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 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:
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.
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:
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:
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:
Objective 2: Increase transparency and accountability of the CCMs, particularly of the community representatives
Expected Outcomes 2:
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
Objective 4: Increase the sustainability and ‘transfer” of in-country civil society engagement in and advocacy at the CCM.
Expected Outcomes 4:
 During the implementation of CCMII, CSOs in Cameroon agreed on a charter for CS representatives in the CCM selection process and established a delegation comprised of 12 members: CSO representatives in the CCM, including alternates, key CSOs leaders with specific expertise in health issues and financing, and a communication focal point.