CCM Evolution CCM Working Group Meeting

1. CCM Evolution CCM Working Group Meeting February, 7th 2019 Geneva, Switzerland

2. Agenda:

3. CCM Evolution Update 1

4. Overview of CCM Evolution • The CCM Evolution project aims to strengthen CCM performance and ensure CCMs are best placed to deliver on the new Global Fund strategy. • In May 2018, the Global Fund Board approved a phased roll-out for the CCM Evolution project which consists of : • A set of proposed activities in four evolution areas • Limited set of selected countries in the June 2018-December 2019 period • A robust performance framework with indicators to further tailor activities based on evidence • Strong commitment from the Board, the Secretariat and partners at country level to support effective implementation • Consistent engagement of GF Secretariat teams and an appropriate mix of resources • Level of future funding to scale activities and numbers of CCMs will be decided during discussions for the next allocation cycle

5. Four evolution areas linked to the GF Strategic Objectives Oversight • Professionalizing the oversight function to maximize impact on grant performance. • Ensuring that the CCM oversight function is better integrated with portfolio management CCM Functioning Oversight CCM Functioning (incl. CCM Secretariat) • Systematizing activities which have demonstrated to improve CCM functioning (i.e. Ethics and CCM Code of Conduct, how to elect members…) Sample text Engagement Linkages • Stimulating a strong and committed CCM leadership. • Ensuring better communication between CCM members and their constituency members • Maximizing the collaboration and coordination between the CCM and the other forums. • On a case by case basis, evaluating opportunities to integrate CCMs into national structures. Linkages Engagement The 4 CCM Areas of focus are linked to the Global Fund’s 4 Strategic objectives

6. Final List of Countries Standard CCMs: Country is representative (not an outlier) B2/C rated grants Support of CCM leaders for CCM Evolution • CCMs in Challenging Contexts • Country is representative (not an outlier) • Fertile political environment • Strong leadership (preferably) Transition Preparedness CCMs Country is representative (not an outlier) Strong leadership * Thanks to additional funding and support from GIZ

7. Key principles underlying project activities • Continuous learning and improvement: • Drawing on lessons learnt to guide interventions and strategic guidance • Building a “so what” element in the analysis: • Supporting CCMs to be more responsive - Prioritization of impact-focused interventions • III. Meaningful engagement with functional and country teams : • Co-creation - Engaging country and functional teams in the development • and implementation of key interventions and guidance.

8. Overview of project activities and timelines Sept 2018 Oct 2018 Nov 2018 Dec 2018 Jan 2019 Feb 2019 Mar-Aug 2019 Sept 2019 Nov 2019 Workshop Oversight Workshop Baseline Assessments Oversight Linkages CCM Functioning Engagement Reporting to Committee and Board for final Decision Oversight officer deployed in CCM On-going Support for the Oversight Officer and Committee End-line Assessment Progress Update Measurement Reporting to Strategy Committee Oversight consultant will help guide the CCM Linkages assignments: mapping of existing platforms and linkages plans Setting up a Performance Management System for the CCM and its structures Capacity building on quality engagement of CCM Civil Society members Enhanced partnerships between CCMs and CBMs All oversight, linkages, engagement, and CCM Functioning activities will be undertaken based on the BA results analysis

9. Key achievements to date Oct 2018 – Feb 2019 Jun -Sept 2018 01 02 Baseline assessments and deployment of activities on the ground Finalizing materials prepared for deployment. • Engagement with all 18 CTs and relevant functional teams throughout the project • All18 baseline assessments and analysis completed (data collection, findings, insights and proposed interventions adjustments) (540 days LoE ); All 18 CTs engaged for validation of work-plans, progress updates, and follow up with oversight). • 21 oversight missions oversight (159 days LoE) + conducted and 3 oversight officers recruited • 7 Linkages missions conducted (140 days LoE) • --- On-going development of a framework for Strategic Oversight • Finalization of the baseline assessment scoring methodology • Developed and implementing a continuous quality assurance process • Conducted an Oversight Consultant Workshop • Completed the development of key tools, guidance papers and materials including the performance framework • Completed training and deployment of 70 consultants on the ground for in-country activities

10. Baseline Assessment Methodology and Results 2

11. Baseline Assessment Summary

12. Baseline Assessment Process 01 02 03 04 • Work plan review and validation • GF Secretariat (CCM hub, CTs and Functional teams) performed a verification step to review the work plans, conduct a strategic prioritization of activities, and make necessary adjustments. • Three independent scorers for quality assurance. • Letter of agreement and disbursement of funds • Reviewed work plans were shared with CCMs for agreements and approval of prioritized activities. • On receiving the CCM approval and signed letter of agreements, funds were disbursed for evolution activities. • Development of Tools and Trainings • Context-specific assessment tools were developed for all countries with foundational and strategic indicators. • 70 consultants were trained in the use of the tools to support implementation of activities. • Conducting Baseline Assessments • Teams of consultants were deployed in 18 countries for 3-week assignments to collect and analyze documentation, interview key stakeholders, and develop a work-plan. • Agreeing on a scoring methodology • Data collected during baseline assessment for analysis and scoring

13. What the baseline was looking to assess for each area CCM Functioning Oversight • Is the CCM Leadership steering the mandate of the CCM. • Does the CCM Secretariat acts a catalyzer and contributes to the implementation of the core functions? • Does the CCM have thoroughly defined and documented  the organization, terms of reference (TORs) and operating procedures and of each committee or working group? • Is the CCM applying all the provisions included in its governance documents diligently and effectively when implementing each of its core functions? • Has the CoC been adopted, endorsed and consistently applied to all CCM members and staff. • Is the oversight function being carried out with focus on national programs performance, risk management, in-country review and dialogue, resilient and sustainable systems for health and funds absorption? • Is the grant contributing to the national disease strategies? • Are changes in epidemiology being analyzed? CCM Functioning Oversight Engagement Linkages • Does the CCM communicate and work frequently in coordination with governmental entities (e.g. relevant ministries engaged in budgeting and planning) as well as other national bodies (especially regarding alignment to robust national health strategies and national disease-specific strategic plans? • Is coordination with other governance bodies thoroughly documented and is constructive discussion being held on how to strengthen coordination or to embed CCM functions? • Is the membership (of each CCM sector) selected/elected via a self-managed, participative, transparent and fairly documented processes? • Is there enhanced participation of CCM Members in CCM meetings? • Do representatives (all sectors) have regular assemblies or have other means for communication, and use it to obtain feedback on CCM and grant performance? • Does the CCM effectively supports and documents community consultations for key and vulnerable populations to provide input/feedback to CCMs Linkages Engagement

14. Reflections on the updated assessment tool • Strengths: • Includes both foundational and strategic performance indicators per CCM Evolution area, which allowed for the definition of capacity ladders. • Provides an opportunity for users to verify the existence of evidence for each indicator of the four evolution areas. • It allowed for consistency between findings and the development of work plans, and for a strategic prioritization of activities. • Provides an opportunity for country teams to provide their feedback on potential areas for improvement. • Limitations: • The tool still circumscribes the assessment of the functions to the CCM rather than the national landscape. • While the tool provided insights on the four evolution areas, it still requires additional tailoring to context. • The minimum number of required interviewees should be defined. • The tool provided a composite maturity level, which was found to be not as useful as having maturity levels by evolution areas.  

15. CCM Baseline Assessment Scoring Methodology - Design Criteria This Allows for

16. Process for designing the scoringmethodology Process Application

17. Maturity Levels at a glance Strategic Most mature governance, CCMs that strategically engage at the national level and tackle issues regarding long-term sustainability. The CCM has formal links with other national coordination bodies/efforts . 04 Engaged CCM carries out most of its governance functions independently but still needs some specific TA, fosters enhanced participation of constituencies and conducts effective oversight. 04 03 Functional CCM carries out basic governance, has most basic elements/structures in place. 03 02 Working Towards Functional CCM has limited or lack of documentation or structures in place to fulfill the required core functions of CCMs . Placeholder Text This is a sample text. Insert your desired text here. This is a sample text. Placeholder Text 02 01 01

18. CCM Assessment Scoring Methodology: Thresholds per Context

19. Preliminary insights (I):

20. Preliminary insights (II)

21. Number of CCMsfallingundereachmaturitylevel *Source: Baseline Assessment Results

22. Standard Context: number of countries by maturity level and evolution area Source: Information from the CCM Evolution Baseline Assessment

23. Transition Context: number of countries by maturity level and evolution area Source: Information from the CCM Evolution Baseline Assessment

24. COE Context: number of countries by maturity level and evolution area Source: Information from the CCM Evolution Baseline Assessment

25. Oversight results: analysis

26. Linkages results: analysis

27. Engagement results: analysis

28. Functioning: analysis

29. Strategic Interventions for oversight Strategic positioning of the CCMs – “Institutional and functional anchorage” 2. Contributing towards aligned and harmonized existing oversight systems, processes and resources to enhance efficiencies 3. Fostering on-going dialogue with relevant in-country stakeholders to align with the national response Strengthening meaningful participation of all stakeholders, particularly civil society in oversight processes 2. Leveraging on partners’, national platforms, and resources for a more efficient oversight 3. Enhancing engagement between CBMs and oversight committees for triangulation of data and decision-making 4. Fostering active participation and contribution of key ministries for effective oversight 1. Strengthening CCM leadership to: a. Steer the CCM towards its key oversight mandate b. Ensure effective implementation and follow-up of key decisions 2. Aligning the CCM secretariat’s mandate and resources to best support the oversight of grants 3. Ensuring ethical oversight decisions and practices (e.g. executive committee identifying and managing potential conflict of interest in oversight activities, ensuring responsible use of data) Linkages Strategic Oversight Engagement Functioning

30. Oversight: key findings and proposed interventions Key Findings • Limited access to required set of skills on the oversight committees • Limited knowledge of grants • Inadequate data-driven discussions taking place between key stakeholders (PRs, CTs, and CCMs). Under-use and lack of continuity - of existing tools (6/18 used dashboards). • Limited implementation of activities linked to risk management, co-financing tracking and participation in program reviews. Proposed interventions • Building oversight members capacity, hiring an oversight officer, revising oversight committee membership • Rolling-out an ongoing “knowing your grant” intervention and aligning oversight plans to the grant cycle, aligning with other donors and key partners for efficiencies. • Focus on data-driven discussions with key stakeholders including data provided by CS and CBMs to CCMs, to allow for an enriched triangulation of data • Aligning and integrating existing risk management and co-financing elements in a comprehensive manner within the oversight function • Transition countries: focus on overseeing transition preparedness. • Countries with portfolios having large health product budgets should ensure the adequate expertise (e.g. PSM) is present in the OC. • Countries with community-oriented interventions should ensure the OC obtains feedback from CBMs and KP receiving services.

31. Linkages: key findings and proposed interventions Key Findings • Linkages interventions started recently. • Limited recognition for the value of creating linkages with existing partners. • CCM’s limited knowledge of various actors within the national health landscape and potential points of harmonization/coordination. Key Recommendations • Identifying coordination opportunities for the CCM through a multi-sectoral mapping • Where possible, establishing engagement agreements and harmonizing with existing key partners for coordination, program delivery and review • Transitioning countries: creating linkages necessary for transition. Begin thought process for integration/anchorage of governance principles.

32. Engagement: key findings and recommendations to date Key Findings • Limited civil society representation and participationin key and critical processes such as data driven discussions, program revisions, grant making, and feedback loops • Limited engagement with key health partners, key stakeholders and ministries (health, finance, etc.) Key Recommendations • Strengthening leadership and capacity of CCM CS representatives (Key populations and PLWDs) to engage in GF processes, especially oversight • Signed engagement plans between CBM groups and CCM CS members to meet and discuss grant related findings and inform Oversight committees and national health programs • Reviewing CCM CS composition, and working with country or regionally based partners to deliver agreed interventions – i.e. CBMs, networks (PLWDs/Key and vulnerable populations).

33. CCM Functioning: key findings and recommendations Key Findings • CCMs experience a three year cycle of renewal • Limited performance and accountability of CCM Secretariats: few have qualified oversight officer or experienced technical managers who analyze and summarize results/documents for CCM members. Key Recommendations • Conducting CCM reform where necessary and aligning CCM membership and structures to the overall CCM mandate. • Institutionalize support for cyclical capacity building for basic functioning and oversight orientation as part of standard CCM support. • Building CCM Secretariat capacity through strengthening adequate skills and human resources with systematic performance assessments • CCMs about to transition should focus on post-GF governance issues. • Differentiation for Standard and COE CCMs by size of portfolio and grant structure.

34. CCM Evolution next phase: Roll-out 3

35. What should be the focus, content, pace of CCM Evolution?

36. Operationalization of the CCM Evolution: Lessons learnt • Full set of interventions (baseline, work-plan implementation) over 12 months in 18 countries, constitutes a considerable workload for the GF Secretariat and CCMs • The ideal moment for introducing the Evolution activities is when countries are not undergoing key processes (e.g. grant-making and CCM renewal cycles) • Country readiness and CCM capacity is key to drive and own required changes • CCMs will require a tailored set of interventions within each differentiated categories (contexts, portfolio, etc.) • Robust coordination of all partners’ priorities (TS and in-country processes) leads to greater efficiency and maximum impact • Assessment tools require modifications before full rollout

37. Rollout options: Key considerations • GF ambition for certain situations – countries in: transitioning, high impact, high allocation, levels of grants performance (strong or weak), etc. • Risk avoidance – focused “evolution” interventions to prevent negative implications on grant implementation • Propitious moments for the country in terms of grant life cycle and CCM renewal/reform • Realistic rollout pace • available resources: GF, partners, CCM domestic resources (financial and human) • Intervention package: targeted areas of support and incremental rollout • Results-based prioritization – prioritization of interventions based pilot-phase results

38. Year 3 Year 2 Year 1 Elements that could inform the evolution rollout • Transition Assessment Transitioning Transition and grant Closure • Membership renewal Implementation • Access to funding • Grant Making Access to funding Grant Making Implementation 2022 2020 2021

39. Group Work Exercise

40. Questions for 2nd Group Work Exercise : • Projecting forward over the next few cycles of the Global Fund, please discuss the following questions and develop a scenario that will ensure the complete roll out of the approach to all CCMs: • What should be the key strategic objectives of the in rolling out CCM Evolution? • In what order should the differentiated groups of CCMs be integrated into the CCM Evolution approach?  Or should there be a constant mix of CCMs from several groups? • Should at least one differentiated approach be “light”, i.e. use the latest assessment and a shorter or less costly set of interventions or a shorter-term objective?  Which CCMs might receive this approach? • At what point in the three-year funding cycle should a new wave of CCM Evolution begin – after new grants are signed or membership renewal is completed, at any point in the cycle? • For transitioning CCMs, should they enter CCM Evolution 1, 2 or 3 years before transition? • What should be the pace of CCM Evolution:  integration of all CCMs should be complete after how many funding cycles (1 cycle = 2022, 2 cycles = 2025, 3 cycles = 2028)? • Therefore, how many CCMs should join the CCM Evolution at one time (taking into account that CCMs would receive active support for 2 or 3 years)?

41. Thank you! 40

42. Possible breakdown of differentiated support packages • Full • Full assessment • 3 year work-plan + regular spot checks and updates • For selected countries entering the 3 year cycle • Four evolution areas • Light • Light assessment • # year work-plan + [regular spot checks and updates] – if applicable • For selected countries already in the year cycle (mid or advanced stage of the implementation • Four or targeted [based on context or grant priorities] evolution areas – less than 3 year work-plan • 3) Focused (mostly transition) • rollout of a maximum of one or two interventions (linkages, transitioning?) • Implementation period: 1 or 2 years Groups of CCMs will need different approaches

43. List of possible differentiated groups and # of CCMs • All or some of current mixed group of CCMs = 18 • Other CCMs transitioning in 2020 = • Other CCMs transitioning by 2022 = • Other CCMs transitioning by 2025 = • Country portfolios with commodities/pharma budgets > 80% = • Other COE CCMs under ASP = • Other COE CCMs not under ASP = • Other Hi Impact Standard CCMs = • Other Standard CCMs with focus or core portfolios = • Which CCMs go first? Is there an order which creates the most effective investment case?