The Role of Civil Society in The Role of Civil Society in Global Health ActivitiesGlobal Health Activities

Milton B. Amayun, MD, MPHMilton B. Amayun, MD, MPHSr. Technical Advisor, The Hope InitiativeSr. Technical Advisor, The Hope Initiative

World Vision InternationalWorld Vision International

CCIH Annual ConferenceCCIH Annual Conference

May 27, 2007 May 27, 2007

Civil Society - DefinitionCivil Society - Definition

Organized activity that acts at the interface Organized activity that acts at the interface between government and the general between government and the general populationpopulation

Civic action not sponsored by the stateCivic action not sponsored by the state Organizations created and run by the people Organizations created and run by the people

for the peoplefor the people Separate from both government and Separate from both government and

commercial sectorcommercial sector

Usual processesUsual processes

VoluntaryVoluntary Self-governedSelf-governed Self-sustainedSelf-sustained Follows democratic Follows democratic

processesprocesses Usually citizen-led, Usually citizen-led,

service-oriented, service-oriented, nonprofitnonprofit

Outside state controlOutside state control

What civil society includesWhat civil society includes

NGOs, CBOsNGOs, CBOs FBOs, including the FBOs, including the

ChurchChurch Professional Professional

associationsassociations Trade unionsTrade unions Communities affected Communities affected

by targeted conditions, by targeted conditions, e.g., AIDS, TB, e.g., AIDS, TB, Malaria, disabilityMalaria, disability

Why civil society?Why civil society? Normally not dependent on political Normally not dependent on political

changeschanges Reaches marginalized populations much Reaches marginalized populations much

better than government institutionsbetter than government institutions Outside the government bureaucracy; can Outside the government bureaucracy; can

be more efficientbe more efficient Church more sustainable than governmentChurch more sustainable than government Promotes diversityPromotes diversity Encourages accountabilityEncourages accountability

Weaknesses of civil societyWeaknesses of civil society

Issues driven; many do not last longIssues driven; many do not last long Often fragmented; coordination neededOften fragmented; coordination needed Uneven levels of transparency and Uneven levels of transparency and

management expertisemanagement expertise Technical expertise variesTechnical expertise varies Financial sustainability always at riskFinancial sustainability always at risk Can be entangled in politics Can be entangled in politics

Civil society participation in Civil society participation in the Global Fund to fight ATMthe Global Fund to fight ATM

Fundamental to GFATM’s new Fundamental to GFATM’s new public-private paradigm public-private paradigm

Required in proposal preparation and Required in proposal preparation and Country Coordination Mechanisms’ Country Coordination Mechanisms’ governancegovernance

Represented in GFATM Board by 3 Represented in GFATM Board by 3 membersmembers

Basic element of accountabilityBasic element of accountability Adds different (citizen-driven, non-Adds different (citizen-driven, non-

governmental) perspectives to governmental) perspectives to programsprograms

Examples of civil society Examples of civil society involvement in GFATMinvolvement in GFATM

Fiduciary control: Principal Recipient in Fiduciary control: Principal Recipient in many countriesmany countries

Service delivery: Implementor or sub-Service delivery: Implementor or sub-recipient for projectsrecipient for projects

Member of civil society delegation to the Member of civil society delegation to the BoardBoard

Advocate for fundingAdvocate for funding Participant in M & E, e.g., on high-level Participant in M & E, e.g., on high-level

global commitments global commitments

Recommendations, 1Recommendations, 1 FBOs must recognize their role as civil society FBOs must recognize their role as civil society

participants, especially their value add contributions to participants, especially their value add contributions to technical, financial, management, and ethical areas of technical, financial, management, and ethical areas of programs and projectsprograms and projects

Special leadership areas to be built: Special leadership areas to be built: Advocacy, M&E and Advocacy, M&E and Skills TransferSkills Transfer

Common manuals for training in above areas should be Common manuals for training in above areas should be developed early developed early

Ideal: A global network of FBOs building on each other’s Ideal: A global network of FBOs building on each other’s uniqueness and strengthsuniqueness and strengths

Common purpose: Collaborate on issues that advance the Common purpose: Collaborate on issues that advance the health and poverty agendahealth and poverty agenda

Joint evaluations to ensure cross-learningJoint evaluations to ensure cross-learning

Recommendations, 2Recommendations, 2 Networks for shared information and resources, but Networks for shared information and resources, but

differences in adaptation allowed to surfacedifferences in adaptation allowed to surface Networks could be national, geographic or based on Networks could be national, geographic or based on

functional leadership – or a combination of both.functional leadership – or a combination of both. Mechanism for continuous interaction should be Mechanism for continuous interaction should be

designed; point persons designated as hubs for designed; point persons designated as hubs for information-sharinginformation-sharing

Bi-annual meetings a minimumBi-annual meetings a minimum Other possibilities to look at: listserves, registries Other possibilities to look at: listserves, registries Networks should not be limited to technical NGOs; Networks should not be limited to technical NGOs;

larger development- or health-focused NGOs must be larger development- or health-focused NGOs must be part of the mixpart of the mix

Specific Roles of FBOs in Global Specific Roles of FBOs in Global Fund Processes at Country LevelFund Processes at Country Level

Proposal writers, consortium Proposal writers, consortium leaders/membersleaders/members

Data-gatherers and providersData-gatherers and providers Implementors/Sub-recipientsImplementors/Sub-recipients Country Coordinating Mechanism Country Coordinating Mechanism

membersmembers Civil society delegation membersCivil society delegation members Principal Recipients (for FBOs with Principal Recipients (for FBOs with

experience in handling large amounts of experience in handling large amounts of foreign currency)foreign currency)

Technical Consultants Technical Consultants EvaluatorsEvaluators