Aidspan solicited feedback from several entities on the findings of the Office of the Inspector General in its audit on country coordinating mechanisms. (See GFO article on the findings.) We heard back from two organizations - AIDS Accountability International and UNAIDS - and a member of the CCM in Zimbabwe. This article summarizes the feedback.
Phillipa Tucker, Co-Founder/Research and Communications Director, AIDS Accountability International (AAI)
Asked whether she thought the OIG "got it about right," Phillipa Tucker said, "Yes, and No. The issues they discovered are indeed issues. How members are chosen, their voluntary status, their engagement and their abilities are all hindrances."
However, Ms Tucker said there were a number of other barriers to CCM members being effective in their work, at least in the countries of the Southern African Development Community. These include the following (we have paraphrased some of Ms Tucker's points):
Most civil society organizations are short of funds, and staff have huge workloads. Attending a CCM meeting unprepared is possible and happens often. CCM members are able to sit and not engage. At one meeting, none of the civil society CCM members could name all five principal recipients, even though they were complaining about their lousy performance. They were also unaware of the major details of the previous round of funds received from The Global Fund. This reflects an accountability issue.
There is a struggle for many non-profits to stay funded and many of them lose their independence from government in order to get funds. CSOs as watchdogs are becoming rarer, and CSOs as service deliverers are growing. This affects politics and power in the CCM spaces.
CCM members do not take their role seriously enough. The OIG report alludes to their voluntary status. CCMs can receive funding support from The Global Fund, but the guidelines prohibit the use of those funds to pay members for fulfilling their role. CCM members should be paid to do this work and should be allowed to focus on it, and it alone. Not many CSOs can afford to carry the cost of a CCM member when it contributes nothing to their own work deliverables.
Lack of training on theories of change, the use of spreadsheets, and other practical issues form real barriers in some CCM members and staff. Just because a person is a formidable activist does not mean that they know how to work with a spreadsheet. AAI has seen first-hand how form-filling can delay CCMs being able to get work done. This bias towards the formally educated and people from the North is deeply troubling.
Conflict of interest is often misunderstood. The concept needs to be teased out, discussed, and debated in a frequent and ongoing manner.
There needs to be greater dialogue around whether and how CCM members represent their constituency and provide feedback to their constituency. A lack of understanding on how to formally, thoroughly and, on a timely basis, create a feedback loop is an enormous barrier to CCM members being effective. This is a huge accountability issue.
Asked whether she agreed with the OIG that it would be desirable for countries that transition away from Fund support to retain their CCMs, Ms Tucker responded in the negative. "In theory, they are a good idea, but that is being idealistic. In reality, CCMs are totally ineffective instruments for greater equality or accountability. The best results are achieved by those who are able to manipulate events and who do so beyond the scope of the CCM and in a variety of other national arenas, using their position of power on the CCM as leverage."
The question The Global Fund should have asked itself, Ms Tucker said, was: "What would the funding process have looked like without CCMs? How could the Fund have engaged with national stakeholders to ensure that the funding goes where it should? These are questions every other funder asks itself."
"Kudos to The Global Fund" for having tried a different model, Ms Tucker said. "It failed. But at least they tried."
Oscar Mundida, member of the CCM in Zimbabwe
Oscar Mundida said that the OIG should also have looked at funding for CCMs. "This can either motivate people to attend the meetings and participate in the process, or hinder their interests in the business of the CCM," he said.
Mr Mundida cautioned against a one-size-fits-all approach. Requiring that every CCM have an oversight committee "may create challenges in some countries." He said. "Some countries provide oversight even though they do not have a body called "Oversight Committee."
Mr Mundida would like to have seen mention in the audit report of the fact that "most civil society representatives in the CCM have challenges of providing feedback to their constituencies since such meetings are not normally funded." This makes it hard to have regular interaction among civil society members, he said, "which, at times, results in apathy."
Mr Mundida applauded the OIG's call for CCMs to be retained even after a country transitions away from Global Fund support. "As noted by the OIG," he said, "CCMs play a very important role in providing oversight... Therefore, even for those countries that are transitioning there is still need for the oversight role to ensure equal participation in decision-making. This is the only platform where the marginalized societies can be heard in the planning and implementation of programs that concern them."
Veronique Collard, Programme Advisor, Office of Global Fund and Global Plan Affairs, UNAIDS
"The OIG report highlights some challenges facing the CCM mechanism but does not take into account other factors that impact the work and operational functioning of CCMs," Veronique Collard said, noting that not all partners consulted by the OIG have an in-country presence and that this could influence the OIG's findings.
"CCM performance is also impacted by the nature of the relationship set up between the PRs and the country teams," Ms Collard said. She thought that the actions agreed to by the Secretariat concerning (a) differentiating CCM policies and tools and (b) improving CCM oversight would be strengthened by ensuring the country teams also direct PRs to regularly and fully share information, including challenges, with the CCM.
Regarding integration with national systems, Ms Collard said that this is a complex issue. "The CCMs' mandate is generally more clearly understood around governance of Global Fund grants and how these relate to other donor and domestic resource streams, but this varies depending upon country context," she said. "The membership structure of the CCM does not require deep expertise in matters such as health systems strengthening, supply chains etc. and hence CCMs may not be able to effectively play a full role in cross-cutting technical aspects related to health systems. The CCM does play a vital role in bringing in the voice and perspectives of key populations and civil society to issues of how health systems meet the needs of beneficiaries."
The OIG finding "that 82% of CCMS reported their work is Global Fund-specific and not a coordinating platform for all HIV, TB and malaria programs in the country can be misinterpreted," Ms Collard said, "as it is primarily a Ministry of Health and NAC (national AIDS commission) responsibility to coordinate all programs. The CCM mechanism should be seen as a contribution to the coordination function, but not necessarily as the only means to coordinate, given its composition as an external body comprised of diverse stakeholders."
Regarding CCM membership, Mr Collard said she thought the action agreed by the Secretariat will strengthen this. "It is worth noting that the broad span of civil society/key population actors and organizations in many countries can make it difficult for a given representative to be recognized as providing adequate feedback to all constituents," she said.
On the issue of whether countries should maintain a CCM after The Global Fund has pulled out, Ms Collard said that there is merit in the Global Fund considering strategies that strengthen the capacity of civil society and affected communities to be strong participants in policy- and decision-making processes once the Fund leaves. However, she said that it was really up the countries themselves to decide if they wish to continue the CCM mechanism currently in place, or look at other options.
In conclusion, Ms Collard said that the OIG's CCM report "is an excellent opportunity for strengthening in-country dialogue on investment priorities for the future, inclusive planning and implementation, driving efficiencies and maximising impact."