I. Project summary

Despite widespread acknowledgement that civil society involvement is a prerequisite for optimally functioning Country Coordinating Mechanisms (CCMs), civil society is still constrained in its ability to influence decision-making within them. The goal of this project is to build on the achievements and lessons learned of previous CCM work carried out in 2009-2010 to strengthen community systems, and increase advocacy and accountability of CCMs for greater access to HIV, TB and malaria treatment, care and prevention, and responsiveness to the needs and rights of key affected populations[1] in Cameroon and Indonesia.

Through gathering and sharing strategic information, analyzing gaps and challenges, conducting mentoring and training with key population groups--including people living with HIV, to engage in national and international advocacy, the project will support work in four interrelated areas: 

 

• work with community sector advocates to better understand and support their CCMs;
• work with community sector representatives in the CCMs on greater transparency in their processes and their accountability to civil society constituencies;
• work with community sector representatives on CCMs to provide them with the tools and knowledge to better represent key populations, including people living with HIV and other key population groups;
• work with community sector advocates  to ensure sustainability and replicability of the project.

II. Detailed project description

1. Rationale

Although some important strides have been made in improving the functioning of CCMs, concerted advocacy efforts are still required to address the challenges present in the CCM model. The community sector has a major role to play in ensuring that CCMs are transparent, effective and accountable so that they can best serve the needs of the communities they are elected to represent.

According to research studies on CCMs published by ITPC (2008) and by ICASO (2009), despite the fact that the Global Fund’s policy is explicit in recognizing that civil society engagement is integral to the CCM model, to date there has been very limited investment in supporting community representatives to effectively carry out their role and responsibility on CCMs. Our experience in implementing the CCM Advocacy pilot project in Cameroon, Tanzania, Indonesia and Egypt (further: CCM II Project) and within CSAT (in particular with the CCM restructuration process in Mauritania) has demonstrated that investments in mentoring, capacity and systems strengthening and direct support to the community sector to broaden its engagement in the full spectrum of CCM activities is worthwhile and we expect this to have a measurable impact on the health outcomes of key affected communities.

There is a clear need for additional support to ensure sustainable capacity strengthening and advocacy and to engage local donor partners to support follow up activities to achieve an impact. The proposed project is a logical continuation of the CCM II work to support, strengthen and increase the sustainability of fragile developments in the pilot stage (see below). Based on consultation with partners and preliminary discussions with the Open Society Foundations, we propose to intensify country-level work with more focused financial and technical support. To do this well with limited resources, ICASO will have to narrow the geographical scope of the project from four to two countries: Cameroon and Indonesia. This was a difficult decision, given the immense progress made and abundance of advocacy opportunities present in all four countries. In the final analysis, Cameroon and Indonesia demonstrated a higher degree of ownership and uptake of the project and the potential to achieve greater results in a short period of time. With their diverse foci (both geographically and programmatically), solid advocacy opportunities for 2011-12 and highly-motivated and sustainable teams at country and regional levels, these two countries were best suited to carry forward the work of the CCM project.

As for the other two countries, Tanzania is in the process of securing funding from different sources and will continue with their work. In the case of Egypt, the revolution halted all activities; therefore they are currently wrapping up CCM-II and deciding what the next steps will be.

In both countries where CCM III will be implemented (in 2011-12)(Cameroon and Indonesia) the results of CCM II are encouraging. So much so, that AfriCASO has been approached by community sector groups in two more countries, Burkina Faso and Democratic Republic of Congo, requesting support to replicate the project’s model. In Cameroon, support from the project resulted in a ‘Charter’ and Terms of Reference that guide civil society representatives in the CCM, as well as the selection of civil society representatives through transparent elections. Also in Cameroon, there is a new election model where candidacies are received and evaluated by a committee of experts consisting of the UNAIDS country representative, a former member of the CCM and an independent observer. Candidacies are evaluated based on eligibility criteria agreed upon and validated by civil society organizations. This is important because at the beginning of the project, no procedure existed and there were fewer seats for civil society representatives who were picked up by the CCM Secretariat and not selected by civil society groups. These are changes that will outlive the project but need to be sustained by strengthening the capacity and the systems of these community groups and of the newly elected individuals by building their understanding of the Global Fund, as well as skills around advocacy and consultation within the community sector.

In Indonesia, for example, the organizations representing and working with key populations – including people who use drugs, sex workers, MSM, migrants, women and others – agreed to establish a Reference Group, a body to monitor Global Fund related work and agree on joint positions. The Reference Group identified a number of challenges and advocacy opportunities to work with the CCM, including increasing key populations’ representation (currently only one CCM member is from a key populations, the PLHIV community), improving the representation principles and monitoring implementation of the grant (whether the Global Fund’s money reaches key population communities). The issue of monitoring is a direct result of CCM-II, where the project helped key populations to better appreciate the importance of understanding the processes to ensure effective implementation of the grant.

However, challenges remain, and it is important that CCM 2011-12 ensures sustainability beyond the life of the project. For example in Cameroon, while the process to elect new members to the CCM has been developed, it still has to be internalized and supported by community sector organizations (those who are currently part of the CCM and want to be re-elected and those who want to apply for the first time). In Indonesia, the key population networks have limited capacity and are spread out throughout the country and therefore it will take time for them to build leaders’ capacity from both national and regional levels. Additionally, the CCM in Indonesia has not been responsive to the Reference Group agenda and this requires strengthening the evidence, arguments and joint action.

2. Context/niche

Currently, there are very few indigenous groups focusing on strengthening CCMs in the long term or working to improve civil society engagement in CCMs. For example, Grant Management Systems (GMS) provides support to CCMs generally but not for strengthening civil society to engage in CCMs. The Global Fund’s Secretariat also provides some technical support and funding for CCM work but again, only for the body as the whole and not focused on civil society or the community sector (and not at all on key populations). Additionally, some international NGOs support their country affiliated partners or branches but not national community groups.

However, CSAT systematically works with community sector groups– providing coaching and other technical and financial support to strengthen organizational capacity and systems, advocacy work and representation mechanisms. One important aspect of this work is that the strengthening of the sector to be engaged is done by strengthening the organization to be relevant, effective and transparent. The project uses the engagement in the CCM as the means to strengthen the representatives to be better advocates and better ‘representatives’.

As the CSAT global host and a significant player in international HIV fora, the ICASO International Secretariat (based in Toronto) is well positioned to convey documented lessons learnt from these processes and highlight key challenges in implementation to UNAIDS, the Global Fund’s Secretariat and particularly the Board where ICASO and its partners are actively engaged as members of the NGO Developed countries, the NGO Developing Countries and the Communities Delegations as well as of different committees of the Global Fund.

3. Project goal, approach and outcomes

Goal: To strengthen civil society systems, advocacy and accountability on the CCMs for greater access to HIV, TB and malaria treatment, care and prevention and responsiveness to the needs and rights of the most affected populations in Cameroon and Indonesia

The project ultimately will strengthen the CCMs to meet Global Fund requirements and implement their functions, particularly their oversight function. The proposed means of consultation and monitoring through civil society systems and networks and feeding that information back to the CCMs would give the CCMs the tools to improve grant management and implementation, which is part of the CCMs’ oversight mandate and an area that the Global Fund has committed to strengthen further from 2011 onwards.

Approach and agendas are tailored to each country:

Indonesia’s agenda is to work through the Key Population Reference Group coordinated by JOTHI, an Indonesia-based national network of PLHIV and established under CCMII, on:

• transparency in CCM processes, specifically transparent elections and monitoring conflict of interest policies (i.e., maintaining a website and making information available by translating Global Fund and other relevant information into community-friendly documents available in local languages);
• increasing representation of people who use drugs, sex workers, transgender people and gay and other men who have sex with men as there are currently not represented and the CCM rejected the inclusion of  the representative of people who use drugs; 
• ensuring broad input from and consultation of community representatives sitting on the CCM;
• improving the “watchdog” function of community representatives (and their constituencies) (i.e., getting Global Fund money to reach community organizations directly and monitoring treatments stockouts);

Currently, there is only one ‘community constituency’ represented in the CCM (people living with HIV) and the project seeks to increase the number of community representatives (and constituencies represented, particularly key affected populations). To do this, the project will strengthen the capacity of community sector organizations and their members, particularly of key populations, to be better and more effective representatives of their constituencies (including issues of consultation among the constituency).  These organizations will effectively advocate for their constituency issues in the CCM (through direct and indirect representation), and the capacity gained (including the tools and systems developed) within the project will allow them to consult and represent their constituency and advocate for their issues in different national, regional and even international fora.

Cameroon’s agenda is to support Positive Generation in their new role of communication focal point for other civil society representatives with seats on the Cameroonian CCM – a role established and strongly recommended during the CCMII implementation process. The expected role of this focal point is to strengthen and support the 12 community members in the CCM to be meaningfully and effectively involved in the decision making and operations of the CCM. Positive Generation will specifically work on:

• supporting the 12 civil society representatives[2] to be prepared in advance of the meetings and discussions in order to have an unified voice for the sector and be more effective;
• supporting gathering and analysis of strategic information to ‘go to the table’ with evidence of the issues and be more effective in their advocacy;
• building the civil society representatives’ understanding of the TRP’s comments on recent successful and failed project proposals and formulating articulated and joint positions for discussions at the CCM;
• conducting a mid-term evaluation of CS representation in the CCM with the support of an external facilitator;
• advocating within the CCM for the preparation of the CCM workplan, the integration of civil society consultations in the workplan and securing funds from the Global Fund for the CCM.

The Cameroonian CCM has just ‘accepted’ the expansion of representation and the election of civil society representatives and the CCM-II was instrumental in this, by developing a transparent and inclusive selection process for civil society representatives. This is so new that the partners in the project had to start their advocacy “within” the sector, as some of the civil society representatives wanted to stay in the CCM and not be ‘elected’ by their constituency. For this reason, the Cameroonian agenda may seem basic, but they are starting from a different position compared with Indonesia and they need to ensure that the basic elements of the representation in the CCM are strong to ensure sustainability and long-term impact.  The project will also look at strengthening the advocacy and negotiation skills of the community members, including processes to facilitate shaping joint advocacy agendas, given that a number of the selected representatives are new to the national advocacy setting as they are coming from local communities.

Objective 1: Strengthen the capacity and the systems of civil society organizations, particularly community sector organizations and key population organizations , including PLHIV, to understand and take advantage of opportunities to influence the operations of the CCM  

Expected Outcomes 1:

• Cameroon: increased knowledge and understanding of advocacy opportunities within Global Fund processes and the CCM
• Indonesia: increased understanding of how to use evidence gathered and analyzed at the community level to create an advocacy strategy (for example, on human rights violations)
• Both countries: increased understanding of Global Fund issues and opportunities by the community sector in general (by developing local language documentation)
• Both countries: increased and improved communication with civil society in general (i.e., regular updated websites, mailing lists, newsletters) and within members of the CCM (i.e, emergency communication (by phone) for making urgent decisions or actions

Objective 2: Increase transparency and accountability of the CCMs, particularly of the community representatives

Expected Outcomes 2:

• Indonesia: Increased transparency in the election of civil society representative(s)
• Indonesia: Increased engagement of groups representing key populations in the nomination and selection processes
• Cameroon: Increased understanding and use of the Charter for Civil Society Representation on CCMs that was adopted in 2010
• Cameroon: Improved coordination of the civil society delegation (i.e., advanced preparation of key position points with a rationale and specific suggestions for CCM meetings)
• Cameroon: Increased transparency and effectiveness of civil society representation (mid-term evaluation will document recommendations for the 2011/2012 period)
• Both countries: Improved communication between civil society representatives before and after the CCM meetings (i.e., by disseminating agendas and documents to be discussed by the CCM and by circulating reports of the CCM meetings with a summary of key points for civil society at large)

Objective 3: Increase the availability and use of  tools to understand the country situation, the priority issues, the lessons learned and recommendations and the needs of the most affected and vulnerable populations in HIV, TB and malaria responses.  

Expected Outcomes 3

• Cameroon: Increased capacity of civil society representatives to understand the challenges of previous Global Fund proposals (i.e., TRP recommendations for both successful and unsuccessful ones);
• Cameroon: Increased understanding by civil society groups of the needs and gaps in HIV and TB responses to make meaningful contributions to the review of ongoing and new proposals on HIV and TB through strategic advocacy in the CCM.
• Cameroon: Better understanding of the community perspective on good practices and challenges in the implementation of ongoing Global Fund supported projects to develop constructive dialogue within the CCM on project improvement.
• Indonesia: Improved “watchdog” function to provide early alerts on treatment and diagnostic interruptions/stock outs;
• Indonesia: Increased transparency in the CCM processes, including the implementation of the conflict of interest policies;
• Indonesia: Improved communication within broad civil society to support the development of advocacy strategies for the CCM discussions.

Objective 4: Increase the sustainability and ‘transfer” of in-country civil society engagement in and advocacy at the CCM.  

Expected Outcomes 4:

• Indonesia: Increased financial support for civil society organizations’ strategic planning processes;
• Cameroon: Increased financial and political support for civil society consultations and communication included in the CCM workplan and budget;
• Both countries: Increased support by major regional and national donors, and technical support providers and UNAIDS during and after project implementation (i.e, preliminary co-funding for workshops is anticipated in both countries);
• Both countries: Strengthened organizational capacity of in-country partners through support provided from regional CSAT hubs;
• Global: Increased global donors, Global Fund’s Secretariat and Cameroon/Indonesia CCM members awareness of the lessons learnt, achievements and challenges of the project (i.e., during the Global Fund’s Partnership Forum);
• Global: Increased awareness of civil society at large of the lessons learned, achievements and challenges of the project (i.e., short updates disseminated to in-country partners, the CSAT network and published on the CSAT website; session submitted to the official program of the International AIDS Conference 2012).