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Final Draft Concept Note for Strengthening Governance and Leadership through CCM Convergence
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Table of Contents
Table of Contents.............................................................................................................................2
.....................................................................................................................................................2
Introduction .................................................................................................................................3
Objectives of the Concept Note...................................................................................................5
Who the Concept Note is for.......................................................................................................5
Strategic Output...........................................................................................................................5
Governance Improvement Framework ......................................................................................5
Governance Improvement Plan (GIP).........................................................................................7
Methodological Approach ..........................................................................................................7
Critical Actions................................................................................................................................7
1.Countries’ and development partners’ readiness to adopt the GIP approach through strategy
planning and EPA;...........................................................................................................................7
Work Plan........................................................................................................................................7
Focal Person.....................................................................................................................................8
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Introduction
The Global Fund through its 2001 Framework Document has consistently supported the scaling up of
intervention in HIV, TB and Malaria based on country led processes. These processes are founded on five
basic principles which include the following2
:
i) Working on programs that reflect national ownership and respect country partnership-
led formulation and implementation processes;
ii) Promoting partnerships among all relevant players within the country, and across all
sectors of society and building on existing coordination mechanisms, and promoting
new and innovative partnerships where none exist;
iii) Work and support national AIDS plans, national health strategies and country elements
of Stop TB and Roll Back Malaria, as well as Poverty Reduction Strategies and sector-
wide approaches. It will take into account regional frameworks and global level
recommendations;
iv) Disbursements will be made in tranches based on results as measured by ex-ante
indicators and independent assessments and surveys and;
v) Leveraging support for innovative capacity development from other financial sources
throughout the programs it supports.
In addition to and based on the basic principles indicated above; the Global Fund issues requirements
and guidelines for CCMs grounded in the core principles, requirements and standards of good
governance. Further, the guidelines support national ownership, respect the central role of government,
and encourage coordination with, and building upon, existing structures wherever possible3
. However,
most CCMs have limited their governance role by positioning themselves as mechanisms for
coordinating the submission of funding applications to the Global Fund. This has resulted in the CCMs
not leveraging on existing national governance mechanisms or structures in the Ministries of Health, and
Ministries of Finance4
. Consequently, the CCMs, by and large operate under the label of “In-country
Global Fund Structures”; thus diluting its potential effectiveness as an innovative governance model.
This is despite the fact that the Global Fund does not have country presence except through the Local
Fund Agents (LFA) which are loosely viewed as the Global Fund’s “eyes and ears” at country level. An
innovative and holistic way of strengthening CCMs is therefore required.
Conceptually, therefore, to effectively strengthen CCMs as a governance model in the health and HIV &
AIDS sector; it is imperative that mutual recognition of and alignment to existing governance
mechanisms is made deliberately. This includes ensuring that CCM strengthening activities emanating
from EPA processes are used as an entry points for governance and leadership convergence beyond
Global Fund grants5
. Arguably, the Global Fund’s New Funding Model (NFM) provides an opportunity for
this. In its essential elements the NFM reasserts the principles espoused in the Global Fund’s Framework
Document. In a sense it provides a business unusual paradigm in the convergence of strategic planning,
financing options; stakeholder engagement, coordination, implementation arrangements and
governance.
2
Global Fund Framework Document (2001)
3
Guidelines and Requirements for Country Coordinating Mechanisms
4
This need became evident during discussions with the Ministry of Health in the Gambia; and consultations the
writer had with the constituency stakeholders in Lesotho in 2010.
5
This is consistent with the fact that Global Fund as a funding mechanisms leverages funding from other sources.
© Africa Capability (Pty) Limited
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Aligning with and embedding the functionality of CCMs to national governance processes is therefore a
policy imperative for countries and could be a value-contribution of the Global Fund in strengthening
governance and accountability. However, this will continue to be a challenge and a missing governance
link if a contrary paradigm (could you explain?) is perpetuated. Consequently, CCMS will remain outside
the mainstream of national systems and structures. In this respect they will continue to be viewed by
the Global Fund itself and national governments as a Global Fund structure at country level. This is
further exacerbated and/or underlined by the fact that the operating costs of the CCM are met by the
Global Fund; diluting markedly country ownership and responsibility. Therefore, if these global efforts
are not harnessed at national level through deliberate alignment to existing mechanisms; the benefits
from CCM and related constituency strengthening are likely to remain be transient and generally non-
transformative. There is therefore a need to ensure that CCM good governance practices, procedures
and processes are institutionalized into national structures to ensure catalytic transformation. The
absence of this disposition will encourage a vicious circle of governance weaknesses at worst or the
creation of an island of governance excellence during the grant life cycle at best. Either way this is
untenable.
Secondly; although the membership of CCMs is ostensibly a public-private partnership based on
constituency representation; the comparative strengths of each constituency are generally not fully and
strategically leveraged upon. There is a number of glaring and sometimes not so obvious reasons for
this. These include:
i) The governance requirements and standards in the CCM guidelines; including
governance documents and manuals in the CCMs, while universal, are not visible in
most constituency organisations;
ii) Governance and oversight responsibilities in the CCM adopt a “compliance to the Global
Fund requirements” posture rather an entrenched governance practice and culture;
iii) CCM governance is confined to the mobilisation and management of grants from the
Global Fund even to the total exclusion of HIV, TB and Malaria programs in which the
grants reside;
iv) Generally, the participation of civil society organisations, key populations and
organisations for people living with or affected by the three diseases is confined to the
CCM; albeit peripheral and generally ineffective;
v) The general institutional and governance capacity of the organisations mentioned above
is weak and;
vi) General public-private partnership engagement in the three diseases does not go
beyond the CCM.
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Objectives of the Concept Note
Recognizing the universality of the principles and procedures that define the roles and responsibilities of
the CCMs as a governance model; it is trite that these principles are extended to national governance
structures. Therefore, this concept note proposes an agenda of strengthening national governance
structures using CCM improvement strategies as entry points.
1. Clarity in the institutional arrangements of CCMs within the national landscape of governance structures and
mechanisms in the HIV, TB and Malaria financing and programming;
2. Identification of strategies which could be employed to strengthen CCMs in a systematic and cost-effective manner
and;
3. Agree on a strategic framework to ensure convergence between CCM strengthening and governance improvement to
enhance national mutual responsibility and accountability
Who the Concept Note is for
It is intended that the concept will be used by national governments (Health, Finance and other social
sector departments and programs), Global Fund; development partners, TA providers, CCMs and CSOs.
Strategic Output
Community and health systems can be strengthened if deliberate efforts are made to ensure that
strategies for CCM improvements are used as a framework for a holistic governance and accountability
enhancement. The NFM provides an impetus for this through the EPA. Therefore, the strategic output
for the proposed objectives will include:
Governance Improvement Framework
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1. Convergence between the CCM oversight and health sector governance activities including the
harmonisation of program oversight planning;
2. Robust national governance institutions supported by function accountability platforms predicated on
working community systems and; (not sure but to me it seems that this is the opposite of the
“Community and health systems can be strengthened if deliberate efforts are made to ensure that
strategies for CCM improvements are used as a framework for a holistic governance and accountability
enhancement.” Maybe I misunderstand, communities’ systems will work when there’s accountability or
accountability will work predicated on working community systems? Maybe you should not suggest
such a somewhat linear relationship.
3. Harmonised and aligned planning, implementation and financing processes on which to inform:
- Programmatic and financial gap analyses;
- Priorities to be funded by Global Fund and other funding sources based on national dialogue and
stakeholder engagement which would include inputs from client satisfaction surveys and;
- Alignment of funding request to national fiscal space; budgets and implementation arrangements,
and capacities.
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The framework presented above not only creates a strategic convergence between the CCM and
national governance structures; it embeds the NFM parameters as well. The involvement and
participation of stakeholders, development partners and key national institutions is the centre of this
convergence. Therefore, the mandate of mobilising additional resources for scaling up HIV & AIDS,
Tuberculosis and Malaria interventions is likely to be effective where there is deliberate harmonization
and alignment to national processes, structures and institutions. These institutions include for example
National AIDS Authorities for the coordination of national HIV, TB and Malaria responses; Ministries of
Health for the coordination, regulation, policy, and strategy formulation of health sector based
interventions, including public health activities; and departments of social welfare for the formulation of
welfare policies, strategies, resource mobilisation and partnerships. Further, CCMs in the convergence
framework are part of the broad national health financing and governance arrangements. This includes
alignment and harmonisation to the national fiscal policies and public sector financial management
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National dialogue and stakeholders’ engagement on the above including
National consensus on funding priorities
Governance, Coordination and implementation arrangements and
Risk management, oversight and monitoring processes
Decisions on funding options
3. Convergence between CCM oversight and health sector governance activities
- Sector/disease planning /Investment Case
- Priority-setting
- Resource Mobilisation
2. Development of priority based health/HIV sector strategy financing plans
National Health and HIV Budgets,
Programmatic and Financing Gap Analyses
Other Financing options: Global Fund Concept Note, GAVI, PEPFAR etc.
Alignment to national financing and program monitoring cycle
National program and grant oversight plan
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systems, including national planning and budgeting cycles. Further, harmonized and aligned approaches
in partnership with development partners at country level will become critical as the global agenda to
invest in public sector infrastructure, management systems and capacities gains momentum. This
includes the strengthening of health, community and welfare systems.
Governance Improvement Plan (GIP)
What is catalytic in the governance improvement framework discussed in the preceding paragraph is the
involvement of stakeholders across all the strategic activities of the convergence perspective. This in
essence brings together the modules of the eligibility and CCM performance assessment tool; including
the CCM Improvement Plan as an entry point for the governance improvement process.
Methodological Approach
Fundamentally the methodological approach will be embedded in the national strategic planning
processes and resource mobilisation decisions. In this regard, any mobilised technical assistance will
necessarily need to include in its approach a review of on-going or scheduled planning and budgeting
processes; stakeholder engagement and related decision pathways as suggested in the convergence
paradigm. As already indicated in the paragraph above; the EPA is the GIP entry point. Therefore, a
good team of facilitative technical assistance will ensure that no additional resources are needed apart
from the readiness of the country and its partners (including the Global Fund country team) to adopt the
GIP paradigm.
Critical Actions
1. Countries’ and development partners’ readiness to adopt the GIP approach through strategy
planning and EPA;
2. Revise EPA and strategic planning Terms of Reference to include GIP activities;
3. Mobilise financial and technical assistance within the strategy development and EPA processes;
4. Review and revise strategic plans to ensure that governance and leadership is part of the
strategic plan’s implementation arrangements and risk assessment and;
5. Develop a holistic governance and leadership plan as part of institutional and systems
strengthening for effective implementation and risk mitigation
Work Plan
To be developed based country consultations and readiness
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Focal Person
Jeffrey Tshabalala
Africa Capability (Pty) Limited
12 Hazyview
24 Drome Road
Lyndhurst
2090
South Africa
Skype: jeffrey. tshabalala1
Mobile: +27798224227
Email: tshabalalaj@africap.org.za
jtshabal@yahoo.com
www.africap.org.za
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