Post on 28-Aug-2018
The Anglophone Africa Civil Society and Communities CCM Shadow Report and Scorecard Initiative
THE RWANDA CIVIL SOCIETYAND COMMUNITIES
CCM SHADOW REPORT
Authors:
Kagaba Aflodis (Health Development initiative)
Mwananawe Aimable (Ihorere Munyarwanda)
Munyaburanga Uwase Nadege (Kigali Hope Association)
2
“Africa’s story has been written by others; we need to own our problems and solutions and write our story”. - President of Rwanda, Paul
Kagame, 2013.*
*Every one of the Country Reports were done using Participatory Action Research: the research was developed, conducted, analysed and written by in-country national civil
society activists.
The Rwanda Civil Society and Communities CCM Shadow Report
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Table of Contents
Abbreviations .....................................................................................................................................................................4
Problem Statement ...........................................................................................................................................................5
About the research ............................................................................................................................................................7
Expected Outcomes ...........................................................................................................................................................7
Methodology ......................................................................................................................................................................8
Analysis .............................................................................................................................................................................10
CCM Performance ............................................................................................................................................................10
EPA Tool & Process ..........................................................................................................................................................16
PIP Tool and Process .......................................................................................................................................................17
Findings .............................................................................................................................................................................18
Finding 1: There is no formal orientation to the CCM .................................................................................................18
Finding 2: No permanent Oversight Committee ..........................................................................................................18
Finding 3: Delay in meeting announcements ...............................................................................................................18
Finding 4: Not aware of the Global Fund tools; the EPA and PIP ...............................................................................18
Finding 5: Protection of guiding documents on the website ......................................................................................18
Recommendations ...........................................................................................................................................................19
Priority Area 1: Orientation for CCM members ............................................................................................................19
Priority Area 2: Civil Society participation .....................................................................................................................19
Notes .................................................................................................................................................................................20
Contact Details .................................................................................................................................................................22
4
Abbreviations
AAI AIDS Accountability InternationalCCM Country Co-ordinating MechanismCoI/CI ConflictofInterestCG Community groupCSO Civil Society OrganisationCS Civil SocietyEANNASO EasternAfricaNationalNetworksofAIDSServiceOrganisationsEPA EligibilityPerformanceAssessmentFBO Faith-Based OrganisationFGD Focus Group DiscussionWSW WomenwhohaveSexwithWomenGF/GFATM GlobalFundforAIDS,TuberculosisandMalariaHIV HumanImmunodeficiencyVirusIDU Injecting drug usersINGO InternationalNon-GovernmentalOrganisationKAP KeyAffectedPopulationsKP Key PopulationsMDR TB Multi-Drug-ResistantTuberculosisMSM MenwhohavesexwithmenNFM NewfundingmodelNCM NationalCoordinatingMechanismNGO Non-GovernmentalOrganisationNPO Non-ProfitOrganisationOIG OfficeoftheInspector-GeneralPAM PeopleAffectedbyMalariaPATB PeopleAffectedbyTuberculosisPIP PerformanceImprovementPlanPLWD PeopleLivingwiththeDiseasesofHIV,TBandmalariaPLWHIV PeopleLivingwithHIVPR Primary RecipientRFA RequestforApplicationSR Subsidiary RecipientSSR Sub-Subsidiary RecipientSW SexWorkersTB Tuberculosis
The Rwanda Civil Society and Communities CCM Shadow Report
5
EffectiveCountryCoordinatingMechanisms(CCMs)areavitalpartoftheGlobalFundarchitectureatcountrylevel.
CCMsareresponsible forsubmittingrequests for fundingandforprovidingoversiteduring implementation.With
theintroductionoftheGlobalFund’sNewFundingModel(NFM)inMarch2014,CCMsplayanevenmoreimportant
centralrole,convenestakeholderstoengagemeaningfullyininclusivecountrydialogue,agreeonfundingsplit,and
participateinthedevelopmentofNationalStrategicPlan(NSP)discussionsforthethreediseasesatcountrylevel.
Withtheenhancedresponsibility,theNFMalsointroducedmorerigorousCCMassessmentprocesses.Previously,
CCMssubmittedaself-assessmentattachedtotheirproposal.Now,CCMself-assessmentsarefacilitatedbyconducted
byanexternalconsultant–either the InternationalHIV/AIDSAllianceorGrantManagementSolutions forandon
behalfoftheCCMHub.Further,CCMsarealsomandatedtohaveaperformanceimprovementplantoaccompany
theirassessment,ensuringthatareasofweaknessareaddressedinanopenandtransparentmanner.
DespitetheimportanceofCCMsinGlobalFunddecision-makingatcountry level,studieshaveflaggedissueswith
CCMmembershipbalance,poorrepresentationandlimitedconstituencyfeedback.1,2Further,therecentauditreport
fromtheOfficeoftheInspectorGeneral(OIG)foundseveralpersistentshortcomingswithCCMperformance:
• 10%ofthe50countriesrevieweddidnothavetherequiredoversightcommittee;
• Morethanhalfofthecountriesdidnothavespecificinformationonroles,timelines,andbudgetsintheiroversight
plans,ortheyhadoversightplansthatwereoutdated;
• 62%oftheCCMswerenon-compliantwiththerequirementofseekingfeedbackfromnonCCMmembersand
frompeoplelivingwithand/oraffectedwiththedisease;
• Morethanhalfofthe45CCMsthathaveoversightbodiesdidnotadequatelydiscusschallengeswiththePRsto
identifyproblemsandexploresolutions;
• 58%oftheCCMshadnotsharedoversightreportswithcountrystakeholdersandtheGlobalFundSecretariatin
theprevioussixmonths;and
• 26%didnotsharetheoversightreportswithrelevantstakeholdersinatimelymannerthatcouldhaveensured
well-timedremedialaction.
InlightoftheOIGCCMAudit,andtheenhancedroleofCCMsincountryleveldiseasegovernanceintheFunding
Model,thereisaneedforawiderangeofstakeholderstobeempoweredtodemandimprovedCCMperformance.
WhilethemovetohaveanexternalconsultanttofacilitatetheCCMEligibility&PerformanceAssessments(EPA)and
thedevelopmentofPerformanceImprovementPlans(PIPs)toguidethesubsequentstrengtheningoftheCCMisan
improvement,thefactthattheseEPAsandPIPsarenotpublicisanobstacletoaccountability.
Problem Statement
1 Oberth,G. (2012).Who isReallyAffecting theGlobalFundDecisionMakingProcess?:ACommunityConsultationReport.AIDSAccountabilityInternational.CapeTown,SouthAfrica.Onlineathttp://aidsaccountability.org/?page_id=80942 Tucker,P.(2012).WhoisreallyaffectingtheGlobalFunddecisionmakingprocesses?AQuantitativeAnalysisofCountryCoordinatingMechanisms(CCMs).AIDSAccountabilityInternational.CapeTown,SouthAfrica.Onlineathttp://aidsaccountability.org/?page_id=8094
6
VestedstakeholdersandcommunitiesmustbeabletouseCCMassessmentsandimprovementplansasaccountability
mechanismstodemandbetterperformance.
AddedtothisisthatfactthatcurrentlyCCMAssessment&PerformanceImprovementPlanslackquestionsthatspeak
toqualityofperformancesuchasmeaningfulengagement,useofdocumentationandinformation,etc.
CivilsocietyneedstobefurtherengagedwiththeCCMAssessment&PerformanceImprovementPlansinorderto
holdstakeholdersaccountable.Similarly, thesesamecivilsocietywatchdogsandaffectedcommunitiesmusthave
thetools,knowledgeandinformationtheyneedtobeabletomeasuretheperformanceoftheCCMmembersthat
representthemandtoholdCCMsaccountable.
Problem Statement
The Rwanda Civil Society and Communities CCM Shadow Report
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About the research
Long term goalMoreaccountableCCMs.
Medium term objectiveIncreased transparency around
CCMperformanceandimprovementplans.
Theprojectcomprisesoftwotypesofresearch:
The Country CCM Shadow Reports
ThesereportsdrilldownintoissuesatcountrylevelandassessCCMperformancefromtheperspectivesofbothCCM
membersaswellastheperspectiveofotherstakeholderssuchasprincipalrecipientsandsubrecipients.Thereport
isbasedontheGFATMCCMAuditProgressAssessmentToolbutalsoincludevariousotherquestionsthatareseen
tobelackingintheexistingauditsbyGeneva.Thereasonwhytheresearchisconsideredashadowreportingexercise
isthatmethodologicallyandintermsofcontentwearehopingtobuildandimproveonthemethodsbeingusedby
Genevaatthistime.Shadowreportsareusedtosupplementand/orprovidealternativeinformationtothatwhich
wassubmittedintheoriginalreports. Inthiswork,ouraimisthesame:tosupplementand/orprovidealternative
informationtothatfoundintheoriginalCCMaudits.
TheCivilSocietyCCMScorecardandCountryCCMShadowReportswillnotduplicate theGlobalFundsupported
EligibilityandPerformanceAssessments(EPAs).ThisisbecausewhilstEPAsareconsultantfacilitatedself-assessments
ofCCMsthatarelargelydrivenbytheGlobalFundtofacilitateaccountabilityusingatopdownapproach;theCivil
SocietyCCMScorecardandCountryCCMShadowReportswillbeundertakenbycivilsocietyincountry,usingabottom
upapproach.Inaddition,theCivilSocietyCCMScorecardandCountryCCMShadowReportssoughttointerviewboth
CCMmembersaswellas implementingpartners (principal recipients (PRs)andsub-recipients (SRs))who interact
withCCMs.TheresearchfortheCivilSocietyScorecardandtheCountryCCMShadowReportswasfacilitatedbycivil
societyresidentincountrysotheexercisecouldbothempowercivilsocietyandsustainthecultureofdemanding
accountabilityfromCCMsincountryandbereplicatedacrossothergrantimplementers.
The Civil Society CCM Scorecard
Acomparativeanalysisthatrankstheparticipatingcountriesagainsteachotherintermsoftheirperformance.Using
theAAIScorecardmethodology,datafromtheCountryCCMShadowReportsisanalyzedandcountriesaregraded
ontheirperformance,asameanstouncoverbestandworstpractice,whoisahead,whoisfallingbehind,andother
similaritiesanddifferencesthatmightmakeforgoodentrypointsforadvocacy.
Focus Countries
Ninecountriesparticipatedintheresearch:Ghana,Kenya,Malawi,Nigeria,Rwanda,Swaziland,Tanzania,Ugandaand
Zambia.
Expected Outcomes
Short term aimEmpoweredcivilsocietyand
communitygroupswhocandoeffectiveshadowreporting.
8
Thetechnicalteam(AAIandEANNASO)developedaquestionnairebasedontheGlobalFundEligibilityandPerformance
Assessments(EPAs)questionnaire(calledtheProgressAssessmentTool).AAIalmostexclusivelyusesParticipatory
Actionresearch(PAR) forfieldresearch,abestpractice inwhichcommunityandcountrycivilsocietypartnersco-
developedthemethodology,researchtools,conductedtheresearchandwrotethefinalreportsandanalysis.
Localcivilsociety,whodonotsitontheCCManddonotreceiveGlobalFundmoney,wereidentifiedtodoconduct
theresearchatcountrylevel,includingdatacollectionandanalysis.Weselected3localwatchdogsineachofthe9
countriesforatotalof27localwatchdogstobetrained,mentoredandsupportedtodotheresearch.Thetraining
alsoequippedcivilsocietywithskillstoenablethemtoengagewiththeCCMSecretariattoplanandschedulethe
interviewsandFGDs.Civilsocietyconductedinterviewstocollectdatausingamixofquestionnaireinterviewsand
focusedgroupdiscussions(FGD).ComprehensivequestionnaireswithopenendedquestionsandFGDguideswere
providedtocivilsociety;theseallowedforprobinganddiscussionswhilstcollectingdata.
First,thecoregroupofrespondentsfromtheCCMfortheinterviewandfocusgroupdiscussionsweredrawnfroma
crosssectionofCCMmembersrepresentingtherespectivegovernments,faithbased,civilsociety,privatesector,key
populations,peopleaffectedbythediseases,thebilateralandmulti-lateralpartnersandtheCCMsecretariat.Civil
societyconductingtheresearchwereexpectedtoundertakeaminimumofeightfacetofaceinterviewsandconduct
onefocusgroupdiscussionofnotlessthansixCCMmembers.
These interviewsandaFGDcollectively includedallofthefollowingsectors:government, faithbased,civilsociety,
privatesector,keypopulations,peopleaffectedbythediseases,thebilateralandmulti-lateralpartnersandtheCCM
secretariat.
Secondly,civilsocietyalsoconductedaFGDof10-12nonCCMmembersmainlydrawnfromimplementinggovernment
andcivilsocietyPRsandSRs.ThesecondFGDenabledtheresearchtogettheperspectivesofnonCCMmembers
whohaveinteractedwiththeCCM.Keyareasofdiscussionincluded:
• HowtheyhavebenefittedfromtheoversightfunctionoftheCCM;
• How,whenandtheoutcomesoftheoversightfieldvisit;
• IftheoversightreportsandoutcomesareformallysharedandpublishedthroughtheCCMwebsite
• WhetherwomenandKPsareadequatelyrepresentedontheCCM;
• Ifcivilsocietymemberswereelected/selectedinanopenandtransparentmanner;
• AnunderstandingofthelevelofmeaningfulparticipationofKPsinCCMleadership;
• AnunderstandingofthelevelofmeaningfulparticipationofKPsinformalandadhoccommittees;
• ThemethodsofsolicitingKPinputandthenthisfeedbacktothelargerconstituency;
• Conflictof Interest (COI)e.g.howgrant implementers (SRs)whoarealsoCCMmembersmanageCOI inCCM
meetingsetc.
Methodology
The Rwanda Civil Society and Communities CCM Shadow Report
9
Oneaimwastobuildthecapacityofthelocalcivilsocietywatchdogstoengagewithavarietyofdifferentresearch
techniquesanddatagatheringmodalities,sothefollowingwillcontributetothisobjective:
• CivilsocietyreceivedtrainingonFGDsattheworkshop;
• Civilsocietycompletedhardcopiesofthequestionnairesatcountrylevelandthenalsocapturedthedataonline
intoasurveymonkey.
• Civilsocietydevelopedtheirown2-3pageanalysisofeachofthe2FGDs,talkingaboutkeyfindings(estimate5-8
findings)andrecommendingstrategicentrypointsforadvocacy(estimate3-5)
• In addition to this, civil societywrote their own 5-8 page analysis of all of the data as they understood and
interpreteditandsubmittedthistothetechnicalteam.Thisanalysisformedthebasisofalloftheresearchthey
conducted,andinformedthetechnicalteam’sanalysisofthedata.
Sub-grantsweremadetoeachofthelocalwatchdogstosupporttheirimplementationoftheshadowreporting.The
contentfromthecountrydatacollectors,onceenteredintothesurveymonkeytool,wasanalysedbyAAI,presented
toEANNASOandcountryteamsatameetinginKigali,RwandainFebruary2017,andfeedbackfromthismeetingand
fromemailcorrespondencefromcountryteamswasincludedtodevelopthefinalreports.
TheRwandacountryteamwaswelltrainedonhowtousethetoolsforthenewCCMScorecardsandCCMShadow
Reports.Thetoolsusedfortheprocessincluded;theFacetoFacequestionnaireforCCMmembers,FGDsquestionnaire
forCCMmembersandnon-CCMmembers.Thenumberofquestions/responsesasked/gotcouldnotbewellcaptured
within45minutesassuggestedfortheface-to-faceinterviews.Theopen-endedquestionsfortheFGDswerelongand
tookmostofthetimeoftheinterviewsthoughitgavetherespondentsanopportunitytosharemoreinformationand
createmoreinterestinthediscussions.Thenon-CCMCSOgroupsweremoreopen,comfortableandcontributed
moreinthediscussions.
Theprocesscame ina timewhenRwandawasplanningtomaketheextensionof thecurrentNSPandsubmita
conceptintheMarchwindowoftheGlobalFundGrantApplicationforRwanda.
10
CCM PerformanceAllCCMsarerequiredtomeetthefollowingsixrequirementstobeeligibleforGlobalFundfinancing:
1. Atransparentandinclusiveconceptnotedevelopmentprocess;
2. AnopenandtransparentPrincipalRecipientselectionprocess;
3. Oversightplanningandimplementation;
4. MembershipofaffectedcommunitiesontheCCM;
5. Processesfornon-governmentCCMmemberselection;and
6. ManagementofconflictofinterestonCCMs.
Belowisahighlightoftheresearchfindingsaspertheaboveeligibilityrequirements:
1. Transparent and inclusive concept note development.
Duringtheinterviewsandfocusedgroupdiscussions,itwashighlightedthattheprocessofconceptdevelopmentis
verytechnical,andthatnotallCCMmembershavethetechnicalcapacitytoparticipateintheseprocesses.Thereis
usuallyatechnicalwritingteam,mainlyandaconsultantresponsibleforconceptnotedevelopment.Accordingtothe
responsesfromsomeoftherespondentsitwasnotedthatthereislimitedCSOCCMmembers’engagementonthe
writingoftheconceptnote,oftheCCMagenda,reallocationoffundsdecisionsandmostoftentheCivilsocietyCCM
membershiphasalsonotbeenabletoeffectivelycommunicatetotheirconstituentsforfeedback.Theyhighlighted
lackofresourcestocommunicateandconvenemembermeetingsasmainreasonforinadequateconsultations
Fromthediscussionswiththeinterviewees,itwasapparenttousthattherepresentationoftheCSOsisweak/poorin
regardtoparticipationofmemberswithinumbrellasCCMcoordinationbodies(theumbrellas)whichdonotmakea
followandconsultationwithintheirconstituenciesupduetolackoffundsfortheseprocesses.
Acapacitybuildingprogramshouldbeputinplacetoenableallmemberstoparticipateonequalgrounds,especially
for key infected/affected communities. There is need for PRs andCSOs (Umbrella CSOs andNGO implementing
organizations/partners)toensuremeaningfulinvolvementandparticipationintheNSPdevelopmentprocessesand
itsOperational Plan. Since, theNSP is supportedby activities in theOperational plan, thereneeds tobe a clear
involvementofCSOsintheentireprocess;fromtheOperationalplan,totheNSPandtotheconceptnotedevelopment
clearlyoutliningtheiractivitieswithoutleavinganygroupbehindespeciallythekeyaffectedcommunities.
Concept note development partners need to have a joint consultative meeting on the process so that they can have
all the issues/interventionsthatCSOsneedtobesupportedand included in theconceptnotetoensure linkages
betweenthecommunityandhealthfacilities.
Analysis
The Rwanda Civil Society and Communities CCM Shadow Report
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2. An Open and Transparent PR Selection process
TherehasbeenonlyMOHasthePrincipalRecipientandsinceafewyearsagofundsarereceivedbytheministry
finance.ThisisbecausetheyowntheprogrammaticandfinancialimpactoftheGlobalFundsincetheyaremandated
tocoordinatenationalhealthandfinancialprogrammes.AccordingtotheagreementbetweentheGlobalFundand
theGovernmentofRwanda, itwasdecidedthatthegrantmoneyfromtheGlobalFundshouldcomethroughthe
MinistryofFinancewhich is responsible tomanagethefinancialprogrammesandtheMinistryofhealthwhich is
responsibleforthehealthprogrammes.ThegovernmentisresponsibletodispersefundstotheSRsandSSRs.
AccordingtotheRwandaTBandHIVconceptnotetotheGlobalFund2014,itwashighlightedthattheMOHhasbeen
PrincipalRecipient(PR)forGlobalFundgrantstoRwandasince2003.TheMOHhasconsistentlyperformedwellinits
PRrole;themaximumgrantperformanceoftheMOHsince2003uptothisdateisA1andtheminimumisB1.Given
thehighlevelofintegrationoftheHIVandTBprograminRwandaintonationalsystemsandstructures,theMOHis
consideredbestplacedtoimplementtheoverallplanning,coordinationandprogrammanagementrolesofthePR.
AsRwandaisnowpilotingtheGlobalFund’snewRBFmodel,theCCMwasstronglyoftheopinionthattheMOHwith
itsexperienceandstrong,provensystemsshouldcontinueassolePR.WithregardstotheselectionofthePR,itwas
quiteevidentthattheCCMmembersfromCSO’swerehappywiththePRthathasbeenselectedpreviouslythough
theyfeltaneedforimprovementinimplementationofactivities.Thesuggestedimprovementwasmainlytoaddress
latedisbursementof fundsandreportingmechanismsreflectingbothclinicalandcommunity interventions.Here
respondentsexpressedtheneedtohaveasecondPRwhoisfromtheCivilSocietyinchargeofcommunitybased
interventionswhiletheMOHwouldstillbethePRinchargeoftheclinicalinterventions.
“Oversight is effective. We also coordinated the selection of the sub recipients for Global Fund funds.”
“Selection criterias for the sub-recipients are determined the PR which is MoH.”
3. Oversight Planning and implementation
According to thescopeof theCCM-RWoversight in theOversightpolicyplanandbudget, theCCM-RWoversight
functionsbeginswithroadmappingandmeetingeligibilitycriteriaforproposaldevelopmentandextendstogrant
negotiation, grant implementation, reviews& renewals, and grant closure. The CCM-RWensures that grants are
beingimplementedefficientlyandeffectively,andinthenationalinterest,bydelegatingitsoversightfunctionstoits
OversightBody.TheOversightBodyactsasanindependentadvisertotheCCM-RWwiththeobjectiveofenhancingPR
performance,especiallywithregardstograntimplementationintheareasoffinance,procurementandmanagement.
AccordingtothecontextoftheResultsBasedFinancingmodel(RBF)andtheNewFundingModel(NFM),theCCM-
RWanditsadhocoversightcommitteemustcollaboratemorecloselyandeffectivelywithexistingplatformssuchas
theHealthSectorCoordinatingWorkingGroup(HSWG)anditsTechnicalWorkingGroups(TWG)andothersimilar
coordinatingmechanismsinRwanda.
100%
90%
90%
86%
100%
73%
100%
100%
88%
0%
10%
10%
14%
27%
13%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Ghana
Kenya
Malawi
Nigeria
Rwanda
Swaziland
Tanzania
Uganda
Zambia
1.AFendmeeGngs?
Yes No Idon'tknow
88%
100%
70%
75%
50%
45%
67%
100%
50%
13%
30%
13%
38%
55%
33%
50%
13%
13%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Ghana
Kenya
Malawi
Nigeria
Rwanda
Swaziland
Tanzania
Uganda
Zambia
2.Speak&beheard?
Yes No Idon'tknow
AccordingtotheCCMbylaws;TheOversightBodyshallcompriseofapermanentOversightCommittee(core)thatwill
havereadyaccesstotechnicalexpertswhomaybeindividuallyco-optedandwhomaychoosetoorganizethemselves
astemporaryissue-drivenadhocWorkingGroupsthatshallbeestablishedanddisbanded,asandwhennecessary,
anduponpriorapprovalbytheCCM-RW.ThefourpermanentcoremembersoftheOversightCommitteeshallbe
representativesofthe3sectorsi.e.Government,NGO,Multilateral/BilateralandarepresentativeofPeopleLivingwith
theDiseaseorKeyAffectedPopulations.TheM&EOfficershallbesecretarytotheOversightCommittee.TheChairof
theOSCcommitteeshallalwaysbedrawnfromtheCCMmembership,whereastheother3membersoftheOSCcan
eitherbeCCMmembersornon-CCMmembers.
However, the reality inpractice is that thispermanentOversightcommitteedoesnotexistasof todaywhen this
assessmentwasconducted.TheroleoftheOversightcommitteewasmergedwiththeHealthSectorCoordinating
Analysis
ATTENDANCE DOES NOT EQUAL BEING12
18%
25%
9%
13%
64%
40%
50%
13%
27%
14%
17%
38%
88%
36%
60%
50%
38%
27%
71%
67%
50%
9%
14%
17%
13%
25%
9%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Ghana
Kenya
Malawi
Nigeria
Rwanda
Swaziland
Tanzania
Uganda
Zambia
QuesGon:Oversight:Howwouldyouratetheperformanceoftheoversightbody?
Totallyunacceptablequality Unacceptablequality Acceptablequality Goodquality Perfectquality Idon'tknow
Question: Oversight: How would you rate the performance of the oversight body?
TheGhanaCivilSocietyandCommunitiesCCMShadowReport
88%
100%
60%
67%
50%
27%
86%
100%
88%
13%
40%
17%
38%
73%
14%
13%
17%
13%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Ghana
Kenya
Malawi
Nigeria
Rwanda
Swaziland
Tanzania
Uganda
Zambia
3.ParFcipatemeaningfully?
Yes No Idon'tknow
63%
100
50%
57%
50%
18%
50%
92%
25%
13%
40%
14%
38%
73%
50%
75%
25%
10%
29%
13%
9%
8%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Ghana
Kenya
Malawi
Nigeria
Rwanda
Swaziland
Tanzania
Uganda
Zambia
4.Influencedecisions?
Yes No Idon'tknow
Workinggroup(HSWG)anditistheonethatplaystheroleoftheoversightthroughtheirdifferentTechnicalWorking
groupsandCommittee.Wefoundthattheadhoccommitteesaretheonlyperformingbodyfortheoversight.There
isaneedfortheGlobalFundandtheGovernmentofRwandatoassesstheeffectivenessofthispracticeaccordingto
therealityandharmonisewhatisprovidedforintheCCMbylawsandthecurrentpractice
The respondents would not clearly mention members of the oversight committee and were not aware of the
compositionandstructureoftheOversightCommitteebutareawareoftheoversightfunction;wheresomehave
participated, and been part of the oversight activities. After oversight visits, feedback is given and solutions are
discussedwithconcernedorganizations.
“I am not aware of the existence of an oversight committee of function, however, within the CCM I see a
collaboration of select CCM members undertaking field visits and reporting back to the CCM.”
“TheCCMfulfilsitsoversightfunction;thefunctionishowevernotstructuredasthereisnooversightplan.Inclusivity
ismoderate.ThisisbecauseCSOsandPLHIVareoftencalledtoparticipateinit,nodeliberateefforthasbeenmade
toincludeKPsintheoversightfunction.Theoversightisalmostalwaysnotfollowedupbyaction.Thisisbecauseonce
issuesarereportedinthemeeting,thereisnocommitteetoaddressfollowupactionsandtheCCMdoesnotreceive
updatesofthefollowupactions.”
4. Membership of affected communities in the CCM
Overall, the representation of affected communities is good and most of the affected communities all have a
representativeintheCCMofRwandaandtheirparticipationintermsoftheirvoicesbeingheardandinfluencingthe
decisionsoftheCCMhasbeengivenpriority.PeopleLivingandaffectedbydiseaseshavetwoslotsontheCCM.PLHIV
arerepresentedbytheNationalNetworkofPLHIV(RRP+);andthepeoplelivingandaffectedbyTBandMalariaare
representedbyanorganisationimplementingTBandMalariaprogramsi.e.RwandaDevelopmentOrganisation(RDO).
ABLE TO INFLUENCE DECISION MAKING 13
14
InRwanda,thecommunitiesaffectedbyTuberculosisandMalariaarerepresentedbytheRwandaNGOForumwhich
delegatedtwoorganizations;ImbutoFoundationandRDO,torepresentyouthandpeoplelivingwiththediseases.
TheKeypopulation(KPs)arealsorepresentedbyANSP+andarealltransparentlyelectedindifferentCivilSociety
organizationconstituencies.SomeoftherespondentsunderlinedlackofsomegroupsontheCCMwheretheynoted
thatthereisnoTBrepresentationbutRPP+isrepresentingpeopleaffectedbyTB&HIV;whichisnotenoughbecause
TBrepresentationmustbespecificandtherebeingnoacademiarepresentationintheCCMbutsomebelievedthat
theCCMisperfectlycomposedanddon’tseeanyneedofchangesinitscomposition.
“There is no TB representation but RPP+ is representing people affected by TB&HIV;
this is not enough because TB representation must be specific.”
“They are represented by TB and Malaria experts from PEPFAR.”
“We believe that the CCM is perfectly composed and don’t see any need of changes.”
5. Process for non-government CCM member selection
In the CCM of Rwanda, non-government CCMmembers and the development partners are selected through a
transparentelectionprocessintheirrespectiveconstituencies.However,weobservedthatwhereastherehavebeen
changesamongCSOrepresentativesonCCM,representativesforDevelopmentpartnershavenotyetchangedfora
longtime.
“TB representation needs to be strengthened by getting its own representation.”
Analysis
18%
13%
43%
18%
14,29
38%
36%
100%
14%
14%
9%
17%
50%
50%
27%
86%
43%
55%
57%
50%
38%
36%
14%
33%
13%
14%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Ghana
Kenya
Malawi
Nigeria
Rwanda
Swaziland
Tanzania
Uganda
Zambia
CSOQuality:WhatisthequalityofcivilsocietysectorrepresentaSon?
Totallyunacceptablequality Unacceptablequality Acceptablequality Goodquality Perfectquality Idon'tknow
The Rwanda Civil Society and Communities CCM Shadow Report
15
6. Management on Conflict of Interests on CCMs
CCMRwandahasputinplaceaConflictofInterestPolicy,whereCoIdisclosureshallbeastandingagendaiteminall
CCM-RWANDAmeetingsandthatallCCM-RWANDAmembersshallberequiredtodiscloseanyactual,potentialor
perceivedmaterialinterestinamatterthatisplacedbeforetheCCM-RWANDAfordeliberation.Alldeclarationsof
interest,whetherverbalorinwriting,areconsideredtobestrictlyconfidentialoncemade.TheChairshallrequest
themembertoleavetheroomwhiletheCCM-RWANDAconsidersthedisclosureanddetermineswhetheraconflict
ofinterestexists.
However,duringthediscussionsweobservedthattherearesomeareasofpotentialriskswheretherespondents
mentionedthatthesolePRforglobalfundsisalsothechairforCCMandallCivilSocietymembersontheCCMreceive
GlobalFundgrants.
“All CSOs CCM Members are getting Global Fund Funds.”
“This can be good decision if the PR is different to the CCM Chair.”
“Once there was a conflict of Interest where the in-coming Chair had been involved in the development of
some inputs when he was still a technical Officer. He recused himself from chairing on that matter. And I
have never seen the CSOs recuse themselves.”
“We sign the documents of the conflicts of interest but there is no one to monitor or make follow-up.”
16
EPA Tool & ProcessThe original Geneva Eligibility and Performance Assessment (EPA) tool and process was well outlined with clear
principles,CCMEligibilityrequirements,minimumstandardsandindicators.
TheoriginalEPAprocesswasaself-assessmentoftheCCMandfocusedmostonface-to-faceinterviewswithCCM
secretariatandexecutivecommitteewithoutmuchinteractionwithotherCCMstakeholders.BothCCMandnonCCM
membershadverylittleknowledgeoftheEPAtools.
Somerespondentsnotedthattheprocessofinterviewsalsotakeslong,therebyadvisingthatthetoolismadesimple
and specific to their roles and also highlight the targets and indicators. The examples of criteria for compliance
assessmentarenotenough;theoptionswhichareIC,NC,FCarelimitedanditwouldbegoodtohavemoreoptions
inthetooltocaterforresponses.
Theself-assessmentoftheCCMusingquestionnairesintheface-to-faceandFGDswasanewpracticeforsomeof
theCCMmemberswhoarenewintheCCM.Eventhoughthepracticewasnew,mostofthemwerehappyaboutit
becauseitfacilitatedaself-assessmentoftheCCMworkandhighlightedthestrengthsandweaknessesofthenon-
CCMfromtheCS.
Analysis
10%
70%
20%
13%
64%
27%
13%
20%
20%
63%
9%
20%
60%
60%
27%
40%
45%
75%
25%
20%
13%
10%
10%
25%
18%
75%
40%
9%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Ghana
Kenya
Malawi
Nigeria
Rwanda
Swaziland
Tanzania
Uganda
Zambia
QuesGon:ArethereanyconflictsofinterestintheCCM?
AlltheGme VeryoRen SomeGmes/Occasionally Seldom Never Idon'tknow
The Rwanda Civil Society and Communities CCM Shadow Report
17
43%
63%
90%
100%
100%
90%
50%
83%
100%
57%
38%
10%
10%
50%
17%
13%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Ghana
Kenya
Malawi
Nigeria
Rwanda
Swaziland
Tanzania
Uganda
Zambia
CantheexisHngEPAbeimprovedon?
Yes No
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Ghana
Kenya
Malawi
Nigeria
Rwanda
Swaziland
Tanzania
Uganda
Zambia
DoesyourcountryPerformanceImprovementPlan(PIP)addresstheCCM'sperformancegaps?
Yes No Idon'tknow
PIP Tool and ProcessThe original PIP outlined the documentation of the plans that guide theCCMprocesses including the oversight,
membership, structures, conflict of interest, enhanced engagement and communication. It also provides the
opportunityforverifyingtheactivitiesandassessingthegapsthatneedstobeaddressed
InRwanda,therearetwoPIPsthathavebeenmadebutasweweredoingthisresearch,wenoticedthatmostofthe
CCMandnon-CCMmemberswerenotawareoftheoriginalGenevaPIPwhileforsomewhoknewitnotedthatthe
PIPneededtoaddresstheallthegapsandmakefollowupontheirimplementationeffectively.
18
Findings
Finding 1: There is no formal orientation to the CCMMost of thenewCCMmembers don’t get a formal orientation. This has greatly affected their knowledgeon the
RwandaCCMandtheGenevaCCMHubwherewenotedthat,asCCMmembers,theyweren’tawareoftheirclear
rolesandresponsibilities,theirfunctionsandtheleadershipoftheCCM.
Finding 2: No permanent Oversight CommitteeIn the research, we noted that the Rwanda CCM does not have an Oversight committee rather forms ad hoc
committees for theassignmentandyet theCCMbylawsprovide for theestablishmentofapermanentoversight
committeetobesupportedbyadhoccommittees.TheroleoftheOversightcommitteewasmergedwiththeHealth
SectorCoordinatingWorkinggroup(HSWG)anditistheonethatplaystheroleoftheoversightthroughtheirdifferent
TechnicalWorkingGroupsCommittee.Wefoundthattheadhoccommitteesaretheonlyperformingbodyforthe
oversight.
Finding 3: Delay in meeting announcementsInthediscussionswithRwandanCCMmembersduringtheresearch,wefoundthatmostCCMmeetingsareannounced
verylate.MeetingsareannouncedonlytwoweekspriortothemeetingwhentheCSumbrellasdon’thavemuchtime
forconsultationsamongtheirconstituenciesforinputsintheproposedmeetingagenda;this,evenmakingitdifficult
forCSparticipation.
Finding 4: Not aware of the Global Fund tools; the EPA and PIPMostCCMmemberswereneitherawareoftheoriginalGenevatoolsliketheEligibilityPerformanceAssessmentand
thePerformanceImprovePlannorhadtheyseentheRwandaCCMPIPandEPA.
Finding 5: Protection of guiding documents on the websiteDuringourresearch,itwasnoticedthattheRwandaCCMwebsitelackedmostoftheguidingdocuments;onlythe
GovernanceManual was available and could not access some of their documents because theywere password
protected.ThewebsiteisfloodedwithmeetingminutesandthelistoftheCCMmembersisdisorganizedandlacking
theexactcontactinformation.
The Rwanda Civil Society and Communities CCM Shadow Report
19
Recommendations
Priority Area 1: Orientation for CCM membersFormalorientationtoCCMfornewmembersshouldbeinstitutionalizedandeffectivelyimplemented.Thereisaneed
forCCMmembers’inductionontheGlobalFundguidelines;buildingCapacityofCCMmembersonCCMPoliciesand
theinductiontothenewCSOsCCMmembersandRefreshertotheexistingCCMMembers.
Priority Area 2: Civil Society participation TheinvolvementandparticipationofCSinkeytechnicalmeetingsoftheGlobalFund.Thereisneedtostrengthen
theroleoftheCSintermsoftheallocationoffunding,fundingtransferprocesses.AdemandfortheCStobepart
of thepreparation,executionandevaluation (oversight).Atcountry level, there isneed for theCSontheCCMto
reachouttotheirconstituenciesandtheCCMshouldlistentoideasfromtheirconstituencies(andputintoaction/
implementation).
TheCCMneedstoadoptthedualtrackfinancingtofacilitatefundsflowthroughaCSPRforeffectiveparticipation
andresults.CSshouldbeinvolvedintheCCMfromthebeginning(CCMmeetings,proposaldrafting/conceptnote,
evaluationandimplementation)andshouldstartholdingtheRNGOFandtheCCMaccountable.
Thefundingisnotenough.TheCSfeltthatthepartiesintheconceptnotedevelopmentshouldberealisticsothatthe
CScanachievetheirgoalssincethereisverylittlemoneyforimplementation.Forinstance,insteadofgivingfundingto
(4)fourdistricts(for1NGO),theyshouldjustincreasethenumberofNGOstoworkinthosedistrictssincethefunding
providedisverylittleandishardforthis1NGOtomovearoundallthese(4)fourdistrictsalone.
There should be effective follow up of Global Fund Audit recommendations, regular and vigorousmeasures for
oversight functions should be enforced. On this note, the CS shouldmake time and periodically meet with the
FundPortfolioManagertoaddresstheircomplaintsofreductionoffunds.Thereisalsoaneedforthekeyaffected
communitiestospeakforthemselvesinsteadofhavingumbrellaCSOsspeak/representthemontheCCMsothat
theirvoicecanbeheardandtheirissuesraisedattheCCMmeetings.
Other closing comments
Thisassessmenthasalsoresultedtoalotoflearningonthepartofthecountryteamandparticipantsinvolvedinthe
assessment.
One of the final comments from the respondents in the FGDs for non-CCMwas that; the CS doesn’t want the
GovernmenttothinkthattheCSisagainsttheGovernmentplansbutinsteadtheyallshouldworktogetherforthe
developmentofthecommunitiesthattheGFsupports.
Budgetallocation: itwouldbegreat if in future theresearchanalysesbudgetallocationtoclinicalandprevention
activitiesandcomparetounderstandifthefundsareallocatedtowherethereisneed!
22
Contact Details
Kagaba Aflodis (HealthDevelopmentinitiative):kagaba@hdirwanda.org
Mwananawe Aimable (IhorereMunyarwanda):mwananaweaimable@gmail.com
Munyaburanga Uwase Nadege (KigaliHopeAssociation):uwasenadege@gmail.com
Olive Mumba (EANNASO):mumba@eannaso.org
Phillipa Tucker(AIDSAccountabilityInternational):phillipa@aidsaccountability.org