global Fund and other related development and health programmes.
Prepare and submit proposals to the Global Fund that are in line with national AIDS, tuberculosis, and malaria priorities and programmes.
Respond to inquires from the Global Fund concerning these proposals.
For each proposal, nominate the PR(s) who will be responsible for implementing the project, should the proposal be approved.
For each proposal, select the SR(s) who will be involved in the implementation of the project, should the proposal be approved.
Monitor and evaluate the implementation of projects financed by Global Fund grants (including the performance of the PRs and SRs).
Approve major changes in project implementation plans that have been proposed by the PRs.
When necessary, submit requests to the Global Fund for re-programming of approved grants.
Submit to the Global Fund Requests for Continued Funding for each approved grant (as required).
Review progress reports that have been or are about to be sent to the Global Fund by the PRs.
Individual CCMs will need to adjust this statement of roles and responsibilities to fit their particular situation.
Core Principles
The CCM Clarifications document states that
[r]educing the social and economic impact of the three diseases requires an extraordinary commitment to open governing processes and new partnerships. No one single institution or government or NGO can solve the multiple challenges of AIDS, tuberculosis, or malaria. New partnerships are needed and these new partnerships function best when they operate in a climate of shared information, open processes, and clear actions that everyone understands and can openly discuss.
The CCM ought to develop a set of core principles by which it will operate. The following is a list of principles which CCMs could adopt:
The CCM will operate as a national consensus group and will promote true partnership in the development and implementation of Global Fund-supported projects.
The CCM will include representation from all relevant sectors.
Representatives from the non-government sectors will be selected by the sectors themselves.
The CCM will be fully transparent in its decision-making.
All members of the CCM will be treated as equal partners, with full rights to participation, expression and involvement in decision-making.
(Note that all of these principles are contained in the CCM Guidelines, though they are not identified as principles.)
Why are these principles important? Because full and meaningful participation from all sectors, and an open and transparent process, will help to ensure that marginalized groups are not left out of projects, that projects reflect the needs of the populations being targeted, that projects have buy-in from all relevant sectors, and that lessons learned are taken into account – all of which will result in better proposals and projects.
Relationship to Other Bodies
The CCM Guidelines state that
[w]herever possible, CCMs should build on and be linked to existing mechanisms for planning at the national level and be consistent with national strategic plans. CCMs could, for example, build on national programs for the specific diseases (e.g., National AIDS Councils, Roll Back Malaria Committees and National Steering Committees on TB Control) and National Health Strategies and be linked to broader national coordination efforts including Poverty Reduction Strategies (PRS) and Sector Wide Approaches (SWAps).
“Wherever possible” are perhaps the operative words in the above extract. It makes sense to establish these linkages wherever national coordinated disease programmes are inclusive of the people most infected. However, in countries where many groups disproportionately affected by AIDS, TB and malaria are marginalised, harmonisation and alignment can mean their exclusion. This is particularly the case where government-led programmes are not inclusive of sex workers, injection drug users or gay men.
So, where it makes sense to do so, the CCM should establish formal linkages with appropriate bodies (usually government bodies). Formal linkages are useful because they will help to ensure coordination and harmonisation among the various entities in terms of the response to the three diseases.
One example of a formal linkage would be for the CCM to submit regular written reports to the government bodies. Another example would be for the CCM chair or vice-chair to hold regular meetings with the chairs or other representatives of these bodies. At the very least, either the chair or another CCM member should know that it is his or her responsibility to report to government on an agreed basis on progress and issues.
Some of these government bodies may be formally represented on the CCM already. Or, some people may be members of both the CCM and one of these bodies. There is a danger, however, that this could actually jeopardize formal reporting relationships between the CCM and the other bodies – i.e., if it is just assumed that the presence of the representatives from these bodies is sufficient linkage.
Terms of Reference
The roles, responsibilities and core principles of the CCM, as well as the relationship of the CCM to other bodies, should be described in a terms of reference (TOR) document. The TOR should also describe the structure and operating methods of the CCM (these are discussed in the following chapters). TORs are sometimes called “governance manual,” “operating procedures,” or "constitution."
Preparing a TOR that provides a formal description of how the CCM is structured and how it operates will improve the effectiveness of the CCM and make it more transparent (and, therefore, more accountable). This description will be invaluable both to members of the CCM and to outsiders who need to deal with the CCM; and will make disputes internally or with other parties less likely – or at least much easier to resolve.
We have provided a sample TOR in Annex I of this guide.
The CCM should ensure its TOR document is widely disseminated within and outside the CCM. Distribution outside the CCM should be to interested stakeholders who are not represented directly on the CCM.
Incorporation
A few countries have decided to legally incorporate their CCMs as a foundation or non-for-profit corporation, complete with bylaws.
In countries with a supportive legal system, incorporation could provide the benefit of an “enforceable” governance structure. In other words, the legal system could be used as a recourse to resolve issues where a CCM makes decisions that are seen as being inconsistent with its own TOR or governance procedures. Another advantage of being legally incorporated is that the CCM could enter into legal agreements with other entities.
The advantages of incorporation may be greater if the CCM feels that it has a role that goes beyond the Global Fund – for example, if the CCM opts for a bigger mandate that involves obtaining funding for large-scale health projects.
Of course, if a CCM achieves legal status through incorporation, it exposes itself to litigation by “dissatisfied parties." For example, it runs the risk of being sued by applicants whose submissions were not included in the proposals forwarded by the CCM to the Global Fund. An incorporated CCM would need to consider appropriate insurance protections; this would involve some additional costs.
Another potential disadvantage of being legally incorporated is the lack of flexibility in making changes to the structure or operations of the CCM. Changing bylaws can be a very onerous process. However, this lack of flexibility may be seen as an advantage by, for example, marginalised populations in a government-controlled environment.
If a CCM decided to incorporate, bylaws would need to be developed. These could be very similar to what would be included in a CCM’s TOR.
Chapter 4: Structure of the CCM
This chapter discusses issues concerning the structure of the CCM – specifically, the size of the CCM, what officers the CCM requires, the use of committees and the need for a secretariat.
Size
In a survey conducted after the fourth round of funding, it was revealed that the size of CCMs ranged from a low of eight members to a high of 55 members. Almost half of the CCMs had between 20 and 30 members, just over a quarter had more than 30 members, and most of the rest had between ten and 20 members.
The CCM Guidelines say that the CCM should be of a size that is ”manageable” and permits it to discharge its responsibilities effectively.
Deciding just how large the CCM should be is a bit of a balancing act. On the one hand, if you have a very large CCM, there is a danger that meetings will become too formal, featuring speeches rather than discussion. A large CCM is more costly to run. A large CCM may make it harder to get a quorum and to get signatures on proposals to the Global Fund; and may make it more difficult to make important decisions, resulting in such decisions being made behind the scenes by the more powerful members.
On the other hand, the CCM has to be large enough to include representation from all of the sectors that need to be included to reflect a true public-private partnership – i.e., the government; in-country multi- and bi-lateral development partners; NGOs and CBOs; the academic and educational sector; people living with the diseases; FBOs; and the private sector. Ideally, the CCM should also include representation from all areas of the country.
If your country has a federal system of government, the CCM will probably need to include representation from sub-national levels of government. Note, however, that countries have the option of creating sub-national CCMs; this may be the preferred course of action in extremely large countries.
Exactly what size is right for a particular CCM will depend on a number of factors, including:
the size of the country;
the administrative structure of the country;
the number of organisations that the CCM thinks should be represented on the CCM;
the extent to which each sector is homogeneous and thus can be fairly represented by a small number of CCM members; and
the balance that the CCM thinks is required among the different sectors.
However, on balance, we believe that with respect to the size of a CCM, “less is more.” The smaller the CCM, the easier it is to manage. A small CCM does not constrict broader participation outside the CCM. This broader participation can happen in a variety of ways, including (a) through sectoral and thematic meetings organised by CCM members with the broader constituencies for which they are responsible; and (b) by appointing non-CCM members (i.e., resource persons) to CCM committees (see “Committees” below). The establishment of formal sector groups is another way to keep the size of the CCM manageable. (See “Selection Process” in Chapter 5: CCM Membership.)
The larger the CCM, the more important it will be to consider setting up committees within the CCM. Managing a CCM that has more than 30 members (and that still wants to have genuine discussions) will be a challenge, no matter what the structure, so we suggest that you not allow your CCM to get this large.
We suggest that you not make any final decisions about the size of your CCM until you have spent some time considering the composition of the CCM (see Chapter 5: CCM Membership).
Officers
The CCM Guidelines state that the CCM should elect a chair and a vice-chair. They also, recommend that the chair and vice-chair come from domestic organisations, and that the people elected to these positions come from different sectors.
Despite this guidance, historically the chairs and vice-chairs for most CCMs have both come from the government sector. The Global Fund’s analysis of CCMs at the end of Round 4 found that all but three of the 78 CCMs that responded to the survey had chairs from the government sector, usually the MOH, and that about two-thirds of the CCMs had vice-chairs from the government sector. There Is evidence, however, that this situation is changing, albeit slowly. The current chairs of the CCMs in Senegal, Mozambique, The Gambia and Madagascar, for example, are from the private sector. As well, increasingly, representatives of civil society organisations are fulfilling the role of chair or vice-chair.
The rationale for having the chair and the vice-chair represent different sectors is that this reinforces the public-private partnership that is at the core of the Global Fund approach. It also makes it more likely that the vice-chair could resist an unpopular idea being pushed by the chair.
To avoid a COI situation, the CCM Guidelines recommend that PRs and the chairs or vice-chairs of CCMs not be the same entity. (See “Conflict of Interest” in Chapter 6: CCM Operations.)
We suggest that the candidates for chair and vice-chair be nominated and seconded by CCM members; that the chair be elected by a vote of the CCM; and that the vote be by secret ballot. Further, we suggest that the CCM determine a length of term for the chair and vice-chair.
The responsibilities of the chair could include the following:
chair CCM meetings;
propose and seek approval of the agenda of each CCM meeting;
inform the CCM of the activities of the Executive Committee, if any;
when necessary, make decisions between CCM or Executive Committee meetings;
seek the opinion of the vice-chair on all important matters; and
when necessary, delegate certain responsibilities and decisions to the vice-chair.
The responsibilities of the vice-chair could include performing tasks designated by the chair, and standing in for the chair when the chair is unable to fulfil his or her functions.
The chair can be from any sector. There is nothing in the CCM Guidelines that says that the chair has to come from the government sector. The CCM may want to consider introducing a system of rotation whereby the chair is elected from among the government representatives one term, and from another sector the following term. The CCM may want to specify that when the chair is from a sector other than government, the vice-chair will be elected from among the government ranks.
It is important that no one serve too many years as chair. The CCM needs fresh leadership from time to time. If the CCM decides that the term of office for the chair and the vice-chair is one year, it may want to consider stipulating that no one person may hold the same office for more than three successive terms.
We suggest that if the chair resigns or is removed in mid-term, the vice-chair should serve as chair until a new chair is elected. We suggest that the election of the new chair take place at the meeting at which the chair's departure is announced, or at the next meeting. Finally, we suggest that the CCM have the option of (a) appointing a new chair only to complete the term of the former chair, or (b) appointing a new chair to complete the term of the former chair and serve an additional term beyond that. The reason for the latter is that if the term of the former chair has only a few months left to run, the CCM may want to avoid back-to-back elections.
The responsibilities of the chair and vice-chair, how they are selected, and what their terms of office are should all be spelled out in the CCM’s TOR.
The CCM may also want to consider establishing positions for other officers, such as a Secretary or Treasurer. If, as we recommend below, the CCM establishes a CCM Secretariat, then these other officer positions may not be required.
Committees
Many CCMs, particularly the larger ones, have established one or more committees. The purpose of these committees is to divide up the workload, to make the best use of the expertise on the CCM, and to increase the efficiency of the CCM. These committees are variously called standing committees, ad-hoc committees, expert committees, working groups, task teams and panels. Generally speaking, standing committees are permanent – i.e., ongoing – while ad-hoc committees, working groups, task teams and panels are temporary – i.e., established for a particular task that has a limited time frame.
Committees that individual CCMs have established include:
an executive or steering committee;
working groups to oversee proposal development (sometimes these are disease-specific);
committees to monitor and evaluate project implementation;
fundraising committees;
communications committees; and
working groups to prepare Phase 2 Requests for Continued Funding.
If the CCM decides to establish standing committees, the CCM’s TOR should spell out the composition, selection process and operating procedures for these committees. If the CCM decides to establish ad-hoc committees or working groups (etc.), it is probably not necessary for these to be enshrined in the TOR. A motion passed at a meeting of the CCM should be sufficient.
The CCM may want to provide the committees it establishes with a budget to enable them to carry out their work.
The membership of some committees should be determined by the expertise required. For certain committees, however, such as a committee to oversee proposal development, it is important to ensure that that the membership of the committee includes CCM members from each sector that is represented on the CCM.
As well, there are significant benefits to appointing some non-CCM members (i.e., resource persons) to some of the CCM committees. First, this allows the committees to benefit from expertise not readily available on the CCM. Second, it allows the CCM to broaden its reach and help to fulfil one of the six minimum requirements for CCMs – i.e., ensuring the input of a broad range of stakeholders. Third, it helps to prevent the CCM from becoming a club of familiars. We suggest that resource persons appointed to CCM committees be approved by the full CCM.
Ideally, CCM committees will make decisions by consensus. However, if there is to be voting in committee, and if the CCM deems it appropriate, the CCM can specify that resource persons on the committees have non-voting status. The chair of each committee should be a CCM member.
Executive Committee
Unless the CCM is very small, it will probably want to establish an Executive Committee that is empowered to take some decisions between meetings. If the CCM does establish an Executive Committee, to avoid any misunderstandings the CCM should decide (and should spell out in the TOR) exactly what the responsibilities of the Executive Committee are. Here are two options for the CCM to consider:
Option A – List precisely what kind of decisions the Executive Committee can make.
Option B – Limit the powers of the Executive Committee to decisions specifically delegated to the Committee at a full meeting of the CCM.
If the CCM selects Option B, it may want to state that the Executive Committee can also make “emergency” decisions between regularly scheduled meetings of the CCM, when it is not practical or possible to organise a full meeting of the CCM. If the CCM does this, however, there is always a risk that the Executive Committee will exceed its authority.
Just as the CCM can at any time make a decision that modifies or even reverses an earlier decision of the CCM, the CCM should also be able to modify or reverse a decision that has been made by the Executive Committee. Additionally, the CCM can institute a formal validation process whereby all decisions of the Executive Committee are ratified (or modified, if necessary) by the CCM.
The CCM will need to decide who sits on the Executive Committee. A larger committee would allow for each sector on the CCM to be represented, but may prove a little unwieldy to operate. The CCM may be satisfied with a smaller Executive Committee consisting of the chair, the vice-chair and perhaps two other persons. We suggest that the other persons be selected from among the sectors not represented by the chair and vice-chair. We suggest that membership of the Executive Committee be determined by the CCM on an annual basis.
How the Executive Committee operates needs to be clear and transparent. The TOR should spell out the composition of the Executive Committee, the process for selecting the members of the committee, and the main operating procedures for the committee (e.g., how often it meets, how its meetings are called, and how its decisions are made).
Secretariat
It is almost essential for the CCM to establish a Secretariat to take care of the administrative work associated with running a CCM. The Secretariat can handle such routine tasks as:
coordinating the meetings of the CCM and its committees, including preparing draft agendas, issuing meeting reminders, making transportation arrangements to bring CCM members to meetings, preparing draft minutes and distributing the minutes;
distributing Global Fund guidelines and other documents;
distributing drafts of proposals and other relevant documents;
maintaining and updating distribution lists;
maintaining the records of the CCM;
issuing public announcements of calls for submissions;
preparing and submitting reports to the Global Fund;
responding to enquiries from the Global Fund; and
responding to enquiries from other organisations and from individuals.
Assuming that the CCM maintains a website, a very useful function for the CCM Secretariat to perform is managing and updating the website. Having a website is very helpful for improving communications and promoting transparency.
If the Secretariat is large and competent enough, it may be able to take on additional tasks on behalf of the CCM. Such tasks could include:
liaising with the PR;
liaising with the LFA;
liaising with other bodies outside the CCM;
providing logistical support for the oversight functions of the CCM;
preparing and distributing informational documents on the Global Fund and on the activities of the CCM;
undertaking research; and
overseeing, facilitating or supporting the work of the proposal writing team (see Chapter 7: Proposal Development).
The precise responsibilities of the CCM Secretariat will depend on the particular needs of the CCM and will be influenced by whether or not the CCM has a functioning Executive Committee.
We suggest that the Secretariat be headed by an Executive Secretary, and that the Executive Secretary be a non-voting member of the CCM. This person should be a technocrat who would make a good leader for the Secretariat. He or she does not need to have been associated with the CCM prior to being selected.
The responsibilities of the Secretariat, the responsibilities of the Executive Secretary, how the staff of the Secretariat will be selected, and to which office-holder or committee within the CCM the Executive Secretary reports should all be spelled out in the CCM's TOR (or in a separate Secretariat TOR). If the CCM Secretariat’s responsibilities are not clearly defined, this could create confusion among CCM members and could even lead to conflict with the PR.
Historically, secretariat services for the CCM have been provided in various ways. Many CCMs have borrowed staff from the MOH or other ministries. In some countries, the PR has provided secretariat services.
The CCM will need to determine how it is going to fund the CCM Secretariat. (See “Covering CCM Expenses” in Chapter 6: CCM Operations.)
How large should the Secretariat be? It will depend a lot on (a) what the CCM wants the Secretariat to do; and (b) what resources the CCM can find to support it. We suggest that the CCM aim for at least a three-person Secretariat, consisting of an Executive Secretary and two staffers. Of these two staffers, one should probably handle most financial issues, and one should assist the Executive Secretary in other areas.
With respect to how the staff of the Secretariat are selected, one option is to have the CCM select the Executive Secretary, and then have the Executive Secretary select other staff. If the Executive Secretary is responsible for hiring other staff, the CCM may want to retain the right to approve any hirings; or at least to approve the job descriptions and the recruitment criteria.
It is important to ensure that Secretariat staff are knowledgeable about the Global Fund’s processes.
Chapter 5: CCM Membership
This chapter describes the importance of having representation on the CCM from different sectors, from people living with the diseases, from vulnerable populations (including women) and from outside the capital city. The chapter discusses the need for gender expertise on the CCM; explores the issue of whether membership should be accorded to individuals or organisations; and discusses the responsibilities of CCM members, the types of expertise the CCM requires and the commitment, time and energy required. The chapter also outlines the need for CCM members to be accountable to their constituencies; discusses issues concerning how CCM members are selected; describes the need for an orientation process for new members; and touches on a number of other membership issues.
Representation from Different Sectors
The CCM Guidelines state that
Membership in the CCM should be broadly representative of a variety of stakeholders, each representing an active constituency with an interest in fighting one or more of the three diseases. Each constituency brings a unique and important perspective, thus increasing the probability of achieving measurable impact against the diseases….
The Global Fund recognizes the importance of national contexts, customs and traditions, and therefore does not intend to prescribe specific CCM compositions. However, in accordance with its guiding principles, the Global Fund expects CCMs to be broadly representative of all national stakeholders in the fight against the three diseases. In particular, the Global Fund encourages CCMs to aim at a gender balanced composition. The CCM should therefore be as inclusive as possible and seek representation at the highest possible level of various sectors.
The Global Fund recommends that all countries strive to include the following actors in their CCMs:
• Academic/Educational Sector;
• Government;
• NGOs/Community-Based Organisations;
• People living with HIV/AIDS, TB and/or Malaria;
• Private Sector;
• Religious/Faith-Based Organisations;
• Multilateral and Bilateral Development Partners in-country.
[The Global Fund recommends that] the membership of the CCM comprise a minimum of 40% representation of the non-government sectors such as NGOs/community based organizations, people living with the diseases, religious/faith-based organizations, private sector, academic institutions.
Note that having representation from all seven sectors, and ensuring that at least 40 percent of the CCM be from sectors other than government and development partners, are recommendations, not requirements. But even though there is no minimum requirement, the Global Fund expects the CCMs to have strong representation from all sectors.
Representation from the NGO and CBO sector should be primarily domestic. However, in countries where international NGOs play a valuable role, they should also be represented on the CCM.
The CCM Guidelines do not say anything about whether the government representatives on the CCM should be civil servants or politicians. In practice, most government representatives are civil servants. However, there are instances where ministers chair CCMs. Whether or not this is a good idea may depend on the politician in question. Some politicians may help to drive the process and may be respectful of the need to involve all sectors in the work of the CCM; others may act in a more dictatorial fashion.
Representation from People Living with the Diseases
CCMs must show evidence of membership of people living with and/or affected by the diseases.
This is one of the six minimum requirements that CCMs must meet (as outlined in the CCM Guidelines document). It was made a requirement because in the first few rounds of funding, representation on CCMs was particularly weak from the people living with the diseases sector. The CCM Clarifications document states that
[t]he spirit of this requirement is to ensure that individuals and communities affected by and/or living with the three diseases are adequately represented, and bring to bear their experiences and expertise in program decisions that affect their lives.
The CCM Guidelines do not address the issue of how many representatives the CCM should have from people living with and/or affected by the diseases. This is something the CCM will have to decide, having consideration for factors such as the overall size of the CCM and the extent to which each disease is represented by people from the NGO, FBO or other sectors.
There is some ambiguity in the language used in the CCM Guidelines. Who is covered by the phrase “people living with and/or affected by the diseases”? “Affected by” could encompass many more people than “living with.” In practice, however, this requirement has been interpreted to mean people living with the diseases, at least with respect to AIDS and TB. With respect to malaria, it is probably not practical to have a person living with malaria sitting on the CCM, since it is not a chronic disease like AIDS and TB. Furthermore, as the CCM Clarifications document explains:
Due to stigma and discrimination, people and communities living with HIV and TB have been historically excluded from decision-making processes and/or their open participation would signal unwanted attention to their conditions. In this respect HIV/AIDS and TB are distinctly different from malaria where, in many places, the majority of the population can be “living with” the disease and experience no stigma or discrimination.
In actual practice, on most CCMs the representative of persons living with the diseases has been a person living with HIV/AIDS.
At a workshop on CCMs organized by the Global Fund in Lusaka, Zambia in March 2005, two working groups identified discrimination, lack of resources and the difficulties of bringing people living with HIV/AIDS together as major constraints to their participation in CCMs. The working groups recommended that CCMs:
actively engage persons living with HIV/AIDS in the CCM processes through direct interaction, sensitization sessions, workshops, etc;
encourage and strengthen organizations of persons living with HIV/AIDS to facilitate the selection process of representatives;
increase the flow of information from CCMs to persons living with HIV/AIDS;
facilitate capacity building to empower people living with HIV/AIDS and strengthen their participation in CCMs and in implementation; and
conduct an open drive for recruiting people living with HIV/AIDS who are educated and familiar with CCM issues.
The full report of this workshop is available on the Global Fund website. See Annex II for information on how to obtain a copy.
A person representing people living with one of the diseases does not have to be “out” – i.e., publicly identified as living with the disease. The CCM Clarifications document explains that
[w]ith regard to documenting representation of a person living with one of the three diseases, the Technical Review Panel (TRP) and Secretariat are cognizant of the very real dangers of ongoing stigma and discrimination. CCM members living with either HIV or TB are strongly encouraged to voluntarily disclose their status when it is safe to do so. However, in cases of extreme stigma and discrimination, the TRP and Secretariat would consider alternative forms of documenting the participation of people living with one of the three diseases (e.g. the CCM could certify that among its membership there is a person who is affected and/or living with the disease(s), but this person wishes to remain anonymous with respect to their disease status).
However, it is difficult to see how a person living with the diseases can effectively represent his or her sector without being open about it, at least with other CCM members.
Representation from Vulnerable Groups
With the exception of women, the CCM Guidelines do not say anything about representation on the CCM from populations that are particularly vulnerable to the diseases – e.g., commercial sex workers, men who have sex with men, youth, injection drug users, orphans. Nevertheless, it is important to ensure that vulnerable groups have a voice on the CCM because each group brings a unique perspective and can contribute to the development of strategies that will have an impact on the fight against the diseases.
(See the next section for a discussion of how women should be represented on the CCM.)
We are aware of one country in South America where, despite the fact that indigenous populations are a key target of Global Fund-supported projects, not one of the three major indigenous populations is represented on the CCM. The government ministry responsible for indigenous people’s affairs is on the CCM by government appointment, not by a decision of the indigenous communities. This does not seem right.
At its meeting in April 2007, the Global Fund Board asked the Fund’s Secretariat to recommend how vulnerable groups can be effectively represented on CCMs and meaningfully participate in the work of CCMs. The problem is how to make this happen; there are some significant challenges involved in trying to ensure that vulnerable groups are effectively represented. For example:
There is a risk that the act of including representatives of vulnerable groups on the CCM becomes tokenistic, with no commitment to ensuring meaningful involvement of vulnerable groups in the process.
In countries where movements of vulnerable groups are not strong, it may be hard for them to participate in structures such as the CCM.
In some countries, it may be hard to find people to represent the vulnerable groups.
There is a risk of manipulating or patronising people who are not used to operating in an environment like that of the CCM, or to discussing issues at a strategic level.
It is not at all clear, therefore, whether the answer is to set aside seats for vulnerable groups; certainly, there is no consensus on this. Several factors need to be considered:
Are some of the vulnerable groups already represented on the CCM through representatives of the NGO or FBO sectors? Is this the best way for the voices of vulnerable groups to be heard?
Can the representative of people living with the diseases also represent one of the vulnerable groups?
Might it be difficult to identify all of the vulnerable groups for all three diseases?
If a number of seats were allocated specifically for vulnerable groups, what impact would this have on the size of the CCM and its ability to function effectively?
If seats were allocated only for certain vulnerable groups, on what basis would these groups be selected?
In the case of children and orphans, it may be not be feasible to include representatives from these populations on the CCM. The next best thing might be to ensure that there is representation from organisations providing services to these groups.
In the end, it should probably be left up to individual CCMs to work out how best to ensure that the voices of vulnerable groups are heard.
Representation from Women
Women are a vulnerable group. Everything that we said in the previous section applies equally to women. We include women in a separate section in this chapter because they are mentioned in the CCM Guidelines and because there are some issues that are unique to women.
But women are also more than just a vulnerable group. Women are often the motors for development in their community; are usually the caregivers in the family and in the community; and are usually mainly responsible for safeguarding their children. They are also disproportionately impacted by HIV/AIDS.
The CCM Guidelines say that “the Global Fund encourages CCMs to aim at a gender balanced composition” on the CCM. Presumably, this means ensuring that the numbers of men and women on the CCM are roughly equal. Where there is more than one representative from a particular sector, we suggest that the CCM promote the idea that at least 50 percent of the representatives from each sector should be female. We acknowledge that this may be difficult to achieve in cultures that do not have a tradition of including women on bodies such as CCMs. At the very least, the CCM should set out to increase the representation of women where such representation is currently inadequate. One possibility is for the CCM to state that either the chair or the vice-chair has to be a woman.
Gender balance is obviously desirable. But ensuring that there are a large number of women on the CCM does not automatically mean that women as a vulnerable group are effectively represented on the CCM. There needs to be one or more women on the CCM speaking on behalf of women as a vulnerable group; ideally, they should be representatives of a women’s organisation and be well versed on how women experience the three diseases and what makes women vulnerable (see also the next section).
A CCM that is struggling with this issue could try to draft a series of steps that it could take to improve the representation of women.
Ensuring Gender Expertise
The CCM Guidelines speak of the “desirability” of including a gender perspective on the CCM, but offer no advice for how this is to be accomplished. The inclusion of a gender perspective on the CCM is very important. But is important to remember that having a gender perspective is not the same as having gender balance on the CCM. Having a gender perspective means having one or more persons on the CCM who have a good understanding of the gender dimensions of the three diseases (particularly AIDS and TB). By “gender dimensions,” we mean how AIDS and TB impact on women and what are the factors that make women vulnerable to these diseases.
A CCM with adequate gender expertise will be well-positioned to evaluate whether proposed projects adequately address gender dimensions.
We suggest that the CCM ensure that its membership includes several people with a good understanding of the gender dimensions of the diseases. As a possible means to that end, the CCM may want to consider ensuring (a) that the government ministry or agency with responsibility for women’s issues is included on the CCM; and (b) that at least one of the civil society representatives on the CCM is from a women’s organisation.
Representation from Outside the Capital City
In some countries, membership on the CCM is largely restricted to organisations whose representatives live in the capital city. This usually results in constituencies outside the capital city being inadequately represented on the CCM.
The CCM Guidelines recommend that CCMs include representation from states, provinces or districts either through direct geographical representation on the CCM, or through mechanisms such as sub-CCMs and state- or provincial-level committees.
Sometimes representation is limited to people from the capital city for budgetary reasons – i.e., to reduce the costs of holding CCM meetings. Where this is the case, every effort should be made to find resources to enable representatives from outside the capital city to participate on the CCM. (See “Covering CCM Expenses” in Chapter 6: CCM Operations.)
If the CCM does not currently have members who formally represent the regions, it should encourage as many sectors on the CCM as possible to include amongst their CCM members at least one person who is not based in the capital. We suggest that the CCM set a target for the percentage of its members that will come from rural areas and cities other than the capital.
In a few countries – countries with a highly decentralized health system, or with very large populations – national organisations may not be well positioned to effectively represent their constituencies in all regions of the country. In these countries, it may not be feasible to create a single, national CCM that is truly representative. It may make more sense to establish a devolved CCM structure – i.e., a national CCM and one or more sub-CCMs, where each sub-CCM can submit proposals directly to the Global Fund, but where the national CCM performs a coordinating function and approves all sub-CCM proposals.
Membership: Individuals or Organisations?
Membership should normally be granted to an organisation, and the organisation should select an individual to represent it at CCM meetings. There may be occasions, however, in some sectors, where there is no organisation that is qualified to represent the sector and where it makes more sense to select an individual who will represent the sector in his or her personal capacity. For example, this might be appropriate in some countries where the people living with the diseases sector is not particularly well developed.
We suggest that each organisational member of the CCM also select an alternate to attend CCM meetings when the regular representative is unable to attend. Alternate members should be specifically named in the CCM membership (i.e., not selected ad hoc when needed), and should be kept up to date on CCM activities and decisions. The CCM’s TOR should make provision for this.
Another approach may be worth considering, particularly in countries with large numbers of organisations in a particular sector (e.g., the NGO and FBO sectors). This approach would work as follows: At the time that organisations are selected for a particular sector, a member organisation and an alternate member organisation would be selected for each vacant seat. The member organisation then selects its representative; and the alternate member organisation selects a person to serve as the member’s alternate. Both representatives can attend CCM meetings. When both are present, only the representative of the member organisation can speak and vote.
This approach has potential advantages and disadvantages. Among the potential advantages: a larger number of organisations in the sector get to participate on the CCM and, as a result, develop more institutional memory; and the member and the alternate can strategize on issues that the CCM is dealing with. Among the potential disadvantages: this would increase the number of people attending CCM meetings; and constituency communications might be harder to maintain (i.e., things might slip through the cracks when there are two organisations “occupying” the same seat).
In some CCMs, when neither the member or the alternate can attend a meeting, some organisations (including some government departments) send other representatives to sit in at the meeting. Often, these people are quite junior and uninformed. They cannot vote and cannot even be counted in the quorum. We believe that this practice should be discouraged. The onus should be on the organisation to ensure that either its member or its alternate is in attendance.
Responsibilities of Members
Earlier, we discussed how the CCM can come up with a list of responsibilities for the CCM as a whole. (See “Statement of Roles and Responsibilities” in Chapter 3: General Governance Issues.) It would also be useful for the CCM to develop a list of the responsibilities of individual members of the CCM.
The CCM Guidelines contains the following statements about the responsibilities of individual members:
Individual members should hold regular meetings with their constituents to ensure that
representative views and concerns are expressed in the national forum....
The government representatives on the CCM should be mandated by, represent the views of and report back to, the senior leadership of the government.
The list of responsibilities of individual CCM members ought to be more comprehensive than what is shown in the CCM Guidelines. We suggest that the CCM use the following list of responsibilities as a basis for discussions on this issue, and adapt the list as required:
Respect and adhere to the Terms of Reference and other policies and procedures adopted by the CCM.
Take his/her membership on the CCM seriously, and attend and participate in CCM meetings in a timely and responsible manner.
Within the CCM, freely share relevant experiences and information.
Respect and adhere to CCM decisions.
Regularly seek the views of, and hold formal meetings with, organisations and individuals within the sector that the member represents.
Within the CCM, fairly and accurately represent these views, not just those of the member organisation itself.
Regularly report all important decisions of the CCM to organisations and individuals within the sector that the member represents.
When the CCM is discussing an issue which could be to the financial or other advantage or disadvantage of the member organization or of its representative, openly declare this potential COI, and offer to leave the room, or to refrain from speaking or voting, while the CCM deals with that issue.
(See “Constituency Communications” in Chapter 10: Information Sharing and Constituency Communications for a discussion of the responsibilities of CCM members vis-Ã -vis the constituencies that they represent. See “Conflict of Interest” in Chapter 6: CCM Operations for a discussion of situations where a CCM member may need to recuse himself or herself from discussion of certain items of the agenda of CCM meetings.)
Expertise Required
Various forms of expertise are required on the CCM. Obviously, there is a need for expertise on the three diseases covered by the Global Fund; this expertise should be provided by CCM members representing the various sectors. As well, see previous sections in this chapter for a discussion of how best to ensure that the voices of vulnerable populations are heard on the CCM
Given the growing emphasis being placed by the Global Fund on the importance of including health systems strengthening (HSS) activities in Global Fund proposals, the CCM should ensure that there are one or more people on the CCM with expertise in this area. When it reviewed Round 6 proposals, the TRP raised concerns about this. The TRP said that because CCM composition has been built up based on the three diseases, many CCMs may still lack the expertise to develop (or oversee the development of) proposals with strong HSS elements.
The Global Fund’s Round 7 proposal form included the following question:
Describe below how the CCM(s) and RCM(s) of countries targeted in this proposal are ensuring that they have, or are developing and/or strengthening, their capacity and experience in the identification of strengths, weaknesses, threats and opportunities in the health system relevant to national plans to prevent and control the disease(s). Applicants must also describe if there have been any changes in the relative capacity of the CCM(s) or RCM(s) since Round 6.
In this question, and in accompanying guidance contained in the Round 7 Guidelines for Proposals, the Global Fund was sending a message to CCMs that they need to take steps to enhance their capacity to identify problems and opportunities in the health system that are relevant to national plans to prevent and control the diseases.
How can the CCM go about ensuring that there is HSS expertise on the CCM? It may be possible to find a current CCM member representing one of the sectors who has this expertise. Failing that, there is no reason why people with HSS expertise cannot be appointed to the CCM in their individual capacity, perhaps as a non-voting member, even if they do not represent a particular sector.
It would also be useful to try to ensure that there is expertise on the CCM from a variety of different disciplines, for example: accounting and financial management, programme management, human resource management, M&E and proposal development. Sometimes, CCM members representing the various sectors will have some of or all of these skills. Where additional skills are needed, people with these skills could be appointed to the CCM (in a non-voting capacity). However, to avoid having too large a CCM, it may be preferable to appoint people with these skills to relevant CCM committees as the need arises. (See “Committees” in Chapter 4: Structure of the CCM for a discussion about opening up seats on CCM committees for people from outside the CCM.) Alternatively, people with the necessary skills could just be brought in as required, on a pro-bono basis.
Commitment, Time and Energy Required
Participating on a CCM requires a significant commitment of time and energy. This is no small task. Potential CCM members should be aware of this before they commit to participating. We suggest that the CCM develop an estimate of the amount of time that is required to participate on the CCM (based on past experience) and that this information be passed on to potential participants so that they know in advance what they are getting into.
Participating on a CCM is an organisational commitment as well as a personal one. Thus, the organisations involved should also know what is expected of them when they accept to be members of the CCM.
Selection Process
CCM members representing the non-government sectors must be selected or elected by their own sector(s) based on a documented, transparent process, developed within each sector.
This is one of the six minimum requirements that CCMs must meet. Proposals from CCMs that do not meet this requirement should be automatically screened out by the Global Fund Secretariat.
If the CCM is to function in the spirit of partnership envisioned and championed by the Global Fund, it is important to ensure that the members of the CCM are truly representative of their constituencies. This is a challenge; it requires organisations that (a) are willing to represent the interests of their constituencies rather than just themselves; and (b) have the necessary resources and systems for consulting and communicating with their constituencies. It also requires that considerable effort be invested in the selection process.
The CCM Clarifications document states that the
[s]election of CCM members from the non-governmental sectors should be made via a transparent and documented process that all members understand.
For example, members of a community could vote to select a member or implement a regular rotation system which includes all members of the constituency. Some could require sectorwide consensus while others may accept a simple majority vote. Whatever process is applied; the criteria for selection should be clear and made known to all members.
The selection process should be documented by the sector. That is, criteria for selection - needed skills and competencies, roles and responsibilities - and the steps for selection should be recorded and made publicly available to constituency members. For example, applicants could provide written material from the organizations themselves showing that they met as a sector and transparently selected their own CCM member(s).
It should be noted that the requirement for a transparent selection process applies to all non-government sectors represented on the CCM – i.e.:
the academic or educational sector;
the NGO sector (including CBOs);
people living with HIV/AIDS, TB or malaria;
FBOs; and
the private sector.
(It does not apply to the development partners sector, though in some CCMs this sector has nevertheless chosen to develop a selection process.)
The CCM Guidelines require that CCM members representing the non-government sectors “be selected by their own sector(s) based on a documented, transparent process developed within each sector." There are four distinct statements within this one sentence. Each one is worth listing separately:
CCM members representing non-government sectors must be selected by their own sectors.
The selection process must be developed within each sector.
The selection process must be documented.
The selection process must be transparent.
We heartily endorse all four of these statements.
In the early rounds of funding, many CCMs were set up very quickly in order to submit proposals by the deadline dates. As a result, in many cases, the MOH simply invited certain people to be on the CCM. The challenge for these CCMs has been to move from having members who were appointed to having members who were elected or selected by their sectors.
Each CCM needs to assess where it is at with respect to the process that it is using to select members representing the non-government sectors. Does it meet the new minimum requirements? If it does not, the CCM will need to spend time ensuring that an appropriate process is in place. Since the CCM Guidelines require that the non-government members be selected by their own sectors, and that this process be developed by the sectors themselves, the CCM will need to initiate a dialogue with these sectors and obtain their collaboration.
If the CCM or the sectors themselves feel that they need assistance with this process, we suggest that they consult CCMs in other countries that already have good processes in place. They may be able to obtain guidance from Global Fund staff to help identify who these CCMs are. CCMs may also be able to obtain technical assistance in this area from organisations providing such assistance; if CCMs have any questions about where to go for such assistance, they can contact their Fund Portfolio Manager (FPM) or the Global Fund’s CCM Manager directly.
In some countries, where the various sectors are fairly well organised, designing and implementing a process to select representatives for the CCM may not be too onerous. This is particularly true where there are sectors that already have umbrella bodies (e.g., the NGO and FBO sectors).
In other countries, for some sectors, the process may be more difficult, especially where there are numerous organisations in the sector, or where the organisations are just not very well organised. To come up with a process for these sectors that is fair and equitable will require collaboration among the organisations in each sector, and may also require some guidance from the CCM itself (or from other stakeholders, such as UN agencies).
For CCMs that have seats reserved for both domestic NGOs and international NGOs, it would be appropriate to have separate selection processes for each sub-sector.
(See the box at the very end of this section for examples of selection process that have been developed.)
Sector Groups
One method of selection that should be considered in some countries involves the establishment of sector groups. This may be particularly useful in large countries where it is not possible to ensure that all stakeholders are directly represented on the CCM. This is one way of keeping the size of the CCM manageable.
Sector groups could work as follows: Organisations in a sector choose several people to sit on a Sector Group that, in turn, chooses one or two of its number to be the sector's representatives on the CCM. That way, the Sector Group can brief, and be briefed by, their CCM member(s), and can also provide people who could be available to serve as resource persons on CCM committees. (This has some parallels to how the Global Fund Board and its delegations work.)
In some countries, existing networks may be able to serve as sector groups. Another option is to open up membership in the sector group to any organisation from that sector that wants to be involved (see the China example in the box).
If sector groups are established in your country, we suggest that there be good representation on the groups from women and from people from outside the capital city.
Selection Criteria
In addition to developing a selection process, each sector should also develop criteria that its representatives should ideally meet. These criteria could include technical skills, number of years of experience, and knowledge of the Global Fund.
For example, several years ago the persons living with HIV/AIDS communities in Bolivia, El Salvador and Peru elected or selected their representatives on the basis of simple criteria such as technical skills, project handling, political capacity and leadership capacity. Other criteria that have been used to choose representatives of persons living with HIV/AIDS include:
membership in a national network of persons living with HIV/AIDS;
work experience and commitment;
communications and advocacy skills;
specialist expertise in a particular area; and
geographical location.
How Well Are the Selection Processes Working?
The requirement that non-government sectors choose their own representatives on the CCM through a transparent selection process was instituted a few months prior to the fifth round of funding. This did not give the affected sectors much time to design and implement selection processes prior to the deadline for the submission of Round 5 proposals. Consequently, we believe that the Global Fund Secretariat did not rigidly enforce this requirement when it screened the Round 5 proposals.
However, the Global Fund Secretariat might have been expected to be much stricter in enforcing the requirement when proposals for Round 6 were submitted. Of the 96 proposals from CCMs submitted for Round 6, only three were screened out. This implies that the vast majority of CCMs are meeting the new requirements concerning the selection of CCM members. To the best of our knowledge, the Secretariat set up a rigorous system to review the documentation that applicants submitted. However, it was not always clear from the documentation whether the CCM met the requirement. In these cases, we believe that the Secretariat generally gave the CCMs the benefit of the doubt, but not before backing up insufficient documentation with additional information from the CCMs themselves and testimony from in-country partners and the Fund’s own FPMs. With respect to the three proposals that were screened out, the CCMs in question did not meet the requirement concerning selection processes (or, in fact, any of the other minimum CCM requirements).
No formal, independent analysis has been undertaken to determine to what extent Round 6 applicants met the requirements concerning selection processes. Aidspan conducted a preliminary analysis of what the applicants said on the Round 6 proposal form about the selection processes. However, there were a number of limitations to the Aidspan analysis, including that (a) Aidspan was able to review only approved proposals; and (b) Aidspan did not have access to the supporting documentation attached to the proposal form.
Nevertheless, the Aidspan analysis raises some questions that require further discussion. Aidspan concluded that despite the fact that 93 of the 96 applications from CCMs were screened in, it is likely that the Global Fund Secretariat exercised some discretion in Round 6 (as it did in Round 5) and that in reality some CCMs are struggling with the requirement concerning the selection processes. If this is indeed the case, Aidspan believes that some thought should be given to clarifying some of the language of the requirement, and perhaps also to altering the requirement to make it less onerous (while still ensuring that the spirit of the requirement is met). Aidspan also believes that the Global Fund Secretariat and others need to continue to assist CCMs to better understand the requirement and to how to comply with it.
Orientation for New Members
Where practical, we suggest that the CCM organise orientation sessions for new members. These sessions should include:
an explanation of how the Global Fund works;
an explanation of how the CCM operates;
a discussion of the responsibilities of individual members of the CCM, including the responsibility to consult regularly with the constituents that the CCM member represents;
a review of the Global Fund projects already underway in the country;
a review of the proposal development process most recently used by the CCM;
a review of the CCM’s TOR; and
an explanation of how the CCM performs its oversight role.
Where a formal orientation session is not practical (e.g., there is only one new member), the CCM could consider other options. One possibility is to ask one of the existing CCM members to mentor the new member. Another possibility is for the Secretariat to generate a manual containing documents that cover the topics listed above.
Other Membership Issues
Categories of Membership: Voting, Non-Voting, Observer
Most CCM members should have the right to vote on any decisions of the CCM that require a vote. However, in some circumstances it may make sense for some CCM members to have non-voting status – particularly when they are appointed rather than selected or elected by a particular sector. For example:
The Executive Secretary of the CCM Secretariat should automatically become a CCM member, but should not be entitled to a vote.
A representative of the PR should sit on the CCM, but should not be entitled to a vote. However, in some cases the representative of the PR may already be on the CCM as someone who has been selected or elected by a particular sector. In these cases, the representative should be entitled to a vote, but may have to recuse himself or herself from certain discussions and decisions as per the CCM’s COI policy. (See “Conflict of Interest” in Chapter 6: CCM Operations.)
The CCM may decide that representatives of some or all SRs should sit on the CCM. They should not be entitled to a vote (unless they are already members of the CCM – see previous bullet).
The CCM may decide that a representative of the LFA should be a CCM member. This person should not be entitled to a vote.
The CCM will need to decide whether non-voting members can participate in discussions as a matter of right, or whether they have to be invited to do so. If the CCM is operating in a collegial and participatory fashion, this should not be a big issue.
Some CCMs refer to certain members having “observer status.” “Non-voting” and “observer” usually mean the same thing. However, it is possible for a CCM to make a distinction between the two with respect to the right to participate in discussions at CCM meetings.
Some CCMs have designated some of the government members of the CCM as non-voting. For example, the CCM in India has designated the MOH’s programme officers for TB and malaria as non-voting members. The Liberian CCM has designated the representatives of the three national disease programmes as non-voting. One advantage of this approach is that it allows for greater participation from government ministries while still limiting the voting power of the government sector. However, there is a risk that the government sector will become too dominant on the CCM even if some of the government representatives do not have voting rights. For example, the CCM in Liberia has about 23 members: nine from the government sector, six representing development partners and eight from all other sectors combined. Even though three of the nine government members do not have the right to vote, the government sector still has a very large presence on the CCM.
Do Members Need To Be Approved by the CCM?
We suggest that new members be formally approved by the CCM though, in most cases, it should be a mere formality. As explained above, it is up to each sector to select its representatives. The CCM should in most instances accept the organisations and individuals selected by each sector, even if some CCM members do not particularly like the organisation or the person representing the organisation. However, formal approval of new members by the CCM would allow the CCM to pass judgment on whether the process used within each sector was fair, open and transparent. This is a useful safeguard, which ought not to be needed very often.
The documentation of the selection process should be reviewed by the chair and the vice-chair (and/or the Secretariat); the new CCM member should be formally recognized at the first CCM meeting he or she attends; and this should be recorded in the minutes of the meeting.
Length of Terms
We suggest that the length of term of a member be set at one or two years. Some CCMs may want to consider a three-year term instead. We also suggest that the CCM place a limit on the number of consecutive terms that a member can sit on the CCM.
Failing To Turn Up for Meetings
A persistent failure on the part of an organisation to send either its regular member or alternate to attend CCM meetings indicates that the organisation in question is either unable to participate fully in the CCM or is not interested in doing so. The CCM may want to consider adopting a policy whereby an organisation ceases to be a member of the CCM if its representative does not attend CCM meetings frequently enough.
The policy could be based on a percentage of meetings attended or on a number of consecutive meetings missed. If the organisation in question has been selected by a sector following a selection process undertaken within that sector, then the CCM will need to ask the sector to go through another selection process.
Dealing with Turnover
Frequent turnover of members can have a negative impact on the effectiveness of the CCM. What strategies can be adopted to reduce and turnover and deal with the effects of turnover? Here are some observations and suggestions:
If the CCM is functioning well, there is likely to be less turnover because CCM members will be happy with the job they are doing.
If the CCM has established one-year terms for membership and is experiencing a lot of turnover, the CCM should consider longer terms.
Organisations that appoint persons to represent them on the CCM should be discouraged from changing their appointees too often. (It is important to achieve a sensible balance, because there are some advantages to having different people represent the organisations over time.)
When it asks the various sectors to choose their representatives on the CCM, the CCM should make it clear just how much time and energy is required to participate effectively on the CCM. This may help to reduce the incidence of people quitting the CCM because they did not realise how much work was involved.
CCMs should ensure that they have a good orientation programme for new members, so that the new members can quickly familiarise themselves with the issues.
Written Membership Criteria
All of the policies and requirements discussed in this chapter should be described in writing in the CCM’s TOR.
Chapter 6: CCM Operations
This chapter discusses the need to ensure that the CCM operates in a transparent fashion and allows for the full participation of its members in deliberations and decision-making. It explains why government leadership is important. The chapter examines a number of issues concerning how CCM meetings should be conducted; describes the need to accommodate the special needs of CCM members; and outlines sources of funding for CCM operations. Finally, the chapter discusses the need for a COI policy.
Importance of Transparency
The CCM represents the major stakeholders in the country involved in the fight against the three diseases and is accountable to those stakeholders. Thus, it is very important that the CCM conduct its business in a transparent fashion. This can be accomplished in a variety of ways, including:
ensuring that good processes are put in place for the selection of CCM members (see previous chapter);
ensuring that CCM members maintain good communications with their constituents; and
disseminating widely information about the CCM and the decisions taken by the CCM.
(See also Chapter 10: Information Sharing and Constituency Communications.)
Importance of Government Leadership
The CCM is designed to operate as a partnership among the various sectors represented on the CCM. Because they tend to have more resources at their disposal, governments can play a strong leadership role in ensuring full and equal participation from the other sectors.
Decision-Making Process
The CCM Guidelines state that the CCM “should function as a national consensus group to promote true partnership in the development and implementation of Global Fund supported programs;” and that all members of the CCM “should be treated as equal partners, with full rights to participation, expression and involvement in decision making.”
If the CCM is to operate as a national consensus group, all members need to have a voice in the decisions made by the CCM.
In the first several rounds of funding, some CCMs said that they used a round-table approach for discussions, where all members were encouraged to express opinions and were given an equal voice. Then, when it came time to make decisions, some reported using a consensus approach, and others said that they used a system of voting on key decisions. With the consensus approach, the chair seeks to find a decision that all can agree with, or at least that nobody chooses to formally oppose. We suggest that as much as possible, CCMs make decisions by consensus. Where this is not possible, a democratic system of voting should be employed, with each member of the CCM having one vote.
Where voting is required, we suggest that the CCM allow for both informal and formal votes. Informal votes should require just a show of hands. Formal votes should require recording each member’s vote in the minutes of the meeting. We suggest that all votes be informal unless any member present demands that a vote be made (or repeated) as a formal vote. The CCM may wish to use secret ballots for some decisions, such as the election of the chair or vice-chair.
We suggest that, in order to pass, most votes should require a simple majority of voting members present at the time of the vote. However, there may be some types of decision that should require a two-thirds majority to pass. These should be specifically indicated in the TOR. Examples of votes that could require a two-thirds majority to pass are (a) changes to the CCM’s TOR; (b) the removal of an officer of the CCM; and (c) approval of grant proposals and PR nominations.
The CCM Guidelines state that major dissents to decisions taken should be reflected in the minutes of CCM meetings. The rationale for this is twofold: (a) including the dissenting opinions in the minutes is a sign that the dissenting opinions are valued and respected; and (b) CCM members who hold dissenting views are more likely to accept and work with the majority decision if the minutes record the reasons for the dissent.
Full Participation of Members in the Deliberations and Work of the CCM
Having an equal vote may not, in itself, ensure full participation. CCM members have to feel confident about speaking out and about expressing a different view to those of other CCM members. This is not always the case, particularly among the members of the CCM who are not from the government or development partners sectors.
The fact is that on many CCMs, even where representation from NGOs, FBOs, academia and the private sector is strong in terms of numbers, the representatives of the government or development partners sectors often dominate the CCM. Why does this happen? It may be because governments in these countries are used to making decisions without consulting other sectors. It may be because development partners are not used to working with civil society or the private sector. It may be because some of the representatives of the NGO, FBO, and academic sectors are not used to operating in an environment like the CCM. It may be because some of the NGOs and FBOs receive funding from the MOH and are therefore reluctant to say anything critical about the Ministry.
Whatever the reasons, the CCM as a whole should make a special effort to ensure that all CCM members are participating in discussions. This may involve exploring issues of stigma and discrimination and other impediments to participation, particularly with respect to representatives of people living with the diseases and marginalised populations. It would be helpful if government members of the CCM took the lead on this. For some CCMs, it might be useful if the CCM formally evaluated the level and scope of participation of non-government members. Such evaluations could determine what the barriers are to full participation and suggest ways in which these barriers could be overcome.
The principle of full participation requires that all CCM members be involved in all of the major activities of the CCM, including the development of proposals submitted to the Global Fund. As well, the chair should ensure that all CCM members are consulted concerning the scheduling of meetings and the development of meeting agendas.
As mentioned above, some CCM members may not possess the skills necessary to function effectively in meetings. This issue is addressed further in Chapter 11: Technical Support and Capacity Building.
CCM Meetings
Holding Regular Meetings
A CCM will operate more effectively if there are regularly scheduled meetings. Regular meetings make it easier to plan and get through the business of the CCM, and to ensure that members have ample opportunity to raise issues that concern them. The best functioning CCMs are those that plan ahead, stick to schedules and create an environment where members can plan and predict. CCMs that are always having crisis or ad-hoc meetings tend not to function very well.
The meetings can be scheduled four, six or more times per year – whatever makes sense for the individual CCM. The number of meetings of the full CCM that are required each year may depend on the extent to which important parts of the CCM’s work is done through committees. Of course, at critical times in the proposal development or project implementation cycle, the CCM can schedule extra meetings in addition to its regular meetings.
Notice of Meetings, Advance Documentation, Minutes
For each meeting of the CCM, all members should receive (on a timely basis) the notice of meeting, the meeting agenda and copies of documents that will be discussed at the meeting. They should also receive the minutes of the meeting within a few weeks of the meeting. If the minutes will take some time to prepare, members should be provided as soon as possible after the meeting with a list of the major decisions taken at the meeting, as well as a list of action items and the names of people assigned to carry them out.
Members of CCM committees should receive the same types of information for committee meetings. In addition, the minutes of committee meetings should be sent to all CCM members.
Support for Member Attendance
It may be necessary to provide financial support to some members to allow them to attend the CCM meetings, particularly members who represent organisations which do not have a lot of money.
Attendance by Non-CCM Members
There will be occasions when the CCM wants to invite one or more persons who are not CCM members to attend a particular meeting. One example of this is if the CCM wants to hear a presentation on a particular issue (e.g., orphans and children) from people with expertise in that area. The CCM will need to decide how decisions are made with respect to inviting non-members; the decisions should not be the sole prerogative of the chair.
Should CCM Meetings Be Open?
Whether CCM meetings should be open to whoever wants to attend is a decision each CCM will have to make. Open meetings can strengthen transparency and accountability. On the other hand, they can involve logistical challenges.
If the meetings were open, could the media attend? Again, there could be advantages and disadvantages. One consideration is that meeting participants have to be able to say what they think without fearing that they will be quoted in the local media.
The CCM may want to consider opening up just some meetings, or some portions of meetings, especially when the CCM has something important to announce (such as approval of its Global Fund proposal) or discuss (such as a progress report on project implementation).
Language Issues
In countries with multiple official languages, the CCM may need to assess whether CCM meetings can be conducted in one common language, or whether it is necessary to provide some form of interpretation at the meetings. There may be costs associated with providing interpretation.
In our opinion, making proficiency in a given international language – such as English or French – a prerequisite for people selected to sit on the CCM would be a mistake. In many countries, it would block participation by women, youth and civil society representatives.
Accommodation
The CCM may need to make an effort to accommodate the special needs of some of its members. Every CCM has to deal with accommodating all of its members, especially those with busy travel schedules and calendars full of meetings. We suggest that the CCM expand the definition of accommodation to include not just accommodating people’s difficult schedules, but also accommodating people’s difficult lives – especially when there are CCM members who will be poor, sick or inexperienced in forums such as CCM meetings.
Accommodation can take many forms. Some examples are avoiding very long meetings; taking frequent rest breaks during meetings; ensuring that nutritious foods are available during breaks; and providing inexperienced members with extra briefings or materials.
Covering CCM Expenses
The CCM should develop a budget that covers all of its expenses, including the costs of running the CCM Secretariat, but also including other costs such as travel to attend CCM meetings, maintaining a website, and conducting site visits to fulfil the CCM’s oversight responsibilities.
Historically, the Global Fund has encouraged CCMs to look for funding to support its operations from sources other than the Global Fund. In many countries, for example, multi- and bi-lateral donors (who are often represented on the CCM) have funded the operations of the CCM Secretariat. While the generosity of these donors is commendable, it raises questions about the independence of the secretariats. We believe that it is important that the CCM Secretariat be independent of individual members of the CCM and that it have its own operating budget and facilities. The CCM Secretariat should be accountable to the CCM as a whole and should not be beholden to any one CCM member.
For the past few years, however, the Fund has had a policy of allowing CCMs (under certain circumstances) to use funds from their Global Fund grants to support CCM operations.
The CCM Guidelines state that
[i]n countries where partner support for CCMs is not available, the Board approves the use of grant funds to provide CCM support, provided that funding is limited to two-years and meets the following terms and conditions.
• Eligible costs shall be limited to the following items:
- Salary of staff. (Number of staff to be supported will be determined by size of grant and number of components);
- Office administrative costs (phone, fax, postage, stationary, photocopy);
- CCM meeting costs, including travel cost for CCM for nongovernmental members (up to 6 meetings per year);
- Communication and information dissemination costs for sharing key information (e.g., call for proposals, periodic reports of implementation status, minutes of meetings) which may include the costs of establishing and updating of website or newsletter;
- Facilitation costs associated with constituency consultation and processes to promote stakeholder participation; and
- Translations of key information to promote participation by all stakeholders.
• The size of grants and the number of components overseen by a CCM will be used as criteria to determine the total amount of its eligible funding.
• Funded costs must be consistent with national salary scales and local operating costs.
• The proposal must include a sustainability plan for financial support to the CCM after the first two years of grant support.
• The proposal should show co-finance or in-kind support from in-country partners.
• Disbursement and activity reports of CCM support funding must be provided to the Global Fund on an agreed periodic basis. These reports will be subject to LFA review and verification.
These funds were only available for a two-year period for each CCM; they were not available on a proposal-by-proposal basis. In other words, the CCM could only access such funding once. To obtain the funds, the CCM had to complete an application form made available by the Fund during the grant negotiations process.
At its meeting in April 2007, the Board of the Global Fund decided that the two-year period could be extended until the end of the grant or until the end of 2007, whichever comes first. At the same time, the Board asked one of its committees to recommend by November 2007 how CCMs could obtain simplified access to funding to cover their operations. So, it looks like there will soon be a new Global Fund policy on this topic. Aidspan believes that it is likely that the Global Fund Board will allow CCMs to use grant funds for the life of the grant, but with some limitations and ceilings. For example, the Board will probably allow grant funds to be used to cover the basic administrative needs of the CCM (including the operation of the CCM Secretariat); however, if the CCM wants to do more than that, it will likely have to raise its own funds from country partners. Readers of this guide should check with the Global Fund for more information.
Other possible sources of funding for CCM operations include: the national government budget; multi- and bi-lateral development agencies; UNAIDS; private foundations; and the private sector.
Conflict of Interest
When the PRs and chair or vice-chairs of the CCM are the same entity, the CCM must have a written plan in place to mitigate against this inherent conflict of interest.
This is one of the six minimum requirements that CCMs must meet. The full text from the CCM Guidelines reads as follows:
To avoid conflict of interest, it is recommended that PRs and Chairs or Vice Chairs of CCMs not be the same entity. When the PRs and Chair or Vice Chairs of the CCM are from the same entity, the CCM must have a written plan in place to mitigate against this inherent conflict of interest. This plan must be documented and made public to ensure the highest levels of transparency and integrity. The plan should include, at a minimum, that the PR, or prospective PR, shall recuse itself from participation at the CCM meeting and shall not be present during deliberations or decisions related to the CCM’s monitoring and oversight of the PR, such as decisions related to:
• the selection of the PR;
• PR renewal for Phase 2;
• a substantial reprogramming of grant funds; and
• those that have a financial impact on the PR, such as contracts with other entities, including sub-recipients.
The above extract describes what restrictions should be placed on the participation of PRs or prospective PRs at CCM meetings. The text seems to imply that these restrictions are only necessary in cases where the PR and the chair or vice-chair are from the same entity. However, we believe that these restrictions should apply whether or not the PR is from the same entity as the chair or vice-chair.
The CCM Clarifications document says that
[i]n general, a conflict of interest occurs when CCM members use their position to advance personal ambitions or the interests of the institution or sector they represent in a way that biases or excludes others, or is detrimental to the efficiency of the overall program. COI’s help protect even the most well-meaning persons whose financial interests or those of close associates could be affected.
Conflicts of interest on the CCM can arise whenever members of the CCM participate in discussions and decisions in which they have a personal interest or in which the organisation they represent has an interest. It stands to reason, therefore, that the PR or prospective PR should not participate in discussions or decisions on the selection of PRs or on other matters in which they have a direct interest. The same applies to SRs and prospective SRs that are represented on the CCM.
Similarly, if the CCM is discussing a submission from an NGO for possible inclusion in the coordinated country proposal, and if there is a representative of that NGO on the CCM, that person should not participate in the discussion of this particular agenda item or in any decisions taken with respect to this item.
The CCM’s policy should describe how these kinds of COI will be handled. We are aware of one CCM where it was decided that no organisation receiving grant funds could be represented on the CCM. This is an option, but we are not convinced that it is necessary to go this far. It should be enough to ensure that CCM members who are in a potential COI situation recuse themselves from discussions and decisions that affect them or their organisations.
In summary, then, we suggest that the CCM consider developing a COI policy that covers all of its members (not just the chair, vice-chair and the PR representatives). We also suggest that the CCM’s COI policy be disseminated to all CCM members and posted on the CCM’s website (if it has one); and that it be made available to anyone upon request.
Examples of COI policies instituted by CCMs can be found on the Global Fund website at http://www.theglobalfund.org/en/apply/mechanisms/.
Chapter 7: Proposal Development
This chapter explains the Global Fund requirements with respect to proposal development; describes the importance of getting a head start on preparing a proposal; discusses the steps involved in designing and implementing a proposal development process; explains the CCM’s role in the selection of PRs and SRs; and provides guidance concerning how the final proposal should be put together.
Introduction
CCMs are required to put in place and maintain a transparent, documented process to solicit and review submissions for possible integration into the country coordinated proposal.
CCMs are required to put in place and maintain a transparent, documented process to ensure the input of a broad range of stakeholders, including CCM members and non-members, in the proposal development process.
These are two of the minimum requirements that CCMs have to meet. They overlap somewhat. Within the two requirements, there are several distinct statements concerning proposal development that are worth noting here:
1. The CCM needs to implement a process to solicit and review submissions for possible integration into the country coordinated proposal.
2. The in-country submissions process has to be transparent.
3. The in-country submissions process has to be documented.
4. The CCM has to implement a process to ensure the participation of a broad range of stakeholders, both CCM members and non-members, in the proposal development process.
5. This participation process also has to be transparent and documented.
The CCM Clarifications document explains that the principle behind these requirements
is predicated on the understanding that in order to effectively address HIV/AIDS, tuberculosis or malaria, all social sectors need to contribute to the proposal and program from the development phase through to implementation. Therefore it is paramount that a broad range of stakeholders (i.e. people, communities, institutions, etc. with a direct interest in programmatic outcomes) have a possibility to participate in the proposal’s development process and that all stakeholders have a voice in determining its appropriateness to the country’s particular situation. This level of involvement ensures that the proposals’ goals and objectives are “owned” by the affected and concerned stakeholders, not just a handful of experts who write proposals.
The CCM Clarifications document also says that
[a]s part of the eligibility screening process [once a proposal is submitted], the [Global Fund] Secretariat will review supporting documentation setting out the CCM proposal development process, and the submission review process, as well as the minutes of the meeting where the CCM reviewed and decided on the elements to be included in a proposal.
Special Note: The Global Fund is in the process of introducing a new funding mechanism called the “Rolling Continuation Channel (RCC).” The RCC will allow organisations with high-performing grants to apply for continued funding when their grants reach the end of their funding terms, under a process that is separate from the rounds-based channels of funding. RCC applicants will be able to apply for up to six years of funding, in two three-year phases. The Global Fund has not yet publicly released policies and procedures concerning the RCC, so we have not attempted in this guide to describe the role of the CCM with respect to proposals submitted under the RCC.
As well, the Global Fund Board has approved the concept of National-Strategy Applications (NSAs). Under this concept, a country that has developed a solid national strategy for tackling HIV/AIDS, TB or malaria will be able to apply for Global Fund support for implementation of this strategy. The requirements for NSAs will be very strict. Detailed policies and procedures for NSAs have yet to be developed, so the role of the CCM in this process is as yet unclear.
Importance of Getting a Head Start
A decision to apply for a Global Fund grant should be made well in advance of the Fund’s call for proposals for any given round of funding.
Judging by the experience of recent rounds of funding, once the call for proposals is issued, applicants have about four months to submit their proposals. Applicants will need the majority of this time to fill out what has always been a rather complicated proposal form and to obtain the necessary approvals and signatures. For this reason, and because the Global Fund requires that applicants engage in a process of soliciting and reviewing in-country submissions for possible inclusion in the country coordinated proposal, Aidspan recommends that applicants begin working on their proposals at least a few months ahead of the call for proposals.
At its meeting in late November 2006, the Global Fund Board announced that the call for proposals for Round 7 would be issued on 1 March 2007, and that the call for proposals for Round 8 would be issued on 1 March 2008. It appears, therefore, that for the foreseeable future the Board intends to go with one round of funding per year, and intends to provide significant advance notice of the dates when the calls for proposals will be issued. This makes it much easier for potential applicants to make decisions and undertake their planning.
Ideally, things should happen in the following order:
1. A country determines its national strategy for tackling HIV/AIDS, TB, or malaria.
2. The country then designs one or more projects designed to implement that strategy.
3. The country then submits proposals (to places such as the Global Fund) seeking financial support for one or more of those projects.
Thus, when CCMs prepare a proposal to the Global Fund, they should, in theory, be in a position to describe a national strategy and a project, both of which have already been designed. If the main elements of the project are already developed by the time the application forms become available, writing the proposal becomes much easier.
But all too often, what actually happens is that applicants use the proposal form and the applications process to design their project – and in some cases to design the national strategy. We think that this is a case of the “tail wagging the dog,” and that it often results in inferior proposals.
CCMs need to have sufficient time for the whole exercise – time enough to ensure that the national strategy and project design are clear, to solicit and review submissions, to write the proposal, to get the proposal endorsed by the CCM as a whole, and to get it signed by individual CCM members.
Designing and Implementing a Proposal Development Process
In order to manage the process of developing a proposal, we suggest:
that the CCM form a proposal development team, made up of CCM members representing the different stakeholders; and
that the proposal development team coordinate the proposal development process, including soliciting and reviewing in-country submissions and writing, or overseeing the writing of, the final proposal.
The CCM could decide to add some resource persons to the proposal development team if it makes sense to do so.
Because CCM members do not always have sufficient time to manage the entire process, many CCMs decide to hire one or more consultants to help manage the proposal development process or to write the actual proposal. In our experience, this can work well providing the consultant plays a supportive role, and the proposal development team plays a central, coordinating role. What should be avoided is having consultants fly in to write entire proposals when they do not really understand the country well.
The proposal development team should define the proposal development process that will be followed, complete with timelines.
Establishing a proposal development team does not diminish the responsibility of the entire CCM for the proposal development process and the proposal itself (which all CCM members have to sign). It is just a way of permitting the CCM to manage the process.
At the outset of the proposal development process, the CCM should review the six minimum requirements for CCMs to ensure that it meets the requirements.
Integration with Other National Processes
There is a need to ensure that the proposal development process is well integrated with other processes for the three diseases, such as national strategic plans and the Three Ones. This should be done early in the development of a proposal, as part of a situational analysis – i.e., the identification of (a) gaps in the response to the diseases that could be filled by a grant from the Global Fund and (b) existing plans for addressing these gaps.
CCMs will need to determine how the situational analysis should be carried out. In cases where the national strategic plans have been developed through a broad consultation process, it may be sufficient to base the situational analysis on the national strategic plans and on the opinions of the lead actors. Where the national strategic plans have been developed without broad consultations, it may be necessary to involve all sectors in identifying gaps and priorities; the priorities of marginalised groups are likely to be ignored otherwise.
The situational analysis should include information on what the multi- and bi-lateral development partners are planning for the next several years.
The Submissions Process
Many CCMs assume that the need for an in-country submissions process requires an open call for submissions. CCMs struggle with this requirement because there is no little guidance on how the call should be organised, what kinds of eligibility criteria should apply (if any), and what framework should be provided to applicants. The process can be quite onerous. Below, we talk about approaches that can be used for an open call for submissions, but we also explore alternatives to an open call.
One possible approach is for the CCM to issue an open call for submissions without establishing any criteria or issuing any guidance. This is what many CCMs have done. The advantages of this approach are that it allows all interested stakeholders to submit their ideas; and it allows them to make suggestions concerning both what thematic areas should be covered in the proposal and what specific services and activities should be included.
The disadvantages of this approach are that the CCM may receive a large number of submissions, which may make the process very unwieldy; that it may be difficult for the CCM to assemble all the pieces into a coherent whole; and that if only parts of some submissions are eventually incorporated into the proposal, many organisations will have wasted a lot of time and energy and may become disillusioned with the whole process.
Another possible approach is to establish a framework and some criteria prior to issuing the call for submissions. For example, for a Round 6 HIV/AIDS proposal, the CCM in Morocco followed the following process:
1. The CCM developed the broad outline of the proposal – including objectives, service delivery areas and indicators.
2. The CCM made sure that the outline of the proposal was aligned with the national strategic plan for HIV/AIDS (which had been developed through broad consultations).
3. The CCM put out a call for submissions based on the outline it developed. In their proposals, applicants essentially had to explain how their activities would contribute to the achievement of the overall project.
4. When it issued the call, the CCM established eligibility criteria covering strategic and programmatic issues, geographic priorities and capacity or experience thresholds for applicants (for example, number of years of experience and levels of donor funds previously managed).
The use of Global Fund service delivery areas and indicators ensured that it would not be difficult for the CCM to collate accepted submissions into the country coordinated proposal.
While stakeholders were preparing their submissions, the CCM was able to work on elements of the country coordinated proposal (e.g., CCM structure, programmatic and financial gap analysis) that were not dependent on the implementation details.
A variation on the Moroccan approach would be for the CCM to hold broad consultations in each sector; to develop the broad outlines of a country coordinated proposal; and to then issue a call for submissions. This approach might be particularly appropriate if the country’s national strategy for the disease (or diseases) in question has not been developed through broad consultations.
But is it necessary to issue an open call for submissions? The Zanzibar CCM followed a process for its Round 6 proposal that did not involve a call for submissions. The process was as follows:
1. The CCM identified potential implementing partners and sources of technical support.
2. The implementation partners participated in a five-day “design forum” where, supported by resource persons, they reviewed the CCM’s Round 5 proposal and identified the goals, objectives, strategies and indicators for the Round 6 proposal.
3. A proposal development group was established to coordinate the planning and writing of the proposal. This 15-member group included representatives from some of the implementing partners and some technical support persons.
4. During the planning and writing of the proposal – a process that took five weeks – consultative meetings were held with implementing partners and development partners.
5. A draft proposal was reviewed by the implementing partners.
So, while the principle behind the requirement for an open call – to ensure that all sectors can contribute to the development of the proposal – is obviously important, perhaps this principle can be achieved in other ways. The Zanzibar example suggests that the Global Fund is prepared to accept that there are alternatives to an open call.
One of the challenges faced by CCMs is to come up with a process which allows both large and small organisations to participate in a way that does not make the process unwieldy.
Whatever process the CCM adopts, remember that it must be documented and disseminated to interested stakeholders. The description of the process should include the criteria that the CCM will use to review the in-country submissions. If the CCM issues a call for submissions, the review criteria should be included in the call.
Issuing the Call for Submissions
The CCM Guidelines do not provide any guidance concerning how the call for submissions should be made. The CCM Clarifications document says that “some options include publicly announcing a call … via print media, radio, television and website.” This appears to assume that the call would be wide open – i.e., that any interested organisation could respond to the call. This may indeed be the preferred approach. For Round 6, one CCM that we are aware of issued invitations to what it considered to be “established organisations.” The danger of that approach is that it leaves it up to the CCM to determine who is eligible, and it risks missing some organisations that may have something useful to contribute.
The Global Fund has not provided a template for CCMs to use for the in-country submissions. Individual CCMs can always develop their own template, but this is not an easy task. In the absence of any template, some CCMs have asked potential applicants to use the proposal form that the Global Fund has designed for the country coordinated proposals. This is clearly not appropriate, because there are large sections of the proposal form – relating to the CCM itself and to the national context – that organisations preparing in-country submissions do not need to fill out. Consequently, Aidspan is preparing a sample template that CCMs can adapt for use in their in-country submissions process. A copy of the sample template in Word or PDF format will be posted on the Aidspan website (www.aidspan.org) and an announcement will be made in Global Fund Observer (GFO) when the sample template is available.
Reviewing Submissions
As noted above, the Global Fund requires that the process for reviewing the in-country submissions must be transparent and documented. The CCM Guidelines also say that “a broad range of stakeholders, including CCM members and non-members” must be involved in the proposal development process; the Global Fund Secretariat has been interpreting this requirement to mean that both CCM members and non-members must also be involved in the review of in-country submissions.
If, as we suggested above, the CCM has established a proposal development team, this team could be responsible for reviewing the submissions and deciding which submissions or which parts of these submissions will be incorporated into the country coordinated proposal. As noted above, the proposal development team could include some outside resource persons. If it does not, the CCM may want to consider adding some resource persons for the express purpose of involving them in the review process. The CCM should be careful, however, to avoid any conflict of interest – in other words, it may be preferable not to add resource persons whose organisations have tendered submissions.
As we indicated above, criteria for the review of submissions should be developed and disseminated along with the description of the proposal development process. The CCM will need to use these criteria to review the submissions. The CCM may also want to develop a rating system to help assess the submissions.
The CCM should provide feedback to all organisations that tendered a submission. To those organisations whose proposals were not accepted, or were only partially accepted, the CCM should explain why this occurred.
Remember to build sufficient time into the process. The CCM Clarifications document explains that
[a]n integral part of a transparent and inclusive proposal review process is the notion of time. CCM members, and relevant non-members, need sufficient time to read and reflect upon the merits of [submissions] prior to any formal discussions. Therefore it is strongly suggested that to meet this requirement, CCM Chairs and/or CCM Secretariats should allow sufficient time for copying and distribution and review long before the day when the CCM meets to discuss the [submissions].
A Final Word
It is important that the CCM be committed to the process of involving stakeholders in the development of the country coordinated proposal, and that it not simply go through the motions. We are aware of one CCM in Round 6 that put in place a process to solicit and review regional proposals, but then the national AIDS programme dismissed the regional proposals and put forward its own ideas instead. This is a CCM that is not functioning as it should.
Selection of PR(s) and SR(s)
CCMs are required to put in place and maintain a transparent, documented process to nominate the PR.
This is one of the minimum requirements that CCMs have to meet. For each proposal it submits, the CCM can nominate one or more PRs. (The CCM can only nominate; the Global Fund must approve the nomination.)
The CCM Clarifications documents explains that the requirement concerning the nomination of the PR
lays the critical foundation for developing an interactive, workable, and transparent relationship between the grant’s administrator/implementer (the Primary [sic] Recipient (PR)) and its custodian/owner (the CCM). Developing a criteria-based, transparent process to select a PR gives credibility and legitimacy to all parties involved. This is important to ensure that solutions to future programmatic challenges - and there will always be challenges - are not compounded by allegations of impropriety. In other words, an open and fair PR nomination process will help ensure that the best possible PR is selected and … has credibility with all concerned partners.
Nominating the PR is one of the critical functions of the CCM. Using the board of directors analogy we used earlier in this guide, this is the point where the board (i.e., the CCM) can choose the organisation (or organisations) that will implement the projects. And Phase 2 Renewal is when the board (CCM) decides whether it wants to continue with the same PR(s).
More and more, CCMs are nominating more than one PR, with each PR being responsible for a portion of the project covered by the proposal. Frequently, the CCM will nominate one government PR and one PR from another sector, usually the NGO sector or the FBO sector. This is known as “dual-track financing.”
Dual-track financing is an approach that the Global Fund favours because (a) it is consistent with the Fund’s principles of partnership and multi-sector involvement; (b) it can increase a country’s absorption capacity; (c) it can accelerate the implementation of projects; (d) it can improve the performance of grants; and (e) it can help to strengthen weaker sectors.
In fact, at its meeting in April 2007, the Global Fund Board decided to recommend to CCMs that starting with Round 8 each proposal should specify a government PR and a non-government PR. Where a proposal does not do so, the Fund will require an explanation.
Additional guidance concerning the role of the PR and the capacities required of a PR can be found in the guidelines for proposals that the Global Fund produces for each round funding. See Annex II for information on how to obtain a copy of the guidelines for proposals for the latest round.
The CCM Guidelines do not say anything about the selection of SRs. This will likely change in the future. The Round 7 proposal form required applicants who had already identified the SRs to describe the transparent process by which SRs were selected, the rationale for the number of SRs and the criteria that were applied in the selection process. In cases where the SRs were not yet identified at the time the proposal was submitted, the proposal form asked applicants to describe in detail the process that will be used to select SRs. The proposal form added that “only in rare cases should sub-recipients not be identified.”
(In recent rounds of funding, some countries have left SR selection until after the proposal is approved, and have then used a process similar to a request for proposals. Under this sort of arrangement, NGOs and other implementers are selected to contribute to specific targets and objectives that have been fixed during proposal development. If these NGOs and other implementers were not involved in the proposal development process, this approach may be problematic, for several reasons: (a) it is difficult to know whether the objectives are feasible; (b) the start of the project is delayed; (c) this does not create a real partnership process (it is more like a contracting mechanism); and (d) once the implementers are known, it may be necessary to re-do the workplan and budget.)
So, CCMs should assume that they need to have transparent processes in place to both nominate PRs and select SRs, and that these processes should be documented. The CCM will need to develop criteria for the selection of the PRs and SRs.
There are no guidelines in place concerning what selection processes the CCM should use. One possible approach is for the CCM to issue a call for expressions of interest. This call could go out after the in-country submissions have been reviewed, when the CCM already has a good sense of the outline of the proposal it will submit. The call could be issued to a number of organisations identified by the CCM as potential PRs and SRs, or through a public announcement, such as a newspaper advertisement, or both. If this approach is adopted, the process could be managed by the CCM’s proposal development team (or a separate committee.)
Another possible approach is for the proposal development team (or separate committee) to (a) draw up a list of potential PRs and SRs; (b) contact the potential PRs and SRs to determine their interest and to obtain information on their qualifications; and (c) make recommendations concerning which PRs should be nominated and which SRs should be selected. Again, this process would likely be initiated only after the CCM had a sense of what its proposal was going to look like.
A third possible approach would be for the CCM to solicit interest from potential PRs and SRs at the same time as it solicits the in-country submissions; and then have the proposal development team make recommendations concerning which PRs should be nominated and which SRs should be selected.
The relationship between proposal development and PR/SR selection is a very tricky one, because the content of proposals is likely to be closely identified with the capacities of actors who can implement the content. For example, if a proposal has a considerable social marketing component, and there is an organisation specialising in that area, it is fairly clear that that organisation should implement the social marketing component (the organisation is probably best placed to write that part of the proposal too). Moreover, it may make sense for that organisation to implement as a PR because its management and financial systems and its procurement systems may lend themselves better to that way of working.
Similarly, if an organisation has particular expertise in providing services to one or more vulnerable populations, it would make sense for that organisation to be involved in developing and implementing that part of the project.
A challenge for CCMs is how to harmonise the ambitions of the CCM with those of potential PRs and SRs. For instance, the CCM may decide to develop a proposal covering all 10 provinces of a country, but potential PRs/SRs may only want to work in five of them (e.g., because that is where they have a history of operations, or because they are not prepared to scale up so rapidly). This example is about geographical coverage, but the same problem could arise in terms of different thematic areas: e.g., a social marketing organisation wants to include a product that the CCM does not want to include; or there is only one agency that is well placed to do AIDS education with good coverage but, because of religious views, it will not agree to include condom distribution.
Thus, the CCM will need to spend some time thinking about the best way to come up a group of PRs and SRs that can collectively do the best job.
Putting Together the Final Proposal
The CCM’s proposal development team should coordinate the preparation of the final proposal. Members of the team may draft the proposal themselves; or they may choose to hire one or more writers. We suggest that there be one head writer to ensure that the pieces fit together neatly, that everything is covered and that the style is consistent.
All CCM members should have ample time to review the submission before they sign off on it. (This may be the single biggest complaint that CCM members have – i.e., they don’t get enough time to review the proposal, sometimes not even 24 hours.) There should be a full meeting of the CCM to discuss the proposal before it is finalized. Ideally, CCM members should have the opportunity to comment on the proposal several times during its development. For example, the CCM could comment on an outline of the proposal (or at least the overall strategy and approach); review the first draft of the proposal, paying particular attention to budgets and targets; and review the final draft before the proposal is submitted. For the final review, we suggest that CCM members obtain a copy of the proposal seven days prior to the CCM meeting where it will be discussed.
(One of the reasons that CCM members often have limited time to review the proposal is that CCMs wait until after the call for proposals is issued before they even start to think about their proposal.)
CCMs need to be aware that they may be asked to respond to requests for clarification from the Global Fund Secretariat and the TRP in the weeks and months following the submission of their proposals. These requests usually have very tight turnaround times.
Chapter 8: Project Implementation
This chapter explains the CCM’s role in overseeing project implementation; discusses how the CCM should monitor progress in implementation; and explains how it should work with the PR to identify problems and develop solutions. The chapter also outlines the importance of involving other stakeholders in the oversight process. Finally, the chapter describes the CCM-LFA relationship.
Oversight Role of the CCM
CCMs are required to put in place and maintain a transparent, documented process to oversee project implementation.
This is one of the minimum requirements that CCMs have to meet. While the PR has primary responsibility for project implementation, and reports to the Global Fund in this capacity, the CCM has an important oversight role. As we indicated earlier, with respect to its oversight role we suggest that the CCM think of itself as a board of directors – ultimately responsible for the success of the projects, but not getting involved in the day-to-day operations.
The CCM Guidelines state that one of the roles of the CCM is to monitor the implementation of projects financed by Global Fund grants, including approving major changes in implementation plans (if such changes are required). The guidelines say that another role of the CCM is to evaluate the performance of these projects, and to evaluate the performance of the PR. The Guidelines for Proposals that the Global Fund prepared for Round 7 discuss the role of the CCM in “overseeing program implantation.”
The CCM Clarifications document says that
[i]n this framework of oversight it is envisaged that the PR is the day-to-day manager and lead implementer of the program. The CCM oversees longer term performance, addresses national strategies for the three diseases, addresses issues related to harmonization with partners, identifies the most efficient utilization of resources, and may ultimately decide to change PR’s when requesting Phase II continuing funds...
and that
CCMs should develop Terms of Reference (TOR) or by-laws to define and guide its oversight role and ensure that the PR has a process for monitoring and evaluating program implementation. TORs should define clear lines of communication among and between CCM members and the PR. TORs outline appropriate feedback loops between the PR and CCM; clarify realistic monitoring and evaluation plans, technical assistance plans, and systems analysis and strategic planning reviews to ensure coordinated implementation.
The grant agreement that the PR signs with the Global Fund says that the PR
shall cooperate with the CCM and the Global Fund to accomplish the purpose of this Agreement. The Principal Recipient shall be available to meet regularly with the CCM to discuss plans, share information and communicate on matters that relate to the Program. The Principal Recipient shall provide to the CCM, upon request of the CCM, a copy of reports and material information relating to the Program for information purposes. This may include, but is not limited to, Requests for Disbursements, items delivered to fulfill a condition precedent, implementation letters and any amendment to this Agreement. In addition, the Principal Recipient shall assist the CCM in the preparation of any Request for Continued Funding. The Principal Recipient understands that the Global Fund may, in its sole discretion, share information about the Program with the CCM.
Despite all of this guidance, there remains considerable confusion about the relationship between the CCM and the PR, and about exactly what the role of the CCM is in project implementation. To some extent, the role depends on how one interprets terms such as “oversee” and “monitor.” The situation is further complicated by the fact that the Global Fund signs the grant agreement with the PR, not with the CCM; and by the fact that many CCM members do not have the skills and knowledge necessary to effectively monitor project implementation.
As a result, most CCMs spend considerably more time on proposal development than on overseeing project implementation.
Given the situation, we recommend that the CCM and the PR agree to, and prepare a written clarification of, their respective roles and responsibilities. Without this written document, the CCM has virtually no ability to challenge or question an underperforming PR. The document should be prepared before the start of the grant. Ideally, it should be done when a proposal submitted, given that the proposal form typically requires that the CCM outline the management arrangements for the project, including defining the roles and responsibilities of the nominated PR(s) and the CCM.
These discussions between the CCM and the PR will be critical to the success of the project. Ideally, they will lead to the CCM and the PR establishing a culture of working together in a mutually beneficial way. It is very important that the CCM understand that it must not micro-manage (which is the natural inclination of many CCM members). It is equally important that the PR understand that it must not hide information or mis-report, but rather that it should present progress along with problems and possible solutions to these problems, so that the CCM can guide, advise and, where necessary, decide on big picture issues. This working relationship can take time to build up, and it is useful to have discussions outside the formality of CCM meetings. Joint review missions, regular PR presentations to working groups or committees, and annual information meetings or occasional open days all help to build this working culture.
The CCM has to find the right balance. If a CCM is too heavy handed, the project could grind to a halt. If it is too hands-off, the CCM won’t find out if there is a problem until it is too late. Getting just the right information with the right regularity for the CCM to make decisions and spot issues, without requiring too much bureaucratic paper work and too many meetings, is the key to making a CCM function well. The CCM needs to be consistent in what it demands of the PR, and must not change its mind every six months; and the PR needs to deliver well.
The CCM Clarifications document says that
[p]rogram oversight is complex and varies from one country and grant to another. Experiences differ widely across a spectrum of management styles ranging from passive involvement to overly micro-managed. Each country will adopt different styles of programmatic oversight depending on many different factors (e.g. geography and travel constraints, communications, capacity of certain social sectors, etc.). The goal is to establish a balance in which CCM members are engaged and informed, offer their collective expertise and on-the-ground knowledge while simultaneously allowing the Principal Recipient(s) and/or sub-recipient(s) to carry out their tasks unimpeded by excessive meetings and paper work. The CCM provides oversight to the PR’s overall performance (which should include programmatic reviews, site visits, etc.), while the PR conducts monitoring and evaluation of project activities.
Note that the CCM is required to document its oversight process and disseminate this information to interested stakeholders.
How Should CCMs Monitor Progress in Project implementation?
It is essential that the CCM have a list of concrete M&E tasks that it needs to perform. We suggest that the CCM establish a working group to help the CCM carry out its oversight activities. (If several Global Fund projects are being implemented, it may be appropriate to establish more than one working group.) A particular focus of the working group should be to anticipate bottlenecks and potential problems.
We also suggest that the CCM develop an M&E plan – a fixed, annual schedule of activities for each Global Fund project. This plan should outline what reports the PR should submit to the working group and when (based on discussions with the PR), and how and when the working group will report to the full CCM. The plan should outline when working group members will make site visits (see below).
As indicated above, one of the responsibilities of the CCM is to satisfy itself that the PR has a process in place for monitoring and evaluating project implementation.
The CCM can also monitor progress by reviewing the information provided by the PR. The CCM Guidelines state that the PR should keep the CCM continuously informed about progress in project implementation, and should provide periodic narrative and financial progress reports to both the Global Fund Secretariat and the CCM.
In the Grant Agreement that it signs with the PR, the Global Fund usually spells out many of the types of information that the PR must provide to the CCM. Some examples of the types of information that should be provided are as follows:
information required before the first disbursement to the PR is made, such as the bank account into which the funds will be disbursed; a description of the organisational and legal status of the PR; and (sometimes) evidence that the accounting procedures manuals have been updated to reflect the additional requirements associated with the project;
information required before the second disbursement to the PR is made, such as a monitoring and evaluation plan for the project; evidence that a project manager and financial officer have been hired; and evidence that the PR has selected an external auditor;
information on how the PR plans to monitor the performance and sustainability of procurement and supply management systems; and
copies of all quarterly or semi-annual progress reports submitted, via the LFA, to the Global Fund.
The Grant Agreement usually also states that the PR must provide the CCM with any reports or information that the CCM may reasonably request.
The CCM may also want to promote the idea of periodic consultative meetings during the proposal implementation phase involving the CCM, the PR(s) and key SR(s).
Another way for the CCM to monitor progress in project implementation is for some CCM members to make occasional monitoring visits to project activities (site visits). These visits would need to be organised in advance with the PR and carefully planned. The CCM members involved could then report back to the full CCM. If done properly, these visits could benefit not only the CCM, but also the PR and SRs involved. The visits should include an opportunity for the CCM members and the PR or SR to sit down together to discuss accomplishments as well as any problems or potential problems. The CCM members participating in these visits should understand that they are there representing the CCM as a whole (and not their particular sectors).
The CCM needs to pay attention to different things at different points during the project cycle. For example:
In the first year of the project, oversight should concentrate primarily on ensuring that the project starts rapidly and effectively, including making sure that the necessary partnerships are formed, that the SRs are in place; that the first disbursements get out to the SRs, and that procurement is underway.
In Year 2, the CCM should ensure that the project is being implemented smoothly and should examine the first reports on progress against targets.
In Phase 2, the focus of the CCM should be primarily on whether targets are being met. But the CCM should also keep an eye on whether the project is running smoothly and whether expenditures are as forecast in the budget.
In addition, in each year of the project, the CCM needs to monitor drug and equipment procurement because the budgets for these activities can be 50 percent or more of the grant. It is very important for the CCM to pay attention to project implementation and finance, not just technical results and field visits.
How Should CCMs Work with PRs to Identify Issues and Develop Solutions?
If the CCM and the PR have a good working relationship, it should not be difficult for them to work together to resolve any problems that may arise in project implementation. Problems can be identified in a number of ways:
the PR can raise issues at CCM meetings (a representative of the PR sits on the CCM);
the PR can identify issues in the periodic progress reports it prepares for the Global Fund, a copy of which should be provided to the CCM;
the PR can identify issues during periodic consultative meetings with the CCM (as suggested above); and
the CCM can identify issues through its review of the periodic progress reports and through its site visits.
Once a problem is identified, the PR and the CCM should sit down together to find a solution. This is a critical step in the process and one that is sometimes missing or not performed effectively. How can the CCM help find a solution? There may be people on the CCM with expertise in the particular area involved. Or, the CCM may be able to suggest sources that can provide the necessary technical assistance to the PR. In some cases, the CCM may be better placed than the PR to address the problem (e.g., when representations have to be made to a government ministry to obtain a tax exemption on health and other products being imported for a particular project).
Note that if, as a result of problems that have been encountered, or for any other reason, the PR decided to make a change to the project that materially alters the scope of the original proposal approved by the Global Fund, the PR must seek CCM endorsement of this change before it is presented to the LFA and the Global Fund for approval.
Involving Other Stakeholders
CCMs are required to put in place and maintain a transparent, documented process to ensure the input of a broad range of stakeholders, including CCM members and non-members, in the grant oversight process.
This is one of the minimum requirements that CCMs have to meet. Note that the requirement refers both to CCM members and non-members.
With respect CCM members, it should be relatively easy for the CCM to ensure that a broad range of stakeholders are involved in project oversight. This will happen automatically whenever the full CCM discusses oversight issues. If the CCM forms one or more committees to help fulfil its oversight responsibilities, it should ensure that the CCM members on these committees come from a variety of the sectors represented on the CCM.
The Global Fund has not provided any guidance concerning how non-CCM members (i.e., resource persons) should be involved in project oversight. Here are some ideas for how the CCM could handle this responsibility:
If the CCM has set up one or more project oversight committees, it could include some resource persons from a variety of sectors on these committees.
Resource persons could be invited to those portions of CCM meetings where project oversight issues are discussed.
Resource persons could be invited to participate in site visits.
The CCM could organise periodic meetings with interested stakeholders to discuss project oversight issues.
The CCM-LFA Relationship
Until recently, the Global Fund did not provide much guidance concerning the relationship between the CCM and the LFA. However, in July 2007, the Fund released a “Communications Protocol for Local Fund Agents.” (See Annex II for information on how to obtain a copy.)
The protocol explains that the role of the LFA is to provide independent and objective advice to the Global Fund. It is not the role of the LFA to act as a Global Fund representative or to represent the views of the Fund. In carrying out its responsibilities to assess grant recipients and to verify programmatic and financial deliverables, the LFA needs to communicate on a regular basis with CCMs (as well as PRs and other stakeholders).
The protocol says that the LFA should explain its roles and responsibilities to the CCM. It also says that a representative of the LFA should be available to attend CCM meetings, that he or she should do so only as an observer, and that he or she should not participate in any decision-making processes. However, the protocol says that the LFA representative can participate in discussions at CCM meetings (if invited to do so) as long as he or she stays within the limits of the LFA’s roles and responsibilities. We suggest that the CCM extend non-voting membership status (or observer status, if the CCM has such a category of membership) to a representative of the LFA.
The protocol says that it is up to the PR (and not the LFA) to provide the CCM with copies of any assessments and recommendations made by the LFA, and that if the CCM requests this information from the LFA, the LFA should refer the request to the PR and the FPM.
Chapter 9: Phase 2 Renewal
This chapter reviews the CCM’s role in the Phase 2 renewal process.
One of the roles of the CCM is to submit a “Request for Continued Funding” before the end of the first two years of a grant. The request solicits funding for the balance of the grant (usually a three-year period). This process provides the Global Fund with an opportunity to formally assess the performance of the grant before it awards additional funding. The CCM is responsible for responding to any questions from the Global Fund Secretariat concerning the request.
The CCM Guidelines state that
[b]efore the end of the two years of initially approved funding, the CCM will assess implementation progress and submit a request for continued funding to the Global Fund. The request for continued funding should include consolidated information for the first 18 months of the program and the objectives, targets, and requested funding for up to three additional years of financing from the Global Fund. The CCM should also provide complementary information to support the request, including a country profile on key health indicators related to the three diseases, as relevant; a description of the functioning of the CCM, including partnerships brought about among different constituencies; linkages established between the program and other national initiatives/programs; and the level of and distribution of other financial resources at the country level to the three diseases and broader related purposes.
The CCM should prepare the Request for Continued Funding together with the PR. As we indicate in the previous chapter, the CCM is required to play an oversight role during implementation, and the PR is obligated to keep the CCM fully informed of progress (and of any problems that arise). If the CCM has not been kept fully informed, it will be very difficult for the CCM to generate a good quality Request for Continued Funding.
How should the CCM manage this process? It is important that all members of the CCM be familiar with the Phase 2 Renewal process and be involved in the preparation of the Request for Continued Funding. However, for practical purposes, it probably makes sense for the CCM to establish a Phase 2 Renewal committee or working group, the composition of which would be drawn primarily from the different stakeholders represented on the CCM. It would be a good idea to have representatives of the PR(s) sit on this committee, and possibly someone from the CCM Secretariat as well. The committee may want to contact other CCMs who have recently gone through the Phase 2 Renewal process in order to learn from their experience.
We suggest that the committee be tasked with preparing a draft of the Request for Continued Funding, and that the draft be discussed and approved by the full CCM. Usually, this will happen at a meeting of the CCM. Prior to the meeting, all CCM members should be given an opportunity to review the draft request.
The unfortunate reality is that in many CCMs, the work is done by one or two people or a small committee and then rubber stamped by the full CCM without any meeting being held. This approach is not in keeping with the Global Fund’s principles of partnership and participation. It is also less likely to result in successful Requests for Continued Funding.
If there are problems with the implementation of the project, and if the CCM concludes that a PR is performing poorly, the CCM can use the Request for Continued Funding to make changes to the management structure of the grant. It can drop one or more PRs and add new ones.
Further information on the CCM’s role in preparing the Request for Continued Funding can be found in the Global Fund’s “Guidelines for Completing the CCM Request (for Continued Funding);” and in the Aidspan publication “The Aidspan Guide to Understanding Global Fund Processes for Grant Implementation – Volume 2: From the First Disbursement to Phase 2 Renewal.” For information on how to obtain copies of these documents, see Annex II.
Chapter 10: Information Sharing and Constituency Communications
This chapter discusses the importance of sharing information both inside and outside the CCM, and the importance of CCM members maintaining good communications with their constituents. As well, the chapter describes various means of communication and discusses language issues.
Good communications, both within and outside the CCM, are essential if the CCM is to operate successfully.
Sharing Information Inside the CCM
With respect to each meeting of the CCM, all members should receive (on a timely basis) the notice of meeting, the meeting agenda, copies of documents that will be discussed at the meeting, and the minutes of the meeting. If the minutes will take some time to prepare, members should be provided as soon as possible after the meeting with a list of the major decisions taken at the meeting, as well as a list of action items and the names of people assigned to carry them out.
Members of CCM committees should receive the same types of information for committee meetings. In addition, the minutes of all committee meetings should be sent to all CCM members.
All important documents from the Global Fund should be shared, including guidelines for proposals and calls for proposals. Members should receive copies of all formal correspondence from the Global Fund, including the comments of the TRP on proposals submitted by the CCM.
All important documents related to the preparation of proposals to the Global Fund should be shared, including calls for in-country submissions, and outlines, drafts and the final version of the proposal.
All important documents relating to the implementation of projects funded through Global Fund grants should be shared, including quarterly or other periodic reports prepared by the PR and sent to the Global Fund.
Members should also receive copies of any information materials about the CCM prepared by the CCM Secretariat for external distribution (e.g., media releases, newsletters). The CCM Secretariat should maintain up-to-date membership lists, complete with contact information, and should make these lists available to CCM members.
Sharing Information Outside the CCM
Because the CCM is accountable to all stakeholders in the country who are involved in the fight against the three diseases, it is important for the CCM to maintain good communications with these stakeholders. The following documents should be disseminated widely and be available on request:
a list of the CCM members, including the sectors represented, along with information on how to contact the members;
information on how to contact the CCM Secretariat;
important CCM documents – such as the TOR, the COI policy, minutes of CCM meetings, the process for proposal development, the process for nominating the PR, the process for selecting SRs, and the process for overseeing project implementation;
documents related to country coordinated proposals – including the Global Fund’s call for proposals, in-country calls for submissions and the text of the proposals themselves; and
documents related to project implementation – including the grant agreements signed between the PR and the Global Fund, periodic progress reports from the PR, and copies of any reports on project implementation prepared by the CCM (or by third parties).
Constituency Communications
Individual members of the CCM who represent specific sectors need to maintain good communications with their constituents for two reasons: to impart information and to obtain input.
It is important that these sectors be kept informed of developments on the CCM. Some of the communications activities described above will help to ensure that this happens. In addition, CCM members should prepare periodic reports on CCM activities and should disseminate these reports widely among their constituents.
In order to properly represent their sectors, CCM members should also look for opportunities to obtain feedback from constituents on the activities of the CCM. The CCM Guidelines state that in order to ensure that the CCM remains responsive to all national stakeholders, individual CCM members should hold regular meetings with their constituents. It may be useful to have these meetings independently or professionally facilitated.
In Chapter 5: CCM Membership, we discussed the possibility of using sector groups to maximize representation on the CCM while still keeping the size of the CCM manageable. Sector groups are one way that interested stakeholders can stay in touch with what is happening on the CCM.
Means of Communication
There are many different ways of communicating information. The CCM should select the means that work best in its country and that fit within the budget of the CCM.
For communications within the CCM, methods include letters, email messages, faxes, telephone calls, and electronic and hard copy distribution of documents. For communications outside the CCM, some of these same methods can be used; so can radio and television appearances, information sessions, media releases and conferences, and newsletters.
Many CCMs are establishing their own websites. This is an excellent way of imparting information. The websites could also be used to obtain feedback from interested stakeholders.
Dealing with Language Issues
Depending on the language situation in the country, the CCM may need to consider having key documents translated into local languages. This may be necessary to ensure effective communications with interested stakeholders.
Chapter 11: Technical Support and Capacity Building for the CCM
This chapter describes the need for the CCM to evaluate its technical support and capacity building requirements. The chapter also identifies sources of funding, and discusses where technical support can be obtained. Finally, the chapter looks at the role of the CCM in defining a technical support plan that extends beyond the CCM.
For the purposes of this chapter, we are defining “ technical support (TS)” to mean assistance to the CCM as a whole, and “capacity building” as training to enable individual members of the CCM to function more effectively on the CCM.
Examples of areas where the CCM might require TS are the preparation of proposals; managing the in-country submissions process; strengthening CCM governance; and enabling the CCM to function effectively as a team (including resolving conflicts and working with people living with the diseases).
Not all members have the skills they need to participate effectively on the CCM. This is particularly true for some representatives of persons living with the diseases, and for NGO representatives in countries that do not have an experienced and vibrant NGO sector. Capacity building for individual members of the CCM may be required in the following areas: designing and implementing programmes, budgeting, budget analysis, monitoring and evaluation, communications and public speaking, networking with their constituencies, leadership, negotiating, participating in meetings, interpersonal relationships, advocacy, decision-making, and policy analysis and development. Some CCM members may require training on the gender dimensions of the three diseases.
Evaluating Needs
We suggest that the CCM conduct a formal needs assessment in order to determine what its TS and capacity building needs are; and that the CCM then develop a plan for meeting these needs. The CCM may want to obtain TS to conduct this needs assessment.
Sources of Funding
The CCM Guidelines recommend
that all proposals include a plan for obtaining technical assistance as needed to strengthen CCM functioning and for capacity building in fulfilling its responsibilities for oversight of program implementation.
(The policy of allowing costs for TS and capacity building was adopted by the Global Fund Board after the fourth round of funding. The Board also allowed CCMs to re-allocate some of the funds in the budgets of projects funded through grants approved in Rounds 1-4 to allow for technical assistance and capacity building for the CCM – as long as the total budgets remained the same.)
If the costs of providing TS and capacity building for the CCM are built into the proposal itself, this will allow CCMs to better control the TS that they receive. In other words, it would encourage national ownership of TS, whereas currently TS is often very supply-driven (by the donor agencies themselves).
.
Where To Find TS
A number of organisations have provided technical assistance and capacity building for CCMs in the past. These include:
multilateral agencies, such as the World Health Organization, the United Nations Development Program, the World Bank, the International Labour Organization, and UNAIDS (including the newly created UNAIDS’ Technical Support Facilities);
bilateral development agencies, such as the (UK) Department for International Development (DFID), GTZ (a German aid and TS agency), the United States Agency for International Development (USAID), the US President’s Emergency Plan for AIDS Relief (PEPFAR) and the Norwegian Agency for Development Cooperation (NORAD);
in-country and international NGOs, from very large to very small;
for-profit companies, including corporations contributing pro-bono resources, and corporations seeking to generate revenue from providing TS; and
technically qualified individuals able to contribute expertise as volunteers, or as paid staff and consultants.
Some of these agencies charge for the TS they provide.
One agency that does not charge for TS is GTZ’s BACKUP Initiative, which is designed specifically to provide TS for CCMs and for the implementation of Global Fund-approved grants. In projects funded to date, the BACKUP Initiative has helped to strengthen CCMs by, among other things, supporting civil society involvement in the CCM, supporting networks of people living with the diseases, developing CCM management capacity, and supporting regional CCM meetings. GTZ is continuing to accept applications for assistance. The website of the BACKUP Initiative is at www.gtz.de/backup-initiative.
With funds from the Office of the US Global AIDS Coordinator, NGOs such as Management Sciences for Health (MSH) have provided short-term TS for CCMs. Recently, MSH provided TS to CCMs in eight countries in Asia, Africa and Central America, using a three-step process of functional analysis (diagnosis, transformation and implementation). For more information, see MSH's Leadership, Management and Sustainability project website at www1.msh.org/projects/lms/.
Aidspan has published “The Aidspan Guide to Obtaining Global Fund-Related Technical Assistance,” which lists 170 organisations or individuals that can provide Global Fund-related TS and capacity building, and that provides contact information and descriptive text for each entry. For information on how to obtain copies of this guide, see Annex II.
The CCM may be able to obtain TS and capacity building from within the academic and research community, or from the private sector, in its own country. These sources would have an advantage in that they will be familiar with local conditions.
CCMs can also contact their FPM for advice on where to obtain TS.
CCM Role in Developing a Broader TS Plan
TS and capacity building may be required not only for the CCM, but also for project implementers – i.e., PRs, SRs and SSRs. This suggests that what may be required in many countries, therefore, is an overall TS and capacity building strategy. In fact, the CCM Guidelines recommend that CCMs develop a single national TS and capacity building framework for all Global Fund-related processes and activities. CCMs also need to remember that they must include in their proposals to the Global Fund the TS plans and costs for project implementers.
Chapter 12: Evaluating CCM Performance and Problem-Solving Within the CCM
This chapter discusses the importance of evaluating CCM performance, and explains how the CCM can address problems concerning the functioning of the CCM.
Evaluations
The CCM should be regularly assessing its own performance. If the CCM is not operating effectively, this will negatively affect the quality of proposals submitted to the Global Fund and the successful implementation of projects financed by the Fund. Performance assessments would allow the CCM to identify weaknesses and to make appropriate changes.
We suggest that the CCM carry out periodic self-assessments of its performance, and that these be supplemented by an independent external review conducted at least once every two years.
The Global Fund has prepared a “CCM Performance Checklist” as well as a “User’s Guide for the CCM Performance Checklist,” to assist CCMs to conduct a self-assessment. (For information on where to obtain both documents, see Annex II of this guide.)
The User’s Guide says that the CCM Performance Checklist “can be used by each CCM to measure progress and to guide technical assistance needed to further improve the structure/composition, roles and responsibilities, and functioning of the CCM.” The checklist covers the following areas: (a) composition and representation; (b) participation and communication; and (c) governance and management.
When the CCM Performance Checklist was first made available to CCMs, the Global Fund Secretariat encouraged the CCMs to send copies of their self-assessments to the Secretariat. This formed the basis of a report on CCMs prepared by the Technical Evaluation Reference Group (“Assessment of the Country Coordinating Mechanisms: Performance Baseline”) produced in December 2005. (See Annex II for information on how to obtain a copy.)
Problem-Solving
If the CCM is functioning in a collegial way, in a spirit of true partnership, where people feel free to raise problems and have them discussed at CCM meetings, then it will not be too difficult for the CCM to deal with problems as they arise. If necessary, the CCM can always turn to other CCMs (or sometimes to the Global Fund) for advice. If a problem is particularly intractable, the CCM may want to being in a outside facilitator to help it work through the issue.
Unfortunately, not all CCMs operate in a truly participatory fashion, and sometimes CCM members are afraid to speak openly at meetings. This is more likely to happen in countries where governments and civil society do not have a history of working well together. There is no magic formula for fixing this problem, at least not in the short term. We should accept that in these countries there will inevitably be tension between government and civil society (indeed, that could be said for almost any country).
That does not mean that nothing can be done to help manage these tensions, at least to the extent that they affect the operations of the CCM. One possible approach is for the CCM to hold a retreat and to bring in an outside facilitator to help identify and deal with issues. This has been done by many CCMs. To be successful, however, it requires that CCM members (especially the chair and vice-chair) be committed to the process, that they approach the retreat in a spirit of openness and honesty, and that they be prepared to implement changes that the retreat may identify as being necessary. One of the outcomes of such a retreat could be a time-limited action plan outlining activities that will be undertaken to strengthen the CCM.
Another approach is to make sure that the CCM has a thorough discussion of its mandate, structure and roles and responsibilities, as recommended in the earlier chapters of this guide, and that these are reflected in a TOR document.
Annex I: Sample Terms of Reference
This section contains a sample Terms of Reference (TOR) that Aidspan has created for a fairly large national CCM in the fictitious country of Ruritania.
It is impossible to create a generic TOR that can be adopted in its entirety by any one CCM, let alone by all CCMs. There is simply too much variation in the circumstances and preferences of CCMs. Thus, any CCM interested in making use of this sample TOR to develop or modify its own TOR should use only those portions that fit its needs, modifying the text as required.
Text in square brackets refers to information that should be decided and inserted by the CCM. Each reference to "[Ruritania]" should be replaced with the relevant country name.
Some alternatives to the provisions in these TOR have been provided in shaded text boxes. Where these alternatives are discussed in the text of this guide, the relevant section of the guide is indicated and a hyperlink is provided.
INTRODUCTION
1. The Country Coordinating Mechanism in [Ruritania] ("the CCM") is established in response to requirements and recommendations of the Global Fund to Fight AIDS, Tuberculosis and Malaria ("Global Fund").
TERMS OF REFERENCE
2. This document is the Terms of Reference (TOR) for the CCM.
3. These TOR shall take effect the day they are approved by a two-thirds majority vote at a CCM meeting.
4. Subsequent modifications to these TOR also require a two-thirds majority vote at a meeting of the CCM for which at least three week’s notice has been provided. The notice must include a description of the proposed modifications.
MANDATE OF THE CCM
5. The mandate of the CCM is to develop and submit proposals to the Global Fund, and to monitor, evaluate and support the implementation of projects that are initiated by the CCM and financed by the Global Fund.
ROLES AND RESPONSIBILITIES OF THE CCM
6. The roles and responsibilities of the CCM are as follows:
6.1 Prepare and submit proposals to the Global Fund that are in line with national AIDS, tuberculosis, and malaria priorities and programmes.
6.2 Respond to inquires from the Global Fund concerning these proposals.
6.3 For each proposal, nominate the PR(s) who will be responsible for implementing the project, should the proposal be approved.
6.4 For each proposal, select the SR(s) who will be involved in the implementation of the project, should the proposal be approved.
6.5 Monitor and evaluate the implementation of projects financed by Global Fund grants (including the performance of the PRs and SRs).
6.6 Approve major changes in project implementation plans that have been proposed by the PRs.
6.7 When necessary, submit requests to the Global Fund for re-programming of approved grants.
6.8 Submit to the Global Fund requests for continued funding for each approved grant (as required).
6.9 Review progress reports that have been or are about to be sent to the Global Fund by the PRs.
6.10 Develop, modify and implement these TOR.
6.11 Fulfil other responsibilities as outlined in these TOR.
CORE PRINCIPLES OF THE CCM
7. The CCM will operate as a national consensus group and will promote true partnership in the development and implementation of Global Fund-supported projects.
8. The CCM will include representation from all relevant sectors.
9. Representatives from the non-government sectors will be selected by the sectors themselves.
10. The CCM will be fully transparent in its decision-making.
11. All members of the CCM will be treated as equal partners, with full rights to participation, expression and involvement in decision-making.
LINKAGES AND RELATIONSHIPS
12. The CCM shall promote linkages and consistency between Global Fund activities in [Ruritania] and the country’s national development strategies; national disease strategies; national systems for monitoring, financial management and procurement; and national efforts to increase the harmonisation, coordination and effectiveness of external assistance.
13. [CCMs may want to add one or more clauses here describing any formal relationships between the CCM and other national entities.]
STRUCTURE OF THE CCM
14. The CCM is composed of members, who shall elect a chair and a vice-chair.
15. The CCM shall appoint an executive committee, and other committees as required.
16. The CCM shall establish a secretariat, and shall select an executive secretary to lead the secretariat.
17. The hierarchy of authority shall be as follows: CCM; executive committee; chair; executive secretary. Within this hierarchy, any party can be over-ruled by parties higher in the hierarchy. The vice-chair shall only have formal powers in this hierarchy when acting on behalf of the chair.
COMPOSITION OF THE CCM
18. Membership on the CCM is granted to an organisation, which then selects an individual to represent it at CCM meetings.
19. The CCM shall be made up both of voting members representing the relevant sectors and of non-voting members (as described below).
20. The sectors represented on the CCM shall be the government of [Ruritania] (government sector); multi- and bi-lateral development partners (development partners sector); academic and educational institutions (academic sector); domestic NGOs, community-based organisations and international NGOs (NGO sector); people infected with HIV/AIDS or tuberculosis or affected by malaria (people living with the diseases sector); religious and faith-based organisations (FBO sector); and private companies (private sector).
21. The CCM shall contain the following numbers of members from each sector:
• government sector ([insert number] members)
• development partners sector ([insert number] members)
• academic sector ([insert number] members)
• NGO sector ([insert number] members)
• people living with the diseases sector ([insert number] members)
• FBO sector ([insert number] members)
• private sector ([insert number] members)
22. The executive secretary of the CCM Secretariat shall be a non-voting member of the CCM.
23. Each organisation serving as PR for a Global Fund grant shall be a non-voting member of the CCM (unless the organisation in question is already a voting member representing one of the sectors on the CCM).
24. The CCM may award non-voting membership to one or more organisations serving as SRs for Global Fund grants; to an organisation serving as LFA for Global Fund grants; and to any other organisation that the CCM deems appropriate. Decisions to award non-voting membership to organisations referred to in this clause require a simple majority vote.
25. Every effort shall be made to ensure that at least [insert percentage figure] of the voting CCM members are from rural areas and from cities other than the capital.
26. Every effort shall be made to ensure that at least [insert percentage figure] of the voting CCM members are female.
27. Every effort shall be made to ensure that the voting membership of the CCM includes representation from youth and from vulnerable populations.
28. Every effort shall be made to ensure that the CCM includes several people with in-depth understanding of the gender dimensions of the epidemics.
29. The CCM shall attempt to ensure that that there is expertise on the CCM in accounting and financial management; programme management; human resources management; and proposal development.
SELECTION PROCEDURE
30. Members from the following sectors shall be selected by the sectors themselves, based on a process that is inclusive, transparent, developed within the sector, documented and based on clear criteria: academic sector, NGO sector, people living with the diseases sector, FBO sector and private sector.
31. The CCM shall, if required, play a facilitating role to enable one or more of the sectors listed in the preceding paragraph to design and implement a process to select its representatives on the CCM.
32. Each member organisation shall select an individual to represent it at CCM meetings; and shall also select an alternate to attend meetings that the regular representative is unable to attend.
33. Each organisation proposed for membership on the CCM must be formally approved by the CCM.
OTHER MEMBERSHIP ISSUES
34. Membership on the CCM is for a term of [insert number] year(s).
35. At the expiry of a term, a CCM member may be nominated by its sector to serve another term, subject to a limit of [insert number] consecutive terms.
36. The CCM shall have an orientation process for new members. This process shall include an explanation of how the Global Fund works; a discussion on how the CCM operates, including a review of the CCM TOR; a description of the proposal development process used by the CCM; a discussion of the responsibilities of individual members of the CCM; a review of the Global Fund projects already underway in the country; and a discussion on how the CCM performs its oversight role.
37. Non-attendance: If a member fails to attend two successive meetings of the CCM, the Executive Secretary shall write a letter of concern to the organisation in question. If the member fails to attend a third consecutive meeting, the chair shall inform the CCM of the development and shall invite the CCM to decide on a course of action. The CCM may, if it so chooses, declare the seat vacant and invite the sector concerned to select a replacement.
RIGHTS AND RESPONSIBILITIES OF CCM MEMBERS
38. Rights of members: Individual members of the CCM have the following rights:
38.1 The right to be treated as an equal partner on the CCM, with full rights of expression.
38.2 The right to participate in all discussions and activities of the CCM.
38.3 The right to nominate people for CCM positions such as chair and vice-chair, and to stand for such positions.
38.4 The right to vote on any matter put to a vote.
38.5 The right to sign, or to decline to sign, proposals submitted by the CCM to the Global Fund.
39. Responsibilities of members: Each member of the CCM has the following responsibilities:
39.1 Respect and adhere to these Terms of Reference and other policies and procedures adopted by the CCM.
39.2 Take his/her membership on the CCM seriously, and attend and participate in CCM meetings in a responsible manner.
39.3 Within the CCM, freely share relevant experiences and information.
39.4 Respect and adhere to CCM decisions.
39.5 Regularly seek the views of, and hold formal meetings with, organisations and individuals within the sector that the member represents.
39.6 Within the CCM, fairly and accurately represent these views, not just those of the member organisation itself.
39.7 Regularly report all important decisions of the CCM to organisations and individuals within the sector that the member represents.
39.8 When the CCM is discussing an issue which could be to the financial or other advantage or disadvantage of the member organization or of its representative, openly declare this potential COI, and offer to leave the room, or to refrain from speaking or voting, while the CCM deals with that issue (see separate CCM COI policy).
CCM MEETINGS
40. The CCM shall hold at least [insert number] general meetings per year. However, additional special meetings may be called by the chair or the vice-chair, or may be called pursuant to a request submitted to the CCM Secretariat by at least [insert number] CCM members.
41. The meetings of the CCM shall be conducted in [language(s)].
42. Voting:
42.1 Decisions shall be made by consensus whenever possible. But where necessary, decisions shall be made by voting.
42.2 If the chair declares that a decision has been made by consensus, but a member believes there was not consensus, the member can ask for a vote.
42.3 Votes shall be of two possible kinds: "simple majority" and "two-thirds majority." “Simple majority” means a majority of voting members present at the time of the vote. "Two-thirds majority" means two-thirds of voting members present at the time of the vote.
42.4 For a measure to pass, a simple majority vote is required except when these TOR state that a two-thirds majority vote is required.
42.5 Voting shall normally be by show of hands. When a member requests a formal recorded vote, the results of the vote (i.e., the numbers for, against and abstaining) shall be recorded in the minutes. When a member requests it, each member's vote shall be recorded in the minutes of the meeting.
42.6 Secret ballots shall be used for voting when called for in these TOR or when requested by a member and approved by a majority vote.
42.7 The chair does not normally vote, but may cast a vote in the event of a tie. The same applies to the vice-chair when the vice-chair is serving as chair in the absence of the chair.
42.8 When neither the representative or alternate of a member organisation is present, that member organisation may not vote and may not have anyone else vote on its behalf.
43. Quorum:
43.1 The definition of a quorum is the presence of at least half of the voting CCM members.
43.2 No decision made at a CCM meeting is valid unless a quorum is present at the time of the decision.
44. Notice and Agenda:
44.1 All CCM members must receive, by email, fax, letter or phone at least three weeks’ prior notice of each general meeting, and at least one week’s prior notice of each special meeting.
44.2 The notice must specify the proposed agenda.
44.3 The draft agenda of the meeting shall be compiled by the chair in consultation with the executive secretary. CCM members may send requests to the CCM Secretariat for items to be included on the agenda.
44.4 At the start of each meeting, the agenda may be modified and must be approved by the CCM.
44.5 Background papers must be sent to members at least several days prior to the meeting. The background papers sent prior to each general meeting should include reports from the PRs on project progress on each grant since the previous general meeting. The agenda of each general meeting should include opportunities to discuss such reports.
45. Minutes:
45.1 Draft minutes of CCM meetings shall be prepared and distributed to CCM members by the CCM Secretariat within [time period] of each meeting. At the following meeting, these draft minutes shall be discussed, amended as necessary, and formally approved.
45.2 In the event that the draft minutes are not prepared and distributed within one week of the CCM meeting, a list of major decisions and action items from the meeting shall be prepared and distributed to CCM members by the CCM Secretariat within that time frame.
45.3 Draft minutes may be shared by members with the organisations and individuals in the sectors they represent providing the minutes are clearly labelled “draft.”
45.4 Minutes that have been formally approved shall be distributed to all members within one week of the meeting at which they were approved. Approved minutes are public documents.
45.5 The minutes of CCM meetings shall record any decisions passed by a vote, and shall record any major dissents articulated at the meeting to any such decision (unless those dissenting agree that the dissent need not be recorded in the minutes).
CCM CHAIR
46. The CCM shall have one chair.
47. The responsibilities of the chair include: convene and chair CCM meetings; propose and seek approval of the agenda of each CCM meeting; inform the CCM of the decisions of the executive committee; when necessary, make decisions between CCM and/or executive committee meetings; seek the opinion of the vice-chair on all important matters; when necessary, delegate certain responsibilities and decisions to the vice-chair; serve as spokesperson for the CCM; provide oversight of the CCM Secretariat; and fulfil other responsibilities as outlined in these TOR.
48. The chair must be from a domestic organisation. The chair and the vice-chair must be from different sectors.
49. The CCM chair shall be elected by a vote of the CCM. Any candidate for chair must be nominated and seconded by CCM members. The vote for chair shall be by secret ballot.
50. The CCM can vote to remove a chair in mid-term. Such a vote requires a two-thirds majority.
51. The term of office for the chair is [insert number] years. No person may serve more than [insert number] consecutive terms as chair.
52. If the chair resigns or is removed in mid-term, the vice-chair shall serve as chair until a new chair is elected. That election shall take place at the meeting at which the chair's departure is announced, or at the next meeting. The new chair shall be appointed to complete the term of the former chair and, at the discretion of the CCM, to serve for a full term beyond that.
CCM VICE-CHAIR
53. The CCM shall have one vice-chair.
54. The responsibilities of the vice-chair are as follows: perform tasks delegated by the chair; stand in for the chair when requested by the chair to do so, and when the chair is unable to fulfil his/her functions; and fulfil other responsibilities as outlined in these TOR.
55. The vice-chair must be from a domestic organisation. The vice-chair and chair must be from different sectors
56. The vice-chair shall be elected by a vote of the CCM. Any candidate for vice-chair must be nominated and seconded by CCM members. The vote for vice-chair shall be by secret ballot.
57. The CCM can vote to remove a vice-chair in mid-term. Such a vote requires a two-thirds majority.
58. The term of office for the vice-chair is [insert number] years. No person may serve more than [insert number] consecutive terms as vice-chair.
59. If the vice-chair resigns or is removed in mid-term, an election shall take place at the meeting at which the vice-chair's departure is announced, or at the next meeting. The new vice-chair shall be appointed to complete the term of the former vice-chair and, at the discretion of the CCM, to serve for a full term beyond that.
CCM EXECUTIVE COMMITTEE
60. The CCM shall have an executive committee.
61. The responsibilities of the executive committee are to: conduct those tasks specifically assigned to it at a full meeting of the CCM; and make emergency decisions between regularly scheduled meetings of the CCM, when it is not practical or possible to organise a full meeting of the CCM.
62. The executive committee shall be composed of the CCM chair, the CCM vice-chair, and such other members as are chosen by the CCM. The CCM chair and vice-chair shall serve as chair and vice-chair of the executive committee. The composition of the executive committee shall include representation from most of the sectors represented on the CCM. At least [insert percentage] of the members of the executive committee shall be from sectors other than the government sector and the development partners sector.
63. Executive committee members must be CCM members. Any CCM member is eligible to be chosen for membership on the executive committee.
64. The membership of the executive committee shall be determined by the CCM every year.
65. The executive committee shall meet as frequently as necessary to carry out its work. The executive committee shall operate by simple majority vote. The quorum for meetings of the executive committee shall be fifty percent of its membership. The executive committee shall report on its work to every CCM meeting (through the chair).
66. All executive committee members must receive, by email, fax, letter or phone at least two days’ prior notice of all meetings of the executive committee. The notice must specify the proposed agenda. The agenda may be modified and must be approved at the start of each meeting.
OTHER CCM COMMITTEES
67. The CCM shall set up standing committees or ad-hoc committees, as needed.
68. TOR shall be developed for each standing committee and included in the CCM’s TOR.
69. Each committee shall conduct tasks assigned to it by the CCM, and make recommendations to the CCM.
70. The composition of each committee shall be determined by the CCM. Not all members of a committee need to be members of the CCM.
71. For each committee: (a) the chair shall be chosen by committee members from among the CCM members on the committee; (b) the committee shall operate by simple majority vote; (c) the quorum for meetings shall be fifty percent of the committee membership; (d) the committee shall regularly report on its work to the CCM.
72. Minutes shall be prepared for each committee meeting within [insert time frame], and shall be distributed to all committee members and all CCM members.
CCM SECRETARIAT
73. The CCM shall establish a secretariat and shall approve its budget and TOR.
74. The secretariat budget shall include the costs for operating the CCM.
75. Responsibilities: The responsibilities of the CCM Secretariat are as follows:
75.1 Coordinate the meetings of the CCM and its committees, including: prepare draft agendas, issue meeting reminders, make transportation arrangements to bring CCM members to meetings, prepare draft minutes, and distribute the minutes.
75.2 If required, prepare a list of major decisions and action items from each CCM meeting.
75.3 Maintain a log of CCM decisions obtained from the approved minutes.
75.4 Distribute to CCM members Global Fund guidelines and other documents.
75.5 Distribute to CCM members drafts of proposals and other relevant documents.
75.6 Maintain and update distribution lists.
75.7 Maintain the records of the CCM.
75.8 Issue public announcements of in-country calls for submissions.
75.9 Prepare and submit reports to the Global Fund.
75.10 Respond to enquiries from the Global Fund.
75.11 Share information with the LFA, the PRs, and other stakeholders, including members of the public.
75.12 Facilitate the work performed by proposal-writing teams.
75.13 Carry out other functions as specified in these TOR or in the CCM Secretariat TOR, or as determined by the CCM.
76. The CCM Secretariat shall be headed by an executive secretary, who shall be appointed by the CCM and who shall report to the CCM chair.
77. The responsibilities of the executive secretary are to appoint and supervise CCM Secretariat staff; attend all meetings of the CCM and of the executive committee in a non-voting capacity, and serve as secretary for these meetings; and perform other responsibilities that are specified in the CCM Secretariat TOR.
INFORMATION EXCHANGE AND TRANSPARENCY
78. Provision of information to CCM members:
78.1 As prescribed in these TOR all members of the CCM shall receive: (a) advance notice of CCM meetings, meeting agendas, and copies of relevant documents; (b) copies of draft and approved minutes of CCM meetings; and (c) copies of the minutes of all CCM committee meetings.
78.2 CCM members shall be also be provided with: (a) all important documents from the Global Fund, including Guidelines for Proposals and calls for proposals; (b) all formal correspondence from the Global Fund to the CCM, and vice versa, including the comments of the TRP on proposals submitted by the CCM; (c) all important documents related to the preparation of proposals to the Global Fund, including calls for submissions within the country, outlines and drafts of the Global Fund proposal, and the final Global Fund proposal; (d) all important documents relating to the implementation of projects funded through Global Fund grants, including quarterly or other periodic reports prepared by the PRs and sent to the Global Fund; (e) copies of any information materials about the CCM prepared by the CCM Secretariat for external distribution (e.g., media releases, newsletters); and (f) up-to-date CCM membership lists, complete with contact information.
78.3 Members of CCM committees shall receive similar types of information for committee meetings. In addition, the approved minutes of all committee meetings shall be sent to all CCM members.
79. Provision of information to organisations and individuals in the sectors represented on the CCM: The CCM Secretariat shall ensure that the following information is disseminated widely to all interested parties within [Ruritania]: (a) a listing of all CCM member organisations, with names and contact details of their representatives and alternates; (b) the CCM TOR; (c) approved minutes of all CCM meetings; (d) any call for proposals received from the Global Fund; (e) any calls for submissions issued by the CCM within [Ruritania]; (f) the full text of any proposal submitted by the CCM to the Global Fund; (g) information on the status of proposals and Phase 2 Renewal requests submitted by the CCM; (h) the full text of any grant agreements signed between the PRs and the Global Fund; and (i) the full text of any progress reports submitted by the PRs to the Global Fund.
80. Provision of information to the Global Fund: The CCM shall ensure that the following information is sent to the Global Fund: (a) the names of all CCM members; (b) contact information for the CCM chair and vice-chair, and for executive committee members; (c) the CCM TOR; and (d) any other information which the Global Fund requires the CCM to provide.
DEVELOPMENT OF GLOBAL FUND PROPOSALS
81. The CCM shall establish a formal process for the development of proposals to the Global Fund. The process shall be transparent and documented, and shall involve interested stakeholders, both those represented on the CCM and those outside the CCM.
SELECTION OF THE PRS AND SRS
82. The CCM shall establish criteria and formal, transparent processes for (a) the nomination of PRs; and (b) the nomination of SRs. The processes shall be documented.
83. The process will be implemented each time the CCM submits a proposal to the Global Fund; and also should it become necessary to replace a PR or SR, or add another PR or SR, once project implementation has begun.
PROJECT IMPLEMENTATION
84. For each CCM-initiated project in [Ruritania] financed by the Global Fund, the CCM shall develop a formal, transparent process to oversee the implementation of the project. That process shall be documented.
85. As part of that process, the CCM shall come to an agreement with the PR concerning their respective roles in the implementation, monitoring and evaluation of the project.
86. The CCM shall ensure that a broad range of stakeholders, including those represented on the CCM and those outside the CCM, are involved in the oversight process.
87. The CCM shall receive and review copies of disbursement requests and progress updates from the PR to the Global Fund.
88. The CCM shall periodically evaluate selected project activities.
89. When necessary, and in consultation with the PR, the CCM shall prepare requests to the Global Fund for re-programming of approved grants.
PHASE 2 RENEWAL
90. The CCM shall prepare and submit a Request for Continued Funding at the end of the first phase of implementation of each Global Fund grant.
CONFLICT OF INTEREST
91. The CCM shall develop a formal COI policy. The policy shall be documented and made public.
92. The CCM shall make every effort to ensure that neither its chair nor its vice-chair is from an organisation that serves as PR for a CCM-initiated project financed by the Global Fund. If this does not prove possible, the COI policy shall describe how the CCM will mitigate this inherent COI.
93. The COI policy will also cover other situations of potential conflict.
EVALUATION OF THE CCM
94. The CCM shall carry out periodic self-assessments of its performance.
95. At least once every [insert number] years, the CCM shall commission an independent external review of CCM performance.
Annex II: List of Relevant Documents
This annex contains a list of documents related to CCMs cited in this guide and provides information on how to obtain copies of the documents.
Global Fund Documents
An Evolving Partnership: The Global Fund and Civil Society in the Fight Against AIDS, Tuberculosis and Malaria
Available via www.theglobalfund.org/en/media_center/publications/evolvingpartnership/.
Assessment of the Country Coordinating Mechanisms: Performance Baseline
Available via www.theglobalfund.org/en/apply/mechanisms/assessments/. Prepared by the Technical Evaluation Reference Group.
CCM Performance Checklist
Available via www.theglobalfund.org/en/apply/mechanisms/guidelines/.
User’s Guide for the CCM Performance Checklist
Available via www.theglobalfund.org/en/apply/mechanisms/guidelines/.
Communications Protocol for Local Fund Agents
Available via http://www.theglobalfund.org/en/about/structures/lfa/background/.
Clarifications on CCM Requirements – Round 7
Available via www.theglobalfund.org/en/apply/mechanisms/guidelines/. The Global Fund may revise this document for future rounds of funding.
Frequently Asked Questions: Use of Grants to Provide Support to CCMs
Available via www.theglobalfund.org/en/apply/mechanisms/guidelines/.
Guidelines for Completing the CCM Request (for Continued Funding)
(Not online yet. It will be posted online when Volume 2 of “The Aidspan Guide to Understanding Global Fund Processes for Grant Implementation” is published. See entry below under “Aidspan Documents.”)
Guidelines for Proposals – Round 7
Available via www.theglobalfund.org/en/about/policies_guidelines/. The Global Fund issues new guidelines for each new round of funding.
Report: Workshop for Strengthening CCMs as Public-Private Partnerships
Available via www.theglobalfund.org/en/apply/mechanisms/workshops/. The workshop was held in Lusaka, Zambia on 16-18 March 2005.
Revised Guidelines on the Purpose, Structure and Composition of Country Coordinating Mechanisms and Requirements for Grant Eligibility
Available via www.theglobalfund.org/en/apply/mechanisms/guidelines/.
Template Grant Agreement
Available via www.aidspan.org?page=implementation. This is the template for the grant agreement that the Global Fund signs with the PR.
Aidspan Documents
The Aidspan Guide to Obtaining Global Fund-Related Technical Assistance
Available via www.aidspan.org/guides.
The Aidspan Guide to Understanding Global Fund Processes for Grant Implementation – Volume 2: From the First Disbursement to Phase 2 Renewal (forthcoming; scheduled for publication before the end of 2007)
Will be available via www.aidspan.org/guides.
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