THE RWANDA CIVIL SOCIETY AND COMMUNITIES CCM SHADOW … · THE RWANDA CIVIL SOCIETY AND COMMUNITIES...

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

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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


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


7

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


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


11

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


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.”

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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


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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.

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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.


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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!

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Notes


21

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Contact Details

Kagaba Aflodis (HealthDevelopmentinitiative):[email protected]

Mwananawe Aimable (IhorereMunyarwanda):[email protected]

Munyaburanga Uwase Nadege (KigaliHopeAssociation):[email protected]

Olive Mumba (EANNASO):[email protected]

Phillipa Tucker(AIDSAccountabilityInternational):[email protected]


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THE RWANDA CIVIL SOCIETY AND COMMUNITIES CCM SHADOW … · THE RWANDA CIVIL SOCIETY AND COMMUNITIES...

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