Civil society has made important contributions on CCMs, but its engagement is seriously limited by several factors that require immediate attention at the national level and by the Global Fund. This is the conclusion of a report that was prepared by the International Treatment Preparedness Coalition (ITPC) and is based on case studies of CCMs conducted in seven countries.

The report, dated October 2008, is entitled “CCM Advocacy Report: Making Global Fund Country Coordinating Mechanisms Work Through Full Engagement of Civil Society.” Copies of the report can be downloaded via www.itpcglobal.org.

The case studies were conducted in Argentina, Cambodia, Cameroon, India, Jamaica, Romania and Uganda. Civil society research teams were established in each country. All teams used a standardized research template to interview 15 to 25 key informants, including current and former CCM members, representatives of government and international and bilateral agencies, grant recipients, representatives of civil society organisations, and members of academia, business and medical organisations.

The ITPC report says that “the original vision of CCMs remains valid and has enormous potential for expanding the reach, equity and effectiveness of health services,” but that “[t]here is much more to learn about how to implement the CCM model effectively and in different settings.”

Overarching findings

The report draws a number of general conclusions from the seven case studies, including the following:

• There has been limited influence of civil society in proposal preparation, shaping programme implementation and oversight.
• There has been very limited investment in supporting civil society representatives so that they are as effective as possible on CCMs.
• The selection process for civil society representatives needs to be improved.
• CCM representatives have to do a better job of representing their constituencies (as opposed to their own organizations).
• There is a need for improved communications between civil society representatives on the CCM and their constituencies.
• There is a need to improve the technical skills of civil society representatives.
• Potential conflicts of interest exist among some civil society representatives that are not being fully acknowledged or adequately addressed. These include situations in which the organisation of a civil society representative receives funds from a Global Fund-supported programme.

General recommendations

The ITPC report makes a number of general recommendations, directed at the Global Fund, other donors, UN agencies, CCMs and civil society. The following is a partial summary of the recommendations.

• The report calls on the Global Fund, donors and UN agencies to invest in capacity building for civil society organisations.
• The report recommends that the Global Fund revise existing policies to ensure that CCMs play a more effective role overseeing grant implementation; develop tools to increase the awareness of civil society representatives concerning their multiple roles on CCMs; and develop key performance indicators for civil society representatives to promote accountability.
• The report calls on UN agencies, particularly UNAIDS, to help civil society organisations convene outside of CCM meetings; and to provide technical support to enable civil society to play a more effective role in CCM deliberations.
• The report recommends that CCMs provide money to civil society representatives to enable their full participation on CCMs and ongoing communications with their constituencies.
• Finally, the report calls on civil society to do more to build the capacity of civil society representatives on the CCMs; to address conflicts of interest involving civil society representatives; and to create mechanisms to ensure that civil society representatives are accountable.

The bulk of the ITPC report consists of findings from the seven case studies. Each of the studies includes a series of recommendations specific to the CCM in question. These recommendations are variously directed to the CCM, to civil society in-country, to the Global Fund, and to other international agencies.

In future issues of GFO, we will report in more detail on some of the issues raised in the ITPC report.