I stand be corrected but my observation has been that many CSOs have vested interests.The founders have more of own interests other than that of the beneficiaries.More often than not they collude with the donor(mark you the donor wants things done their way regardless of the situation on the ground)and INGOs to impose projects on the beneficiaries.There should be more scrutiny and accountability and more emphasis on the bottom up approach if positive long term impact.Have the people/beneficiaries in mind...

My contribution is that these interventions should be participatory in which the CSOs,the private sector,governemts and communities and even the end users should consult and work together for positive long term impact.The corporate sector should be treated as a major stakeholder in this fight against malaria,HIV and TB and other diseases.I say this because they are increasingly investing in Corporate social responsibility,giving back to the societies in which they operate.Besides,they are the manufacturers of drugs and other medical supplies urgently and earnestly needed in the intervetion.This would be good because the urget drugs would be manufactured and would be affordable to all(a woder scope would be reached)

The best implementation of any program is without any doubt by including the "Civil Society". The definition of "Civil Society" has been adopted by the UN, saying that "private sector" i.e. profit-making activity is excluded. With regard to Malaria activities, excluding this sector means that most important voices which have quite some experience directly from the front-lines, are not asked to give input. As a representative of the "private sector", I nevertheless feel strongly that input from these bodies should be included into the implementation process of GF programs, too. Is "profit-making" that bad ? Isn't also allowing to re-invest into R&D for e.g. neglegted diseases? Further, in diseases such as malaria, there is nearly no profit possible (possibly with the exception of  drugs for prophylaxis). The successful implementation of any GF program should rely on experience and expertise from all parties involved. Public - Private Partnerships have proven to be very effective. Some years ago, nobody would have thaught that such cooperations would be possible, todays reality shows that it is not only possible but urgently required. There should not be any limits at all with regard to input on implementation processes, otherwise, bad examples will be increasing. Best regards, Dieter

SIAYI AXWESSO NICODEMUS The Programme Officer, CSY/The Samaritans

 

We have been looking at the experiences of hospice and palliative care civil society organisations in accessing and implementing Global Fund funds. Some of our findings have been: Many services are unaware of Global Fund processes and how to access funding Successes in accessing and implementing Global Fund funding related to: 1. Knowledge about Global Fund processes 2. Advocacy skills 3. Connections with government 4. Connections with the CCM 5. A strong champion and advocate within the organisation 6. Capacity within the NGO to deliver 7. Partnerships with other NGOs 8. Access to technical assistance if needed 9. Reputation of the NGO 10. Recognition of the need for palliative care and understanding of what palliative care is by the CCM Those who were unable to access funding was largely due to a combination of not having all of the above or elements of the above. The major challenges relating to implementation of programmes were: 1. Funds being delayed from the time they leave the Global Fund office to the time they reach the NGO. This can have a severe impact in terms of small organisations. 2. Lack of understanding about what palliative care was by the principal recipient and CCM therefore differences in understanding of what should be implemented 3. Issues when other sub-recipients did not deliver thereby affecting their funding 4. Good technical assistance relating to palliative care 5. Palliative care being included in proposals but no evidence of where this is being implemented and by whom whether by civil society or not The major benefits that came out of successfully implemented projects includes: 1. Improved partnerships with government and other NGOS as there was a need to discuss and work together 2. Increased capacity 3. Increased and better quality care Therefore in order to support the implementation of programmes with civil society, the following would be helpful: 1. Improved technical assistance in certain areas e.g. palliative care according to the WHO definition. 2. Education and information at the local level for civil society about the Global Fund (not simply large INGOS) - basic information about how the Global Fund works 3. The GF website is an excellent resource but perhaps a section which highlights in country processes around election of CCM members, calls for proposals in-country etc which would make it easier for civil society to know where to go for information. 4. Somewhere where it is possible to find what sub-recipients are being funded in countries. PRs are supposed to be able to give this information but it is very difficult to get hold off. 5. Supportive networking opportunities with civil society and CCMs. 6. Enabling good case studies to be heard in all interventions e.g. Global Fund funded Palliative Care programmes in South Africa. To answer your question about how to identify good NGOs. Within palliative care there are regional and international networks of NGOS worldwide who would be able to provide information on effective palliative care civil society organisations in country. These include the African Palliative Care Association, the Asia Pacific Hospice Palliative Care Network, the European Association of Palliative Care, the Latin American Association of Palliative Care (ALCP) the International Association of Hospice Palliative Care and the Worldwide Palliative Care Alliance. Thanks, Claire

The role of civil society in fighting HIV AIDS is obvious. However, understanding them and how they work and their limitations is necessary for finding ways for their continued and sustained contribution in this struggle. Local organizations are very varied in many aspects such as knowledge base, strategies, capacity to communicate and sell their ideas, resourcefulness, vision, advocacy, motivation, linkage with target groups, ability to partner, and so on. More research into this issue is necessary to enable better capacity building efforts. This will lead to evaluating and structuring them to ensure that they cover all aspects of HIV AIDS management in a defined region. Global Fund must support such an exercise.The outcome will clarify the need for extensive training, coordination and financial supervision. It seems that a too centralised a system should be avoided because it creates unnecessary bureaucracy. In this regard there is room to develop a more efficient coordination mechanism at national level. Small organisations should not be seen to be 'swallowed' by the bigger ones. Another great weakness of civil society is how to sustain its work.Those who work for NGOs are made to believe that funds should be available for their work and for their recurrent expenditure, salaries etc. I am saying that HIV AIDS has become the latest employment sector and therefore, this must be put into consideration when funding of activities is being done.High unemployment levels in Sudan and Africa makes this a priority area of concern. It is therefore important for Global Fund to explore financing mechanisms with long terms results. Perhaps a conference of this nature would be appropriate. Sometimes motives for HIV AIDS work are very complex. In one group of PLWAs it became apparent that, rather than have the leaders being compensated for their volunteer work, assistance should instead be directed to individuals. That is why more studies should be conducted to explain certain attitudes and come up with better methods.

I am sorry to say that the character and nature of Civil Societies accessing funds from the Global Fund require very close scrutiny. I don’t think it is fair for a civil society worth its salt to sit in waiting for money to be provided by the Global Fund and other grantees before it is able to achieve the objective for its creation and its mandate. A lot of them are created to serve selfish, tribal, regional and even personal interests. If I am to advise funding support to any Civil Society, I would recommend that the Global Fund and her principal grantees should support what a Civil Society is already doing, and must not wait, cap-in-hand nor be supported to start doing Global Fund’s thing. Each civil society must as a necessity have a vision and a mission and must not be redirected to achieve a particular recepients' purpose. What I saw in Nigeria when Global Fund was coming was the proliferation of Civil Societies/NGOs who were directed to attend trainings by Global Fund Partners to do their bidding. What I expected the principal recipients to do was to move straight to Local Government Headquarters and create their own structures and start working.From thi location they would be able to identify those NGO's who are working on appropriate control programmes which would be listed for support. The problem of HIV, AIDS and TB require a community approach, and the most devastated persons live in the rural areas, but the NGOs/Civil Societies and State Governments hijacked the Global Fund programme and made it appear that only those who are close to the corridors of power can access it.sometimes through the active and occasionally passive connivance of the Principal grantees. I challenge the Global Fund or GHAIN or FHI to mention just one NGO/Civil Society that has its true origin in a rural area. The truth is that the conditions set for the fulfillment by GHAIN, PEPFAR, etc. cannot be met even by the Local Governments let alone individuals but only the sophisticated Civil Societies/NGOs have been able to fulfill the so-called standard operating procedures set out.Therefore if Global Fund need to support Civil societies/NGOs, this support should be given to truly indigenous NGOs/CBOs who are involved in various community services in their own little ways, and not the NGOs that have large sophisticated offices in the big town but little or nothing on ground to show in the rural areas. The tricks of the NGOs is to place large sign posts in rural areas with a part-time attendant hanging around the office. But the first thing the Global Fund and the principal grantees needs to do is to have a Local Government/Community Office from where an objective decision on which NGO/Civil Society to be support could be made. The support should be in terms of transport vehicle(not SUV's)and a revolving grant for running the meetings, campaigns, referrals and emergency needs.

The civil society should strengthen, be all-inclusive in response to H.I.V and AIDS i.e.(bottom-up).

• Play an effective role as watchdogs to ensure effective implementation of programmes free of misplacement and mismanagement of resources.
• Advocate for an efficient and high quality health care system that is accessible, equitable and affordable to all (particularly people with disabilities and the marginalized communities).
• Participate in the provision of integrated and high quality promotive, preventive, curative and rehabilitative health care services.
• Provide complimentary rather than competitive services.
• Consult patient groups on priority programmes for implementation.
• Increased committment to involve people living with H.I.V and AIDS in programmes at all levels in all the three diseases-related activities.

 
On the role of the Global Fund, we will require: -

• Increased recognition of the role of the civil society particularly PLWHA networks at country levels.
• Ensure gender balance in Country Co-ordinating Mechanisms to avoid imbalance.
• Ensure evaluation of proposals undergo a transparent and independent review process.
• Involvement of Technical assistance in selected programme areas.
• Follow-up to ensure CCM meetings are well documented and circulated to the wider public.
• Diversify the terms of reference (TOR) of CCM members e.g. to be involved in monitoring the use of resources at grassroot levels and the impact.
• Harmonization of programmes implementation processes between the public/public sector.
• Strategise on workable solutions to reduce poverty prefence among PLHA in developing nations and increase investments on womens' programmes as key factors contributing to the spread of H.I.V virus, morbidity and high mortality rates.

Dear mma Jane, your ideas is as bright as your face.You have  already  narrated on the points i wanted  to emphasis on.Thanks a lot a word is enough for the wise.

By a general study of my community I have been able to come up with 5 basic supportive roles of civil organizations in the implementation of programs to fight against HIV/Aids. These roles are mobilization, consultation, volunteerism, neutralization and complementation. On what the Global Fund can do to promote the role of civil societies, I think facilitation of the integration of civil society concerns with those of other stakeholders to reduce current and potential conflict of interest and opinion requires more urgent attention.
 
Mobilization
 
Because of their greater proximity to communities and their involvement, civil societies can play a significant role in the mobilization of communities to be part of the implemented programs. Also because civil societies are generally more visible and more open to the public than most NGOs, private and public entities, they are in a better position to influence community opinion and participation in the implemented plan of action.

Consultation

Civil societies can also assist in the implementation of programmes in a consultative capacity. An influential civil organization is in a better position to understand the collective concerns of both its members and non-members within a given locality. Such knowledge is very necessary in the planning as well as implementation stages of any program. Civic groups can also play an instrumental role in identifying community needs as HIV/Aids programmes are concerned.

Volunteerism

Civil societies’ voluntarist orientation can be passed on to program implementing bodies such as NGOs. If the right affiliation is created between implementing bodies and civic societies, communities can naturally relate to the implementing body in the same manner they voluntarily interact with their civil organizations. This spirit of voluntary participation once passed on to implementing bodies increases community trust and participation in the implemented programs.

Neutralization

Also, Civil organizations by their pressure group orientation can also help to break barriers caused by custom, bureaucracy, knowledge gaps, fear or any other. They thus have the capacity to neutralize negativity and resistance of programs under implementation resulting in greater community participation hence probability of programme effectiveness.

Complementation

For programs that NGOs, private and public entities can channel indirectly to the community, civic groups can be one such conduits through which implemented programmes are transmitted to the community. For example in projects like pamphlet and other literature distribution, public notices on meetings and gatherings, identification of the affected etc where extensive involvement brings logistical challenges to implementing bodies and where independent entities can effectively assist civil groups can complement efforts of other players to reduce logistical challenges that can adversely affect project implementation.

What the global fund can do to promote the role…

As far as promoting the role of civil society in program implementation, I believe the GF has done quite a lot. The inclusion of civil society activists in the CCM structures for one, is a significant effort as it enables these organization a direct platform from which to influence the fight against HIV/Aids. Furthermore, the recognition of the role of civil societies as evidenced by their inclusion in the GF documentation is a strong motivational factor that urges these organizations to move on.

The greatest effort however is integration. By this I mean the GF must encourage greater integration of programs between civil societies and other players. Given the differences in orientation, it is not surprising to find that sometimes-civil organization and other stakeholders in the fight against HIV/Aids actually develop conflict of interest and conflict of opinion as far as program implementation is concerned and may actual end-up pursuing different goals and approaches to each other’s detriment.

As an example in my community, organizations in the fight against HIV/Aids sometimes downplay each other on the issue of abstinence versus protection. Church organizations speak violently against the use of condoms, when other organizations are so much involved in the project to make free male and female condoms freely available or at least very affordable. This difference of approach though expected in a diverse society, if not integrated,can result in the weakening of the total national efforts to fight the Situation.

Given that both entities (civil societies on side and other stakeholders i.e. NGOs, government departments, private organizations on the other) actual overlap the same population groups, the risks are that different scopes and schools of thought in the programs may confuse the target population and in the long-term this may reduce the credibility of the implemented programs giving victory to the disease.

The GF hence has to go beyond inclusion of civil societies into the CCMs and implement the terms of relationship amongst stakeholders especially in conflict situations. These terms and other memoranda must be made binding before any funding is released by the Fund. Furthermore the agreements must include how quickly conflict will be resolved amongst players giving actual time frames and deliverables where possible.

• Treatment of Leprosy
• Polio-eradication program
• DOTS
• Anti-dengue& Anti-Malaria innovative treatment
• Integration of states& national health programs (Rationale of decentralization-civil society participation) -Use of information technology
• Environmental factors analysis
• Integration of University level education in rural development
• Promotion of indigenous media& broadcasting
• Social resources& networking for real learning environment