PartnersGF - 2004-06-28
Progress of the GFATM CCMs
PartnerGF eForum Discussion 1 - Summary
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Introduction:
The first series of two structured discussions on the progress of the Global Fund to Fight AIDS, TB and Malaria (GFATM) Country Co-ordinating Mechanism (CCMs) on the PartnersGF eForum concluded recently and drew contributions from Costa Rica to Zambia. A range of competencies and views from people living with HIV/AIDS (PLWHA), health and development professionals, young people, women, AIDS and social activists, the media and an anonymous member of a CCM (i) were represented on the forum. Further voices from the Asia Pacific Alternative Community Forum in Bangkok, as well as GFATM-organized regional consultations (in Siem Reap, Cambodia and Nairobi, Kenya) were gathered and shared on the eForum. The overarching aim of the discussion was to develop a specific set of actionable recommendations and perspectives to be submitted to the GFATM Board for concrete action.
In spite of the diversity in range and perspective of contributions, five broad themes emerged as imperatives in maximizing GFATM and CCM impact in countries and communities. These themes focused on GFATM institutions and processes at country level and related specifically to GFATM achievements, CCM composition, representation, operations and co-ordination of partnerships. Within these themes lay overlapping principles of inclusiveness, meaningful and robust partnerships that are informed by local expertise and realities. Clear and adaptable processes and/or guidelines, strengthening of best practices and capacities, response efficiency and accountability were also identified as critical underpinnings of these themes.
Predictably, there were variations in contributions relating to pace, sequence and scale of desirable activities towards maximizing GFATM functions at the country level; but that the realization of optimal impact of GFATM requires targeted investment by the Fund (and others) towards specific desirable outputs. The tabulation below, therefore, does not imply cardinal arrangement of themes and principles.
Achievements
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A fundamental point reiterated through the eForum is that the Fund is a valuable instrument for resource mobilization and allocation against the three diseases. And that so far it has been successful in moving substantial resources to countries and communities in a very short period of time under tight deadlines and often unrealistic expectations (ii). In the process, it was felt that the Fund, in some places, has initiated and catalyzed responses against the three diseases and elsewhere generated debate on how best the responses against the three diseases can be innovative. These are achievements members felt should be acknowledged and consolidated.
Given the Fund's invaluable potential role in prevention, care and mitigation of the three diseases, collective and sustained efforts should be directed at translating the Funds functions to genuine health and life gains in countries and communities. Forum members further noted that courage to innovate and "do things differently" require deliberate investment on the part of the Global Fund Board, Secretariat and teams and the different partners in "hard thinking," listening, collaboration, innovation, adaptation and continuous involvement of independent people who have grappled with the Global Fund over the past few years. (iii)
CCM Composition
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Contributions consistently acknowledged the opportunities and challenges presented by pre-GFATM collaborative structures and partnerships on which CCM institutions and processes have been built. The opportunities were that these pre-GFATM structures and processes presented competencies that can be harnessed and adapted to the demands of the three diseases. The challenges however are that these competencies are predominantly AIDS response specific and often dont lend themselves to working effectively with the new partnerships CCM functions entail.
Furthermore, participants stated that power dynamics within CCMs reflect inherent unequal competencies and that deliberate efforts should be exerted at redressing these inequalities, and be informed and sensitive to geographical balance; include vulnerable groups especially women, young people, children and drug users; and organizations working on TB and Malaria, not only on those working on AIDS. Incentives to attract and retain diverse and representative competencies touted on the forum included development of guidelines on the roles, functions and ideal qualifications of the different CCM members. In fact several contributions suggested that CCM chairpersonship should be held by a development professional or technocrat of pragmatic character to expedite CCM functions (iv).
CCM Representation
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"To be a CCM member is not enough!" CCM members representing the civil society are often criticized by their peers as "just being there to approve government decisions" (v). This summarizes forum participants' dilemma in getting "true" representation on CCMs: On one hand civil society demand representation onto CCM and on the other being granted presence on the CCM is not effective representation unless members' constituencies have been involved in their selection, are able to consult with them and logistical and capacity building support is provided to facilitate their participation in CCMs' activities. It was felt that difficulties also arise in selection, nomination or election of representation. First, civil society is organized in unrepresentative ways; much as the definition of civil society is at the most ambiguous. Secondly, constituencies may not be developed and where they are, to be truly effective and representative a CCM member is likely to be from the "senior" people, from civil society, government, multilateral and development assistance "who are just too busy too give more time to the Global Fund" (vi).
Suggested strategies for resolving these issues included: reduction in transactional costs of participating in GFATM mechanisms through issuance of explicit guidelines on nomination or election of constituency representatives, direct investment in constituency development and functioning including training in locally felt and identified leadership skills of constituency representatives.
CCM Operations
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It was pointed out on the forum that it is not enough for the GFATM to declare that it is efficient, flexible and innovative without the requisite support to implementation. Again it was pointed out that the GFATM institutions and process have been built on "failed mechanisms" that have advantaged the politically and financially astute participants and organizations that have been adept at managing previous financial and donor systems. These have had their views heard in CCMs, leveraged resources in their direction while the less savvy representatives and organizations - often from rural areas - who have something essential to contribute have had their views or responses unrecognized.
The funding and institutional processes of the Fund were also deemed as devoid of innovation and creativity: "Our PR has worked hard to meet the demand of the Global Fund; there has just been no time for creativity and innovation." Even though one experience cannot be extrapolated to other countries, the above contribution illustrates how the performance model is lacking in allocating resources to needy areas and new frontiers.
Investment in innovation, listening, "hard thinking" simplifying and making application guidelines accessible and developing processes that identify innovative responses were suggestions from the forum for improvement.
CCM Partnerships/Co-ordination
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"The lists of communities that are meant to be engaged in the co-ordination process include:
- Academic/educational sector:
- Governments:
- NGOs/Community based organizations;
- People living with HIV/AIDS TB and/or Malaria
- Private Sector;
- Religious/Faith based Organizations;
- Multilateral and bilateral Development partners in-country;
- (Media representatives)."vii
Comments on partnerships and co-ordination mechanisms in the GFATM mechanisms recognized challenges in fostering meaningful partnerships due to inherent power inequalities in CCMs, which have been founded on different and often incompatible competencies. Despite repeated suggestions on this forum and elsewhere about the urgency for integration, numerous development agencies including the GFATM have either been incapable to integrate or have not just invested in integration. Thus the essence of the GFATM foundation - "courage to do things differently" remains unresolved: "many stake holders are still operating in the old paradigm whereby governments dominate through a North-South donor-recipient power dynamic rather than true partnerships between state and non-state actors." Also: "CCMs, with the exception of a few, are disgracefully marginalizing civil society, and especially the communities infected and affected by AIDS, TB, and malaria." (viii)
Suggestions to optimize these partnerships included investment in co-ordination specifically financial and technical support for small but full-fledged functioning CCM Secretariats and direct investment in developing functioning partnerships, with among others, the media and the private sector. It was noted that while these partnerships exist their comparative advantages have not been brought to bear against the three diseases. Developing clear guidelines, for instance, on the roles and functions for the media and private sector in CCM, which could include possible process and impact monitoring or program and service provision.
Conclusion
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Investment is the key word that sums up this structured discussion on the PartnersGF eForum. Investment in listening not only to the "usually suspects" but even to the harshest critics and those whose voices are difficult to listen to, either because they are unsettling or because they are just too far technically and geographically from the often urban-based policy-makers; these voices should be drawn into the GFATM mechanisms as they have an essential contribution to make. Investment in efficiency and accountability through sharing best management practices that exhibit sound economics in service delivery. Investment in commitment to program information dissemination on links between inputs and outputs in real life gains in countries and communities. Investment in the institutions and processes charged with prevention, care and mitigation of the three diseases, and Investment in "having the courage to do things differently" through matching rhetoric with indispensable financial and technical resources. Investment.
There were over 750 participants in this initial online discussion, with 37 people actively contributing:
HDN eForum Moderation Team
Email: info@hdnet.org
Chiang Mai, Thailand
Friday 25th June 2004
Endnotes:
(i) A list of participants is attached to this summary.
(ii) Mick Mathews
(iii) CCM anonymous
(iv) Dr. S.K. Trivedi PhD, Celina Castro, Richard Stern, Renuka
(v) Pol Jansegers
(vi) CCM anonymous
(vii) Peter Burgess
(viii) Paul Zeitz