PartnersGF - 2004-07-09
1st Partnership Forum: CCMs Conflict of interest or bias due to overwhelming government control?
HDN Key Correspondent Team
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With the opening of the Global Fund (GF) Partnership Forum, recommendations from various stakeholders showed several misgivings about the composition and functioning of Country Coordination Mechanisms (CCMs).
Discussions on the electronic PartnersGF eForum moderated in the run-up to the conference had already indicated some of the major concerns.
Prime among them were that ministries of health dominated the composition of national CCMs, that there are no clear guidelines on the composition of CCMs, and that members are not truly representative of their alleged constituencies.
Also of concern was the potential for conflict of interests in CCMs. The principle reason is that although CCMs recommend projects and provide oversight on those that are accepted, some CCM members such as governments also have executive functions as principle fund recipients. In addition, many of the constituents represented on the CCM are also health service providers.
An allied issue stems from the lack funds specifically for administration of CCMs, including secretarial support or field visit costs. Given this, national governments often provide some support, thus increasing their influence over the functioning of the CCM.
These views were also shared by the NGO perspectives on the Global Fund published in June this year (International Council of AIDS Service Organisations (2004), NGO Perspectives on the Global Fund, June 2004, available at www.icaso.org)
In addition, NGOs raised two further issues: that civil society representative are not treated as equal partners, and that there is a generally poor flow and sharing of information between stakeholders and the CCMs.
Delegates to the Partnership Forum attending the parallel session on fund processes and structures debated some of these CCM issues.
It was noted during discussions that although a good number of CCMs have done well, many have problems, some to the extent that they have been bypassed entirely, with applicant organisations or consortia approaching the GF directly. This has been the case in Ukraine. Since CCMs are viewed by country stakeholders as avenues for accessing GF funds, this has been a source of considerable frustration.
There is clearly a lack of guidelines on how best the CCMs can promote a forum where different partners can freely express themselves and contribute to the objectives of Fund visa-vie partnership between civil society, government and the private sector.
The multiple roles played by CCMs and their members were thought by some to result from a lack of mechanisms to ensure their independence. Hence CCMs are often seen to kowtow to or even be extensions of government. This is somewhat understandable, since they were initially set up by national governments. In the most extreme cases, government-appointed CCM members, rather than ask for appropriate representation from different stakeholders, have largely kept responsibility for CCM activities. Clearly, for many Global Forum delegates this is a problem.
Delegates suggested a need to consider alternative co-ordinating mechanisms for CCMs. One view is that the GF should insist on restrictive guidelines for the composition of these bodies. There is broad agreement, however, that one country co-ordinating mechanism should handle all country plans under the GF, and possibly including issues pertaining to other initiatives and commitments such as the WHO 3 by 5 plan and the US presidents emergency plan for AIDS relief.
In this view, CCMs are made accountable to but independent of national governments. That means the CCMs should be set up to act on behalf of national interests, as defined by all country partners. It has been suggested that CCMs should be professional entities providing technical oversight to nations, co-ordinating and processing disease responses funded under GF, while taking into account national strategic frameworks.
Given the concerns raised in various forums, including the Partnership Forum, CCMs clearly must not be seen to belong to any single national partner. They should instead play the role of developing country co-ordinating mechanism, answerable to the government and the GF. The Fund should then aim to ensure that the CCM identifies persons with technical skills to strengthen and facilitate country co-ordination.
Furthermore, CCMs should not necessarily comprise people or organisations who are potential principal recipients or possibly even implementers. This is crucial in eradicating unnecessary conflict of interests, which many feel to undermine the aims of the Fund. Full independence would also require CCMs to have separate operational budgets.
Assuming greater independence of CCMs, one interesting possibility for expanding the role of CCMs beyond the more usual vetting of proposals and thereby increasing their effectiveness was offered during the Partnership Forum. Termed Three Ones (as an adaptation of the recently announced UNAIDS-Donors strategy), the idea is for three separate CCM functions. One function is to define a national strategy for Fund investment; one function is to co-ordinate proposals and dispersal of money in a way that is accountable to all partners; one function is to act as a monitoring and evaluation body, to avoid duplication of efforts and enhance national priority-setting.
HDN Key Correspondent Team
Email: correspondents@hdnet.org