COUNTRY COORDINATING MECHANISM Evolving CCMs to align with the Global Fund Strategy

1. Draft version COUNTRY COORDINATING MECHANISM Evolving CCMs to align with the Global Fund Strategy 30 May 2017 Geneva, Switzerland This document is part of an internal deliberative process of the Global Fund and as such cannot be made public.

2. Objectives • Confirm the vision and strategic topics for CCM evolution • Review what we know about CCMs today, including how they are performing • Analyze factors that impact CCM and grant performance • Agree on next steps, including modalities for CCM and Board / Committee consultations

3. CCM evolution roadmap Focus today Today Diagnose and assess current state Now - May 2017 June 2017 – December 2017 January 2018 – March 2018 Develop vision and evolution pathways Create detailed implementation plan I II III • I.1 Define ecosystem • Outline partner’s roles • Define engagement plan • II.1 Confirm vision • Confirm CCM vision, guiding principles and key enablers • III.1 Develop rollout plan • Define strategy rollout roadmap • III.2 Prepare rollout • Change guidance documents • Update training material • Prepare deployment changes • Prepare monitoring tools • II.2 Develop evolution pathways and targeted models • Define portfolio segmentation (targeted models) and evolution pathways • Consult with internal and external stakeholders, including CCM members, Board committees and constituencies • I.2 Identify data sources & commence compilation • Collect quantitative and qualitative data sources • Analyze data • Define trends & learnings • I.3 Establish portfolio baseline • Define which change should come with new GF Strategy (COE, STC, RSSH, ITP….) • II.3 Articulate benefits of approach • Estimate feasibility and benefits of the proposed models and pathways • Prioritize activities and estimate costs IV • Communicate and align strategy with stakeholders via change and stakeholder management

4. Content Confirming Vision for CCMs 1 Understanding CCM Structure 2 Review of CCM performance 3 Correlationwithbetter CCM and grant performance 4 Next steps: consultations and work planning 5

5. CCM Definition from Global Fund Framework Document • From the Global Fund Framework Document (Section VI. Chapter B): • “..Coordination Mechanism at Country Level..” • The Global Fund will work with a country coordination and partnership mechanism that should include broad representation…The mechanism should be at the highest national level …. It should preferably be an already existing body. A senior government official should in most cases chair the mechanism... Based on the CCM Guidelines, CCMs perform five core functions: 1. Coordinate the development and submission of national request for funding 2. Nominate the Principal Recipient 3. Oversee implementation of the approved grant 4. Approve any reprogramming requests 5. Ensure linkages and consistency between Global Fund grants and other national health and development programs

6. Review of the qualitative informationAvailable literature has been reviewed and aggregated into the overall analysis

7. Vision for CCMs and key themes emerging from discussions Recent analyses, especially “OIG Audit on CCMs” and “Country Presence” paper, confirm overall CCM model is still “fit for purpose”. It has to evolve rather than being replaced. Key themes emerging from the consultations and literature review • CCMs should be differentiated, there is a need to outline different models and their characteristics and to guide CCMs accordingly: • Oversight function should be clarified and professionalized • Focus on PLWD and KAP quality engagement and consider how they could be local watchdogs. • Transform CCM Secretariat to be more effective and efficient. • Remove duplications/strengthen coordination with other groups. • Think beyond Global Fund for CCMs (resource mob, sustainability..)

8. CCMscanplay a key role in the new Global Fund Strategy Resultsfrom March CCM Working Group Meeting f b a c e d MAXIMIZE IMPACT AGAINST HIV, TB AND MALARIA a How should CCMs evolve to deliver on strategy? a b BUILD RESILIENT & SUSTAINABLE SYSTEMS FOR HEALTH PROMOTE & PROTECT HUMAN RIGHTS AND GENDER EQUALITY b c d c MOBILIZE INCREASED RESOURCES e d c b a

9. Content Confirming Vision for CCMs 1 Understanding CCM Structure 2 Review of CCM performance 3 Correlation with better CCM and grant performance 4 Next steps: consultations and work planning 5

10. This section shows information on how CCMs operate today Key areas to understanding CCMs Funding amounts and cost categories 3 1 Composition and number of members 2 4 Types of Leadership CCM Secretariats CCM

11. 1 CCM size varies but most have >40% CS members Number of Members Average Percentage of Members • Average Civil Society membership is about 50%, which is 10% more than the minimum set by the Eligibility requirement. • CCM membership ranges from 5 (Solomon Islands) to 39 members.

12. 2 Majority of CCM chaired by government officialAs per Framework Document “a senior government should in most cases chair the mechanism” Chair: Gov Other • Note: As per Eligibility Requirement 5, the CCM elects its Chair and Vice-Chair(s) from different sectors and also follows good governance principles of periodic change and rotation of leadership

13. 3 CCM / RCM funding has increased over the past 4 yearsFunding averaged US$90k / year for CCMs and US$180k / year for RCMs Disbursement Amount 2016 disbursements were US$11,411,018 (US$790,036 for RCMs and US$10,620,982 for CCMs) Steady pressure on CCM funding over time, driven largely by increase in number of RCMs

14. 3 Variance of CCM budgets in differentiated portfolios Average Percentage USD on Average • High Impact and COE have the biggest budgets. • Human resources represent about 33% of the budget. • Second biggest category is about consultations

15. CCM Secretariats are between 1-3 people 4 Average HR Positions in CCM Secretariat • Only GF funds, others is not quantified here (not available). • High Impact CCM often have co-funded position by others (Government, Partners…)

16. 4 How are CCM Secretariats being assessed? As part of the new CCM funding policy, all CCM Secretariats are assessed annually (by both CCMs and GF) This started September 2016 and will influence CCM funding disbursements beginning September 2017

17. Content Confirming Vision for CCMs 1 Understanding CCM Structure 2 Review of CCM performance 3 Correlation with better CCM and grant performance 4 Next steps: consultations and work planning 5

18. CCM performance is measured across 18 dimensions ER 3: Oversight function ER4: Representation of affected communities ER5: Transparent election process ER6: Conflict of interest Oversight Plan KAPs are represented Selection of CS members CoI Policy 1 11 8 15 Oversight Body has 4 core skills PLWDs are represented 40% are CS members CoI Declaration forms 16 12 2 9 Election of Oversight Body Gender Equality CS Engagement plans Mitigation of CoI 17 10 13 3 Oversight Visits Rotation of Chair & Vice-Chair CoI does not exceed 1 member per constituency 4 14 18 Oversight Body meets with PRs 5 CCM takes corrective action CCM shares oversight results 6 7

19. Performance improved since 2014 but still lags in Civil Society engagement and sharing oversight results • The most improved indicator is on demonstrating the mitigation of CoI issues in CCM meeting minutes.

20. Oversight function - indicators Average performance for all CCMs for ER3 Indeterminate Compliant Non Compliant • High Impact CCMs do better due to increased partner engagement 0: non-compliant 1: indeterminate compliant 2: fully compliant

21. Representation of affected communities - indicators Average performance for all CCMs for ER4 Fully Compliant New indicator Indeterminate Compliant Non Compliant • In 3 years only KAP representation (new requirement) has reached a satisfactory level, in terms of “seats”. 0: non-compliant 1: indeterminate compliant 2: fully compliant

22. CCM survey on country dialogue shows high level of satisfaction Please rate your level of engagement with the country dialogue: 2% N=561 48% 43% 7% Strongly Engaged Moderately Engaged Rarely Engaged Not Engaged 7% 4% N=552 I felt free to express my views 44% 45% 1% 7% 4% I felt prepared to participate and add value to the funding request development 37% 51% N=551 1% 5% Those coordinating country dialogue actively reached out to civil society groups and key populations 42% 42% 9% N=555 3% 7% The country team provided good support to country dialogue and the funding request preparation process 32% 50% 8% N=551 3% Source: Participant Survey As of 09 May 2017 Strongly Agree Agree Disagree Strongly Disagree Do Not Know Note: Includes Window 1 only • 84% of respondents agreed that civil society and key populations were engaged in the Country Dialogue process

23. Transparent election process - indicators Average performance for all CCMs for ER5 Fully Compliant Indeterminate Compliant Non Compliant • Quality of CS/PLWD/KAP engagement (#13) is lagging behind for all portfolios. This is the least performing indicator. 0: non-compliant 1: indeterminate compliant 2: fully compliant

24. Conflict of interest - indicators Average performance for all CCMs for ER6 Fully Compliant Indeterminate Compliant Non Compliant • More to be done in terms of COI implementation. High Impact are doing slightly better. 0: non-compliant 1: indeterminate compliant 2: fully compliant

25. Secretariat conducted an analysis to find how CCMs clustered by performance Percentage (Avg) Score CCM Performance • Using a K-means method of clustering* on the 18 performance indicators, we have successfully created two distinct groups of CCMs: • Higher Performing CCMs • CCMs with Performance Issues *An algorithm randomly chooses “k” points (“centers”) among n observations, and create clusters around them by assigning each of the (n-k) remaining observations to whatever center they are closest to. Then once each observation is assign, the algorithm recalculates each center as the mean point of the group and repeats the process until a stable number of clusters is reached.

26. Clustering results in two distinct performance groups

27. 15 CCMs across regions account for most low performance Higher performing CCMs CCMs with performance issues • These CCMs should be major focus of improvement.

28. This is correlated to low performing CCMs in COEs countries : COE country (not all are plotted) There is a strong correlation between low performing CCMs and COE. Those countries have difficulties to implement the CCM model. • COEs will need differentiated approach. 0% 100%

29. Content Confirming Vision for CCMs 1 Understanding CCM Structure 2 Review of CCM performance 3 Correlation with better CCM and grant performance 4 Next steps: consultations and work planning 5

30. Analysis: What correlates to CCM performance? • To enhance CCM performance, we need to answer two key questions: • What factors correlate to improved CCM performance that GF can influence? • Does stronger CCM performance correlate to better grant performance? • The Secretariat conducted analysis to answer the questions above: • Regression analysis based on country, grant and CCM characteristics (independent variables) and CCM and grant performance (dependent variables) • The analyses help us identify correlations but cannot prove causation • Based on the analysis, we found that: • CCM performance has a small but positive correlation with grant performance • Stronger CCM performance is correlated with several factors Global Fund can influence (amount of CCM funding, turnover of CCM members and size of CCM)

31. CCM/Grant Performance Assumptions: Correlation Chain Country characteristics (income level, country risk, size, continent, etc) GF funding characteristics (number of grants, total amount invested, etc) CCM characteristics (size, turnover, GF funding, etc) Assumption: setup of CCM impacts its performance Grant performance (rating, indicator achievement, etc) CCM performance (EPA scores, functioning level, etc) Assumption: well performing CCM => well performing grants

32. CCM/Grant Performance Assumptions: Methodology • We built statistical models to test each of the two assumptions, controlling for other effects (country or funding characteristics) • If these assumptions are verified, it means that: • We may improve the performance of CCMs by acting on their setup or funding; • We may improve the performance of grants by ensuring CCMs are well functioning Assumption: setup of CCM impacts its performance Assumption: well performing CCM -> well performing grants

33. Factors correlated to grant performance rating Level of CCM Functioning Total Amount Signed +10’000’000 USD +1 Level Limit is USD 335’443’038 + 7.4% + 3.7% Total Population GDP per capita +1000 USD + 1.56% - 6% +10’000’000 Well Performing Grants

34. Factors correlated to EPA Quantitative assessment scores CCM FundingEnvelope +100’000 USD Increases in CCM Funding related to increase in performance – up to USD 196,000 Number of Grants + 8.75 Turnover +100 Days +1 Grant + 5.29 + 13.43 EPA Number of grants increases EPA score up to a limit of 6 grants Less turnover of CCM members related to higher performance Non Compliant Fully Compliant 0 100 Quantitative assessment

35. Factors correlated to EPA Qualitative assessment scores Total Amount Signed Grants + 10% Number of Members COE + 6.6% +1 Member - 63% + 2% Increase in number of members (up to 28) related to higher performance COE strongly decreases the level of functioning Qualitative assessment EPA

36. Content Confirming Vision for CCMs 1 Understanding CCM Structure 2 Review of CCM performance 3 Correlation with better CCM and grant performance 4 5 Next steps: consultations and work planning

37. Key Next Steps • Prepare materials for Strategy Committee Meeting • Develop diffentiated pathways for CCMs • Finalizeapproach to consultations withCCMs and Board / Committeemembers • Conductconsultations to determine key activitiesfor each type of CCM • Prioritizeactivites and estimatecostof implementation

38. Models Characteristics Phase II will focus on determining differentiation for CCMs COE • Linked to potential emergency response coordination group • Lightweight (max 10 members) • …… Recognizing the different realities, it is critical to differentiate CCMs and to guide them in their relevant transformations. • Lightweight • Conflict of interest is unavoidable • …. Small Countries CCM Current CCM implementations • Strong partner’s presence • Oversight is professionalized • …. High Impact CCM • Diversify resource mobilization • Consider MoF presence • …. Transition CCM …… : Pathway to adapt (activities)

39. Illustrative: Thematic areas emerging from analysis GF relevance is calculated as: GF Investments / ALL Diseases investments

40. Different ‘Governance’ Roles for CCMs - Today Always • - The CCM operates using ‘good governance’ practices. • - The CCM coordinates Global Fund activities in country. • - The CCM coordinates all international health projects in country (e.g. Myanmar). • - The CCM is the governing body for all HIV/AIDS, Tuberculosis and Malaria activities in country (e.g. TBC). • - CCMs are part of the Global Fund governance model: are playing an active role in Board committees as “CCM members” (rather than individuals or representing a donor/implementing country/organization). Always Sometimes (if CCM is not GF specific, country level decision) Integration* Rarely (if CCM functions are fulfilled by existing body, country level decision) No unless the Board decides otherwise * GF and partners are supporting countries who want to assess this option.

41. GF Sec. and CCM Working group GF Secretariat Strategy Committee Deadline to provide SC material Gantt chart / Progress work plan Board today 2018 2017 June July Dec. Jan. Feb. Oct. Aug. Sept. Nov. Phases Mar. May • Phase 1 – Diagnose and assess current state • Define eco-system, engagement plan • Analyze data and define learnings • Phase 2 - Develop vision and evolution • Confirm CCM Vision • Define portfolio segmentation + activities • Consult with CCM members • Consult with Board committees and constituencies • Develop high level plan, Prioritize • Phase 3 – Create implementation plan • Develop rollout plan • Prepare rollout • Board level documents approved Status update to Strategy Committee on “Work stream II” October, 10th – 13th Consultation with GF Sec. and CCM Working group Second week of September Board update (optional) November, 14th – 16th Consultation with GF Sec. and CCM Working group June, 1st Status update to Strategy Committee on “Work stream I” June, 21st - 24th Consultation with GF Sec. and CCM Working group Mid-Feb SC “Work stream III” TBD Board DP May ‘18

42. Finding the most appropriate way to consult CCMs • Available options to consult CCM Members (mutually exclusive or combination): • Online survey • Phone interviews • Regional CCM workshops (EN-Africa, FR-Africa, Asia, EECA/LAC…?) • NB: can also use them for ITP-T/Code of Conduct consultations • Other? • Considered period: July to mid-September

43. Finding the most appropriate way to consult Board Constituencies • Available options to consult Board constituencies: • Online survey • Phone interviews • Joining the Regional CCM workshops • Other? • Considered period: August to mid-September

44. Backup materials

45. CCMs definition from GF Framework Document • From the Global Fund Framework Document (Section VI. Chapter B): • “..Coordination Mechanism at Country Level • 1. The Global Fund will work with a country coordination and partnership mechanism that should include broad representation from governments, nongovernmental organizations, civil society, multilateral and bilateral agencies and the private sector. The mechanism should be at the highest national level responsible for national multi-partner and multisectoral development planning. It should preferably be an already existing body. If no appropriate coordinating body exists, a new mechanism will need to be established. Where public-private partnerships do not exist, the Global Fund may support alternative partnerships among nongovernmental organizations and the private sector. • 2. The Country Coordinating Mechanism will be the focus for program accountability, depending on the Board’s decisions regarding overall Global Fund accountability and fiduciary issues. • 3. A senior government official should in most cases chair the mechanism. Where agreed upon among the partners, any member of the mechanism can chair it. • 4. The role and function of each player within the partnership of the mechanism will be agreed upon by the mechanism, safeguarding equity and transparency among the partners. • 5. The role of the United Nations agencies, multilateral and bilateral agencies and other development agencies in the mechanism should be country partnership-driven and reflect the roles of these partners in AIDS, TB, and malaria programs in-country. The country partners may want to identify a "Lead Support Agency", either bilateral, multilateral or civil society to support the preparation of proposals and undertake any other support as requested by the Country Coordinating Mechanism. ….”

46. CCM Performance : Model 1 per Indicators

47. CCM Performance : Model 1 per Indicators (cont’d)