Following are two sample excerpts from "The Aidspan Guide to Building and Running an Effective CCM (Second Edition)", whose publication is announced in Article 4 above.
Excerpt 1: Full Participation of Members in the Deliberations and Work of the CCM
Having an equal vote may not, in itself, ensure full participation. CCM members have to feel confident about speaking out and about expressing a different view to those of other CCM members. This is not always the case, particularly among the members of the CCM who are not from the government or development partners sectors.
The fact is that on many CCMs, even where representation from NGOs, FBOs, academia and the private sector is strong in terms of numbers, the representatives of the government or development partners sectors often dominate the CCM. Why does this happen? It may be because governments in these countries are used to making decisions without consulting other sectors. It may be because development partners are not used to working with civil society or the private sector. It may be because some of the representatives of the NGO, FBO, and academic sectors are not used to operating in an environment like the CCM. It may be because some of the NGOs and FBOs receive funding from the MOH and are therefore reluctant to say anything critical about the Ministry.
Whatever the reasons, the CCM as a whole should make a special effort to ensure that all CCM members are participating in discussions. This may involve exploring issues of stigma and discrimination and other impediments to participation, particularly with respect to representatives of people living with the diseases and marginalised populations. It would be helpful if government members of the CCM took the lead on this. For some CCMs, it might be useful if the CCM formally evaluated the level and scope of participation of non-government members. Such evaluations could determine what the barriers are to full participation and suggest ways in which these barriers could be overcome.
The principle of full participation requires that all CCM members be involved in all of the major activities of the CCM, including the development of proposals submitted to the Global Fund. As well, the chair should ensure that all CCM members are consulted concerning the scheduling of meetings and the development of meeting agendas.
An example: In one particular CCM, the arrival of a new chair changed the way things were done. The new chair instituted regular meetings of the CCM, encouraged open and frank dialogue and ensured that decisions were made by consensus. Tensions between CCM members were managed by making sure that all parties could give their views openly during meetings. As a result, all CCM members now participate openly, meetings are well attended and there is a sense of ownership of the programmes.
Excerpt 2: The Submissions Process
Many CCMs assume that the need for an in-country submissions process [that is, where organizations around the country are invited to submit to the CCM their suggestions for what should be included in the CCM's proposal to the Global Fund] requires an open call for submissions. CCMs struggle with this requirement because there is no little guidance on how the call should be organised, what kinds of eligibility criteria should apply (if any), and what framework should be provided to applicants. The process can be quite onerous. Below, we talk about approaches that can be used for an open call for submissions, but we also explore alternatives to an open call.
One possible approach is for the CCM to issue an open call for submissions without establishing any criteria or issuing any guidance. This is what many CCMs have done. The advantages of this approach are that it allows all interested stakeholders to submit their ideas; and it allows them to make suggestions concerning both what thematic areas should be covered in the proposal and what specific services and activities should be included.
The disadvantages of this approach are that the CCM may receive a large number of submissions, which may make the process very unwieldy; that it may be difficult for the CCM to assemble all the pieces into a coherent whole; and that if only parts of some submissions are eventually incorporated into the proposal, many organisations will have wasted a lot of time and energy and may become disillusioned with the whole process.
Another possible approach is to establish a framework and some criteria prior to issuing the call for submissions. For example, for a Round 6 HIV/AIDS proposal, the CCM in Morocco followed the following process:
- The CCM developed the broad outline of the proposal – including objectives, service delivery areas and indicators.
- The CCM made sure that the outline of the proposal was aligned with the national strategic plan for HIV/AIDS (which had been developed through broad consultations).
- The CCM put out a call for submissions based on the outline it developed. In their proposals, applicants essentially had to explain how their activities would contribute to the achievement of the overall project.
- When it issued the call, the CCM established eligibility criteria covering strategic and programmatic issues, geographic priorities and capacity or experience thresholds for applicants (for example, number of years of experience and levels of donor funds previously managed).
The use of Global Fund service delivery areas and indicators ensured that it would not be difficult for the CCM to collate accepted submissions into the country coordinated proposal.
While stakeholders were preparing their submissions, the CCM was able to work on elements of the country coordinated proposal (e.g., CCM structure, programmatic and financial gap analysis) that were not dependent on the implementation details.
A variation on the Moroccan approach would be for the CCM to hold broad consultations in each sector; to develop the broad outlines of a country coordinated proposal; and to then issue a call for submissions. This approach might be particularly appropriate if the country's national strategy for the disease (or diseases) in question has not been developed through broad consultations.
But is it necessary to issue an open call for submissions? The Zanzibar CCM followed a process for its Round 6 proposal that did not involve a call for submissions. The process was as follows:
1. The CCM identified potential implementing partners and sources of technical support.
2. The implementation partners participated in a five-day "design forum" where, supported by resource persons, they reviewed the CCM's Round 5 proposal and identified the goals, objectives, strategies and indicators for the Round 6 proposal.
3. A proposal development group was established to coordinate the planning and writing of the proposal. This 15-member group included representatives from some of the implementing partners and some technical support persons.
4. During the planning and writing of the proposal – a process that took five weeks – consultative meetings were held with implementing partners and development partners.
5. A draft proposal was reviewed by the implementing partners.
So, while the principle behind the requirement for an open call – to ensure that all sectors can contribute to the development of the proposal – is obviously important, perhaps this principle can be achieved in other ways. The Zanzibar example suggests that the Global Fund is prepared to accept that there are alternatives to an open call.
One of the challenges faced by CCMs is to come up with a process which allows both large and small organisations to participate in a way that does not make the process unwieldy.
Whatever process the CCM adopts, remember that it must be documented and disseminated to interested stakeholders. The description of the process should include the criteria that the CCM will use to review the in-country submissions. If the CCM issues a call for submissions, the review criteria should be included in the call.