CCM Evolution CCM Working Group Meeting February 7

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

Agenda: 1. CCM Evolution Update 2. Baseline Assessment Methodology and Results 3. CCM Evolution next phase: Roll-out 1

1 CCM Evolution Update 2

Overview of CCM Evolution q The CCM Evolution project aims to strengthen CCM performance and ensure CCMs are best placed to deliver on the new Global Fund strategy. q 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 3

Four evolution areas linked to the GF Strategic Objectives io ni n ct CC t M gh F i rs un ve • xt te e pl m Professionalizing the oversight function to maximize impact on grant performance. Ensuring that the CCM oversight function is better integrated with portfolio management Engagement 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. • m en ga ge En s e ag The 4 CCM Areas of focus are linked to the Global Fund’s 4 Strategic objectives t Linkages nk Li • • Sa • Systematizing activities which have demonstrated to improve CCM functioning (i. e. Ethics and CCM Code of Conduct, how to elect members…) O • Oversight g CCM Functioning (incl. CCM Secretariat) • Stimulating a strong and committed CCM leadership. Ensuring better communication between CCM members and their constituency members 4

Final List of Countries Region/CT GF D 4 I 1. Benin Core 2. Burkina Faso * HI 2. Cameroon Core 4. Lesotho Core 5. Malawi * Hi 6. Mozambique HI 7. Nepal Core 8. PNG Core 9. Tanzania * HI 10. Uganda HI Country is representative (not an outlier) B 2/C rated grants Support of CCM leaders for CCM Evolution GF D 4 I Region/CT 1. Albania Focused 1. Burundi Core 2. Colombia Focused 2. DRC HI 3. Guatemala Core 3. Haiti Core 4. Niger Core 4. Romania Focused Transition Preparedness CCMs Standard CCMs: a. b. c. Region/CT a. b. Country is representative (not an outlier) Strong leadership CCMs in Challenging Contexts a. b. c. Country is representative (not an outlier) Fertile political environment Strong leadership (preferably) * Thanks to additional funding and support from GIZ 5

Key principles underlying project activities I. Continuous learning and improvement: ü Drawing on lessons learnt to guide interventions and strategic guidance II. Building a “so what” element in the analysis: ü Supporting CCMs to be more responsive - Prioritization of impact-focused interventions III. Meaningful engagement with functional and country teams : ü Co-creation - Engaging country and functional teams in the development and implementation of key interventions and guidance. 6

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

Key achievements to date Jun -Sept 2018 01 Finalizing materials prepared for deployment. ü Completed the development of key tools, guidance papers and materials including the performance framework --- On-going development of a framework for Strategic Oversight ü Engagement with all 18 CTs and relevant functional teams throughout the project ü Completed training and deployment of 70 consultants on the ground for in-country activities Oct 2018 – Feb 2019 02 Baseline assessments and deployment of activities on the ground ü Finalization of the baseline assessment scoring methodology ü Developed and implementing a continuous quality assurance process ü Conducted an Oversight Consultant Workshop ü All 18 baseline assessments and analysis completed (data collection, findings, insights and proposed interventions adjustments) (540 days Lo. E ); All 18 CTs engaged for validation of work-plans, progress updates, and follow up with oversight). ü 21 oversight missions oversight (159 days Lo. E) + conducted and 3 oversight officers recruited ü 7 Linkages missions conducted (140 days Lo. E) 8

2 Baseline Assessment Methodology and Results 9

Baseline Assessment Summary q The CCM Evolution project aimed to look at the performance of CCMs in the four evolution areas of oversight, linkages, engagement and CCM functioning. q A baseline assessment was conducted to assess this performance: Ø Ø Ø The baseline assessment establishes a reference point against which to compare further measurements of CCM Evolution. While the framework for the CCM Evolution baseline assessment considered some of the areas of focus used in CCM eligibility and performance assessments, it included specific strategic elements linked to each Evolution Area (e. g. risk management, data-driven discussions, coordination, enhanced constituency communications and active participation, etc. ). The objective was to move from compliance to performance. Baseline assessment results were critical in developing/adjusting work plans for intervention. 10

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

What the baseline was looking to assess for each area CCM Functioning Oversight § Is the CCM Leadership steering the mandate of the § Is the oversight function being carried out with focus on CCM. § national programs performance, risk management, incountry 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? ht ig rs ve Engagement § Is the membership (of each CCM sector) En es ga ge ag nk § 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? Li Linkages § Does the CCM communicate and work frequently in m en t § O § § Fu § 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 Co. C been adopted, endorsed and consistently applied to all CCM members and staff. nc CC tio M ni ng § Does the CCM Secretariat acts a catalyzer and § § § 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 12

Reflections on the updated assessment tool q Strengths: Ø Includes both foundational and strategic performance indicators per CCM Evolution area, which allowed for the definition of capacity ladders. Ø Provides an opportunity for users to verify the existence of evidence for each indicator of the four evolution areas. Ø It allowed for consistency between findings and the development of work plans, and for a strategic prioritization of activities. Ø Provides an opportunity for country teams to provide their feedback on potential areas for improvement. q Limitations: Ø The tool still circumscribes the assessment of the functions to the CCM rather than the national landscape. Ø Ø While the tool provided insights on the four evolution areas, it still requires additional tailoring to context. Ø The minimum number of required interviewees should be defined. Ø The tool provided a composite maturity level, which was found to be not as useful as having maturity levels by evolution areas. 13

CCM Baseline Assessment Scoring Methodology - Design Criteria Ø Provide for a continuous series of numerical scores by Evolution Area(oversight, engagement, linkages and functioning) to: (1) position the CCM within a maturity level; (2) compare country results’ within contexts Ø Use a binary (0, 1) system of scoring indicators to reduce inter-rater variability. Ø Introduce capacity ladders: ordering indicators from the foundational to performance related ones. Useful for governance maturity and progression pathways. Ø Set relevant maturity thresholds for each context – e. g. COE thresholds Ø Maturity levels determined on performance of each evolution area instead of a single summary measure. This Allows for Ø Progression pathway within the same maturity level as well as aiming at moving to levels above. Ø Tailored and realistic performance priorities for the CCMs. 14

Process for designing the scoring methodology Process Disaggregating indicators of each evolution area by components Organizing indicators in a capacity ladder for each area based on difficulty of the activity Calculating the total number of points per evolution area Application Determining point and percentage thresholds for each maturity level and context Assigning 0/1 values to each indicator based on review of Updated Assessment Tools and Reports for each country Calculating percentage scores for each evolution area, country and context 15

Maturity Levels at a glance 04 04 03 03 02 02 01 01 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. 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. Functional CCM carries out basic governance, has most basic elements/structures in place. 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. Text 16

CCM Assessment Scoring Methodology: Thresholds per Context Oversight Thresholds Engagement Thresholds 100% 80% 60% 40% 20% 0% Working towards functional Functional Standard COE Engaged Strategic Transition Standard Linkages Thresholds Functional Standard COE Engaged Transition COE Engaged Strategic Transition Functioning Thresholds 100% 80% 60% 40% 20% 0% Working towards functional Functional Working towards functional Strategic 100% 80% 60% 40% 20% 0% Working towards functional Functional Standard COE Engaged Strategic Transition 17

Preliminary insights (I): Ø Country context is not the only determining factor for CCM progression pathways - Even countries within the same context have different maturity progression paths to follow (e. g. transitioning countries have different visions of the future and different timeframes, standard countries have different levels of capacity and performance). Ø Differentiated models - Are about adaptation and responsiveness of the CCM functions to the grant focus and priorities and national development priorities Ø CCMs need to understand the priorities and focus of the grants to better oversee them - The need to foster purposeful oversight – There is a need for a clearer link between oversight activities, the focus and priorities of grants. 18

Preliminary insights (II) Ø A focus on compliance rather than CCM effectiveness/performance was identified. Compliance elements form (still) the majority of foundational elements under each evolution area capacity ladder. Ø The strength of the CCM leadership and secretariat drive the effectiveness of the CCM Ø Effect of membership renewal on the efficacy of the governance body. 19

Number of CCMs falling under each maturity level CCM Evolution Area (Total # of Countries: 18)* Working Functional towards functional Engaged Strategic Oversight 7 6 5 - Linkages 15 2 1 - Engagement 2 14 2 - Functioning 3 15 - - *Source: Baseline Assessment Results 20

Standard Context: number of countries by maturity level and evolution area Working towards functional Functional Engaged Strategic Oversight NP, TZ, MOZ MAL, BEN, LES, BUK PNG, UG, CAM Linkages NP, TZ, MOZ, MAL, BEN, LES, PNG, BF, CAM UG UG 10 1 1 9 3 Number of countries 8 7 6 9 5 4 9 9 4 3 NP, TZ, MOZ, MAL, BEN, LES, PNG, BUK, CAM Engagement 2 3 1 1 0 Oversight Linkages Working towards functional Engagement Functional Engaged Functioning MOZ NP, TZ, MAL, BEN, LES, PNG, UG, BUK, CAM Strategic Source: Information from the CCM Evolution Baseline Assessment 21

Transition Context: number of countries by maturity level and evolution area 4 1 Number of countries 3 Oversight 2 1 2 3 Linkages 4 Engagement 1 2 Working towards functional Functional Engaged Strategic ROM, ALB GUA COL ROM, ALB, GUA, COL ROM, ALB GUA, COL ALB, GUA, COL 2 Functioning 1 ROM 0 Oversight Linkages Working towards functional Engagement Functional Engaged Functioning Strategic Source: Information from the CCM Evolution Baseline Assessment 22

COE Context: number of countries by maturity level and evolution area 4 1 Number of countries 3 1 Working towards functional Oversight HT, NIG BUR Linkages HT, DRC NIG, BUR Strategic 2 1 3 2 3 HT, NIG, BUR Engagement 1 Functional Engaged 2 2 1 Functioning BUR DRC HT, NIG, DRC 0 Oversight Linkages Working towards functional Engagement Functional Engaged Functioning Strategic Source: Information from the CCM Evolution Baseline Assessment 23

Oversight results: analysis Ø 39% are Working Towards Functional; 33% Functional; 28% Engaged and 0% Strategic Ø In general, countries have the foundational elements required to conduct the oversight function but have not fully carried out purposeful and strategic oversight, i. e. regular data-driven discussions (including CBMs), risk management, co-financing tracking, engagement in disease program reviews, contributing to Health Systems Strengthening. Ø Limited oversight of priority transition activities, including uptake of interventions by government, continued provision of services to KPs, implementation of transition work-plans. Ø Limited oversight capacities and implementation of the oversight function in standard countries with large portfolios - MOZ (500 M and TZ 580 M). Ø Need to introduce differentiated oversight according to grants focus (Health products, treatment and care; prevention, etc. ) 24

Linkages results: analysis Ranking of linkages scores by country 100% Ø 83% are Working Towards Functional, 11% Functional and only one engaged. Ø Overall - no stakeholder mapping of relevant national coordination bodies, nor any documented strategy to ensure the realization of commitments made for cofinancing. Ø Limited indication of substantial progress in terms of the establishment of functional and strategic partnerships between the CCM and relevant. Ø Linkages is proving to be a nexus that contributes to performance with other evolution areas 90% 70% 60% 50% 40% 30% 20% 10% Country UGA BUR NIG CAM BEN NEP MAL PNG DRC HAI GUA COL ALB LES ROM MOZ TAN 0% BUK Linkages score 80% * Initial assumption: linkages was seen from the perspective of integration of CCM in other bodies only not necessarily as a mean to ensure harmonization and sustainability through robust national governance bodies. 25

Engagement results: analysis Ranking of engagement scores by country Ø 11% are Working Towards Functional, 78% Functional and 11% Engaged. Ø Countries are generally meeting numerical representation requirements (women, national CSO) but quality and meaningful participation remains challenging. Ø Engagement amongst CCM sectors is not fully explored nor are strengths of each sector fully leveraged (e. g. private sector, development partners, CBOs, etc. ) Ø More proxy representation in COE countries Ø Membership is not always aligned to the focus of the grant. Ø Ministries of Finance and/or Planning are part of CCM membership in 67% of countries, but this does not translate into active participation in CCM structures or enhanced grant oversight (e. g tracking of co-financing). 100% 90% 70% 60% 50% 40% 30% 20% 10% UGA GUA LES BUK DRC CAM HAI Country NIG BEN MOZ TAN BUR PNG COL MAL ALB NEP 0% ROM Engagement score 80% 26

Functioning: analysis Ranking of functioning scores by country Ø 17% are Working Towards Functional and 83% are Functional – None Engaged nor Strategic (indicators focus on foundational aspects). Ø CCM Secretariats often carry out basic administrative and logistical functions and less support to the core function (e. g. data analysis, triangulation and synthesis) Ø CCM leadership (incl. oversight) seem to focus on carrying out governance procedures with little strategic leadership or communication. Ø No institutionalized performance management system and culture in place (for CCMs and structures). Ø CCMs do not have effective Conflict of Interest management processes. 100% 90% 70% 60% 50% 40% 30% 20% 10% O M M O Z BU R N EP TA N N IG AL B H AI BE N LE S C O PN L G U G A D R C G U A BU K M AL C AM 0% R Functioning score 80% Country 27

Strategic Interventions for oversight 1. Strategic positioning of the CCMs – “Institutional and functional anchorage” 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 3. Fostering on-going dialogue with relevant in- key oversight mandate country stakeholders to align with the national b. Ensure effective implementation and follow-up of key decisions response 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 Strategic oversight activities, ensuring responsible use of data) resources to enhance efficiencies Linkages 1. Strengthening meaningful participation of all stakeholders, particularly civil society in oversight processes 2. Contributing towards aligned and harmonized existing oversight systems, processes and ment Engage Oversight Func tionin g

Oversight: key findings and proposed interventions Key Findings Proposed interventions 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. • • • 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 cofinancing 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. 29

Linkages: key findings and proposed interventions Key Findings Key Recommendations • Linkages interventions started recently. • • Limited recognition for the value of creating linkages with existing partners. Identifying coordination opportunities for the CCM through a multi-sectoral mapping • CCM’s limited knowledge of various actors within the national health landscape and potential points of harmonization/coordination. 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. • 30

Engagement: key findings and recommendations to date Key Findings • • Limited civil society representation and participation in 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). 31

CCM Functioning: key findings and recommendations Key Findings Key Recommendations • 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. 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. • • 32

3 CCM Evolution next phase: Roll-out 33

What should be the focus, content, pace of CCM Evolution? # of Differentia ted groups Differentia ted content Number of CCMs per year Pace (cycles, point in cycle) All CCMs complete Evolution by x date 34

Operationalization of the CCM Evolution: Lessons learnt Ø Full set of interventions (baseline, work-plan implementation) over 12 months in 18 countries, constitutes a considerable workload for the GF Secretariat and CCMs Ø The ideal moment for introducing the Evolution activities is when countries are not undergoing key processes (e. g. grant-making and CCM renewal cycles) Ø Country readiness and CCM capacity is key to drive and own required changes Ø CCMs will require a tailored set of interventions within each differentiated categories (contexts, portfolio, etc. ) Ø Robust coordination of all partners’ priorities (TS and in-country processes) leads to greater efficiency and maximum impact Ø Assessment tools require modifications before full rollout 35

Rollout options: Key considerations Ø GF ambition for certain situations – countries in: transitioning, high impact, high allocation, levels of grants performance (strong or weak), etc. Ø Risk avoidance – focused “evolution” interventions to prevent negative implications on grant implementation Ø Propitious moments for the country in terms of grant life cycle and CCM renewal/reform Ø Realistic rollout pace Ø available resources: GF, partners, CCM domestic resources (financial and human) Ø Intervention package: targeted areas of support and incremental rollout Ø Results-based prioritization – prioritization of interventions based pilot-phase results 36

Elements that could inform the evolution rollout Year 1 2020 Year 3 Year 2 2021 Transition Assessment Transitioning Transition and grant Closure Membership renewal Implementation Access to funding Grant Making Implementation 37

Group Work Exercise 38

Questions for 2 nd 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: 1. What should be the key strategic objectives of the in rolling out CCM Evolution? 2. 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? 3. 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? 4. 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? 5. For transitioning CCMs, should they enter CCM Evolution 1, 2 or 3 years before transition? 6. 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)? 7. 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)? 39

Thank you! 40 40

Possible breakdown of differentiated support packages 1) Full Ø Ø Full assessment 3 year work-plan + regular spot checks and updates For selected countries entering the 3 year cycle Four evolution areas 2) Light Ø Ø 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) Ø rollout of a maximum of one or two interventions (linkages, transitioning? ) Ø Implementation period: 1 or 2 years Groups of CCMs will need different approaches 41

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? 42