The Anglophone Africa Civil Society and Communities CCM Shadow Report and Scorecard Initiative

THE UGANDA CIVIL SOCIETYAND COMMUNITIES

CCM SHADOW REPORT

Authors:

Prosper Byonanebye - Social Justice for Health HIV and Gender (UGANET)

Jacqueline Alesi - Uganda Network of Young People Living with HIV/AIDS (UNYPA)

Katende Dan - Uganda Harm Reduction Network (UHRN)

2

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 Uganda Civil Society and Communities CCM Shadow Report

3

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 ..........................................................................................................................................................14

PIP Tool and Process .......................................................................................................................................................14

Findings .............................................................................................................................................................................16

Recommendations ...........................................................................................................................................................17

Notes .................................................................................................................................................................................21

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 Uganda 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 Uganda Civil Society and Communities CCM Shadow Report

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About the research

Long term goalMoreaccountableCCMs.

Medium term objectiveIncreased transparency around

CCMperformanceandimprovementplans.

Short term aimEmpoweredcivilsocietyand

communitygroupswhocandoeffectiveshadowreporting.

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

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 Uganda Civil Society and Communities CCM Shadow Report

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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.

MethodologicallyitisimportanttonotethedatesofwhentheshadowEPAsandtheGenevaEPAswereconductedas

differencescouldbearesultofchangesovertime.AlltheshadowEPAresearchwasconductedbetweenNovember

2016andFebruary2017.Uganda’sGenevaEPAsweresubmittedonthe2017-01-19.

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

TheUgandaCCMistransparentandinclusivebuttheprocessmaynotnecessarilybetransparentatconstituency

level, because themajorityofnon-CCMmembers testified that theywerenotbeing consultedor given feedback

periodically asexpected. Theneed for theCCM toput inplacemechanisms for evidence-based consultationsat

constituencyleveliscritical.Forinstance,thesexworkers,IDUs,andLGBTIsinterviewedhadnotbeenconsulted/

notifiedabouttheGlobalFundconceptnotedevelopmentprocess.

2. An open and transparent Principal Recipient selection process

UgandaCCMplaysalimitedroleinselectingthePrincipalRecipient(PR),becausePR1isdeterminedbytheGovernment

whilethePR2(thePRforcivilsociety)selectioncriteriawasnotcleartothegeneralpublicand/ornotdisseminated

widely.

“CCM should be more strict and seek more transparency regarding selection of sub-grantees.”

3. Oversight planning and implementation

UgandaCCMhasafunctionaloversightbody;theoversightbodyconductssitevisitstofollowupontheimplementation

ofGlobalFundactivities.ThebodyhasheldthePrincipalRecipientaccountableformishandlingGlobalFundresources

associatedwithhighbureaucracythathasledtochallengesinabsorptionofGlobalFundresources,amongothers.

However,theCCMhasnotused/exhausteditsportfolio/mandatetoadvocateforeffectiveresponses,forinstance

theCCMhasnotstronglycomeouttoadvocateforanenablinglegalframework,leavingCSOswithlimitedsupporton

thelegalandpolicyfronts.SimilarlytheCCMhasnotadvocatedforprioritisationofThirdlinetreatmentregimensfor

PLHIV(patients)inthestrategicplanandresourcemobilisationconcepts,leavingthiscategoryofPLHIVatthemercy

ofthevirus.

Analysis

The Uganda Civil Society and Communities CCM Shadow Report

11

“The CCM fulfils its mandate, all members attend all the CCM engagements and field work by members

is often carried out for supervisions. Committees are very active and areas of concerns are prepared,

presented and discussed at the CCM. PLWDs are not represented because they are not defined in the

Global Fund strategy. This could be an operational issue rather than governance.”

“The oversight role of CCM is of a good quality because issues are agreed upon and actions and follow up

plans are put in place, these are actually documented and put in writing.”

“CCM has organised meetings to hold principle recipient accountable. CCM has highlighted areas of

underscore in as far as global fund and principle recipients are concerned, for example, the recent query

on why food was not reaching the TB patients that made to centralising of procurement.”

4. Membership of affected communities on the CCM

Onmembership,thereislimitedrepresentationofkeypopulationsub-groups,hencethesuggestionthatsub-groups

shouldalsoberepresentedontheCCMBoardasobserversandgiventhemandatetoexplaintheissuesconcerning

them.KAPsub-groupsattendingasobserversshouldbeencouragedtopresentpositionpapersthatcanformpart

oftheCCMagenda.Itisthesamewiththejudiciary:someCCMmembersinterviewedexpressedtheneedtoreview

publicsectorrepresentationtoincludearepresentativefromtheMinistryofJustice/LawReformCommission.

(CCM should) “Consider young people, people living with disabilities and Key populations

Need to separate the 3 diseases; HIV, TB and Malaria.”

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?

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

“Need to consider people living with disabilities. Need to reserve the roles and mandate of CCM to their

constituencies. Some members are overwhelmed where some representatives of people thus limiting

engagement of constituency.”

“There is need to define representation of PLWD i.e. it is not someone affected but someone with

knowledge on (the disease mentioned).”

5. Processes for non-government CCM member selection

Analysis

ATTENDANCE DOES NOT EQUAL BEING12

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

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

UgandaCCMhasawell-definedprocessfornon-governmentCCMmemberselectionwhereCSOsnominate/electa

membertheythinkcanrepresenttheirviewsandpriorities.

However,notallmembersofCSOsparticipateinthisexercisebecauseoflimitedinformationflow,limitedconsultative

meetings,andconsultationsthatseemnottoreachtoremoteareas.

“Meeting were held were different constituencies were called upon to discussed their on their representation

at the CCM secretariat. Transparent and different constituencies were given a chance to select influential

persons from their constituencies under their sub-committees.”

“Not certain of the process.

6. Management of conflict of interest on CCMs

UgandaCCMhasaguidelineofdeclaringconflictsofinterestwherebywhenevermeetingsforCCMbegin,thefirst

itemontheagendaisalwaysdeclaringconflictofinterestbesideseachmembersigningthepolicy.

However,someCCMmembersinterviewedexpressedignoranceofwhatconflictofinterestentailsinthatcontext,

suggesting that itshouldnot justbea formalitybut thereshouldbedeliberateeffortswithdetailsorChairciting

examplesofrepresentativesthatarelikelytobeinsuchasituationdependingontheagendaoftheday.

ABLE TO INFLUENCE DECISION MAKING 13

14

EPA Tool & Process

Analysis

Strengths Weaknesses Failures Successes Gaps

It’s clear and easy to understand.

It measures the “what” but does not measure

the “how” e.g. asks the availability of an

oversight plan but does not ask about effective implementation of the

plan

Some CCM members have not appreciated the

EPA tool.

It identifies gaps and successes of the CCM for

proper planning.

Capacity building on the EPA tool for CCM

members.

Provides measurable indicators.

It does not define well the criterion of compliance and non-compliance.

Limited feedback from the outcomes of the tool.

It provides the results of the successes in tangible

graphs that are easily understood.

Limited target audience to access the results

It provides room for evidence (provides link to

upload attachments).

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 Uganda Civil Society and Communities CCM Shadow Report

15

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

Strengths Weaknesses Failures Successes Gaps

It’s clear and easy to understand.

Its emphasis is on the “what” but does not

effectively track / measure the “how”.

Limited follow-up on the actions on PIP.

The PIP has helped to identify gaps that are included in the CCM

strategic plan.

Indicators need to be modified e.g. include the

CCM’s advocacy role.

Provides measurable indicators.

It does not define well the criterion of compliance and non-compliance.

Some CCM members have not appreciated or

used the PIP tool.

PIPs should be followed up critically to make

evaluations meaningful.

It provides the results of the successes in tangible

graphs that are easily understood.

PIP Tool and Process

16

Findings

Finding 1: There is limited inclusivenessof theKPCSOs inconceptdevelopment.Forexample,by theendNovember2016,

all theKPs interviewedhadnotyetbeenengaged in theprevious6monthsregardingCCM issuesandespecially

conceptdevelopmentwheretheyfeltthattheyhadreliablecontributionstomake.Secondlyyoungpeopleconstitute

thebiggestpercentageof theHIVburdenbut theyarenot representedon theCCM.There is ahighprevalence

ofHIVamong thefisher-folksofUganda,but their representative is1alternate seatat theCCM.Lastly from the

interviews,itwasobservedthattheCCMdoesnotmakeitmandatorytogetfeedbackfromitsmembersonperiodic

consultationsatconstituencylevel.TheimpactisthattheCCMmaymissinputfromcriticalstakeholders,e.g.from

remotecommunities,andhencemissoutonrealissuesthataffectthecommunities.

Finding 2: ThereisanunclearmechanismofcommunicationfromandtotheCCMandNon-CCMmembers.90percentofthe

non-CCMmemberswhoparticipatedinthefocusgroupdiscussionsexpressedignoranceabouttheoperationofthe

CCM.Theimpactisthattheprioritiesoftheaffectedpeoplemaynotbeeffectivelyrepresented.Thisalsomakesit

hardforthecommunitiestosharebestpracticeswiththeCCMmembers.Forinstance,100%ofNon-CCMmembers

wereunawarethattheycouldapplytoparticipateasobserversontheCCM.

Finding 3: TheCCMOversightCommitteehaslimiteddecision-makingpower(“theycannotbite…TheCCMisalooseorganisation

thatcannotholdthePrincipalRecipientaccountable,”aCCMmemberobserved).Forexample,regardingthe2016

costextension,ofmoneythatwasallocatedforkeypopulationactivities,fewoftheseactivitieswereimplemented

andtheeightconstituenciesdidnotreceiveresourcestocompletetheactivitiesasperallocation.Similarly,theMoH

has,forthepasttwoyears,failedtoremitfundsforMDRTBpatientstohospitalsandinallthesecasestheOversight

Committeedidnot take any conclusive action. This hashindered continuous service-delivery and keypopulation

programminginthecountry.

TheactionplantoaddresstheAuditreporttooktoolongtobesubmitted,partlyduetothelimitedmandateofthe

CCMtotakesanctionsagainstdutybearers(“Theonlyclearsanctioningmandateavailabletousisdeadlyi.e.refusing

tosubmitcountryconcepts,”oneCCMmembercommented).Lastly,theCCMdoesnothaveaclearbudgetvotefrom

Government;indirectlyitisatthemercyoftheMinistryofFinanceforsomelogisticalsupport,andhenceitsauthority

tomonitorMinistryofFinanceasaPRmaynotbeaseffectiveasexpected.

The Uganda Civil Society and Communities CCM Shadow Report

17

Recommendations

Priority Areas: What, who, when, why, how, where, by whom?

1. TherehasbeenlimitedmeaningfulinvolvementofKPsandCSrepresentativesintheselectionofSubsidiary

Recipients(“Wewerenotconsultedontheselectionofkeypopulationgroupstoimplementthecostextension

grantforUganda,”saidtheKAPsduringthefocusgroupdiscussion;“RecentlywehadthatTASOisthesub-

recipientinchargeofCSsector,that’swhentheyhadadvertisedforGrants…Whytheprocesswasnot

exhaustivelydisseminated?”arespondentwondered).

2. MandateoftheCCM:thevoluntaryandnon-legalstatusoftheCCMmakesitlesseffectiveininitiatingand

implementingsanctionsagainstnon-performingSubsidiaryRecipientsorPR.ThereisneedforGlobalFund

Genevatoadvocatethroughtheprimeminister’sofficeetc.,fortheCCMstructuretoberespectedasanentity

What Who Why Where By whom

Increase funding for constituency engagement and clear allocation / dissemination of funds to key

populations.

Global Fund.

Because a few people are consulted, e.g. Local NGOs representatives stated that

according to current funding only few people are consulted, locking out the views of many

key stakeholders in the response.

Rural constituencies.

Constituency secretariat /

representatives

Ineffective communication from PR2, TASO, CCM,

MARPS Network and the lower communities. There is unclear

information flow on concept note development, resource allocation,

selection of sub-recipients for KPs, KPs grant monitoring and

reporting, according to the MARPs CSOs

CCM / TASO / MoH.

The priorities of KPs and access to Global Fund F resources by KPs is problematic and CCM has not come out to save the situation or to disseminate its decisions on the matter. This also makes it hard for KP programmers

to share best practices with the CCM members.

Call for proposals by TASO do not take into consideration the different capacity levels of CSOs in Uganda (“TASO Global Fund RFAs indirectly target majority international NGOs

with capacity to take care of advanced requirements,” a member observed).

Between CCM and country

stake-holders

Representatives, observers and CCM

Secretariats.

Government of Uganda should allocate a budget for the

functioning / operations of the CCM. The Global Fund may

also advocate for a percntage allocation to the CCM out of the

funds received by a country and / or as part of the country’s annual budgeting process for the CCM’s

oversight work.

Govern-ment of Uganda / Global

Fund.

Increase government ownership and sustainability even during the time of Global

Fund transition. The CCM has played a critical role in systems strengthening and response under the three diseases and

deserves budget allocation to enhance its independence in decision-making.

Ministry of Finance budget.

Ministry of Finance.

Inclusiveness of key population sub-groups in CCM operations,

e.g. as observers.CCM. For the purposes of effectively capturing the

voices of affected communities.

Through observer

portfolios of the CCM.

Key populations.

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thathashelpedtooverseeresourcesthathavesavedmillions.(“Currently,theonlypunitivepowerwehaveis

extreme…wecanstopsubmissionofcountryconceptstoGlobalFundwhichislikeadeathsentencetoour

brothersandsisterssufferingfromTB,MalariaandHIV,”notedoneoftheCCMrespondents).

3. Fromtheface-to-faceandFDGsspecificallyforCCMmembers,itwasclearthatthereareinformationgaps,

hencetheneedforimproved/innovativemodelsoforientingCCMmembers,includingexchangevisitsamong

differentconstituencyrepresentativestoenhanceevidence-basedconstituencyconsultativeprocessesand

inter-constituencylearningbyCCMmembers.

4. CSOsarenotsatisfiedwithGlobalFund,andpartlywiththeCCM,fornottakingactionagainsthighprocurement

costs.Forexample,highchargesinsupply-chainmanagementinUgandaandonunitcostforARVs.Duringa

focusgroupdiscussion,CSOsexpresseddissatisfactionwithGlobalFundpayingtoomuchforProcurementand

Supply-ChainManagement(PSCM)coststhroughNMSandpayingtoomuchforARVs.However,theteamwas

unabletoconclusivelydoacomparativeanalysiswithothercountriestoappreciatethevalidityofassertionson

highcosts.Thereisneedforacomparativestudytoascertainvalueformoneyincludingcompetitiveprocessto

selecttheagencytodosupply-chainmanagementandGOUrenegotiatingthepricesofARVs.GlobalFundcould

alsoexploreeffectiveadvocacyengagementswithMinistryofFinance,thePrimeMinisterandPresident’sOffice

foreffectiveandcosteffectivedeliverables.

5. GlobalFundGenevaandGOUcanexplorepossibilitiesofdocumentinganddisseminatingtheCCMmodelto

supportbigcountrygrants,e.g.resourcesforimmunization,water,andclimatechange,amongothers;which

havefacedsomemanagementcapacity/structuralgaps.InUganda,despiteafewgaps,theCCMremainsa

highlyrespected,multi-skilled,andmulti-sectoralbodythatcaneffectivelyoverseeimpactfulprogramming.

6. Improvesupportandadvocacyforhumanrights-basedprogrammingandstrategiclitigation.ThoughGlobal

FundhasinvestedsubstantialresourcesinUganda;thelegalenvironmentremainsharsh,associatedwith

moralistchallengesthatcompromisehumanrightsapproaches,andcounterproductivetoeffectivehealth

outcomes.HencethereisneedforGlobalFundtoinvestinrightsawarenessandsocialaccountabilityaspart

ofthecountryinvestmentstrategy.…..”Theupcominglaw,i.e.theSexualOffencesBill,isverydangeroustothe

responseandrequiressubstantialsupportforinterrogationandlegalresearchtomitigateitsnegativeeffects

ondisease-control,amongotherlegalchallenges(“GlobalFundshouldpurposivelyfocusinthisarea,sinceat

countrylevel,politicalandmoraldynamicsmayaffectrightspromotionandprioritization,”onerespondent

asserted).

7. Communicationgaps:informationflowfromtheCCMonconceptdevelopmentuptotheawardingstage

iscomprehensive,howeversomemembersobservedthatcommunicationonnegotiationsandgrant

implementationmodalitiestendtobebetweenGlobalFundGenevaandthePRs,henceskippingtheCCMand

Recommendations

The Uganda Civil Society and Communities CCM Shadow Report

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affectingthemultipliereffectoftransparencyinsharinginformationonGlobalFundgrantimplementation.The

teamdidnotgetrealevidenceonthisassertion.

8. Needforcapacitybuilding:whileGlobalFundGenevaandotherpartnersexpectCSOstomonitorthe

effectiveandefficientutilizationofdonorresourcesandtoalertCCMongaps,therearelimitedfinancial

resources,informationandTAtoperformthisfunction.AsaresultthePRsandSubsidiaryRecipientsalways

havemoreandlatestinformationthantheCSOs’/watch-dogs,andthelatterlackfinancialcapacityto

generateevidencetoeffectivelyholdtheformeraccountable.

9. Effectiveadvocacyforfunding/logisticalsupporttoCCM.CurrentlythesupporttoCCMisleftatthegoodwill

ofanygovernmentdepartmentsinceCCMgetslittlefundingfromGlobalFundandit’snotalegalgovernment

entity.GlobalFundandGOU(thePrimeMinister)shouldpurposivelyallocatefundstoCCMeitherthrougha

percentageallocationfromresourcesfromGlobalFundtothecountryorandthroughtheGOUbudget–e.g.

theMinistryofFinance.Otherwisetheirindependenceandoversightrolecaneasilybecompromised–yet

theyoverseehugeresourcespartofwhichshouldhavebeenputasidetofacilitatetheCCMsecretariat.(“The

chairmanoftheCCMisusingUgandaAIDSCommissionvehicleetc.;ifweelectanotherCCMchairwithout

accesstosuchfacilities;whathappens?”–onerespondentwondered).

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10. GivenUganda’sbadbackgroundoflimitedtransparencyasacountryinthemanagementofGlobalFund

resources,theCCMshouldlookintoseriousrebrandinganddisseminationofitsoversightmandatetoharness

sustainablegoodwillandsupportfromthepublic.MostNon-CCMmembersstillthinkofGlobalFundin

Ugandaintermsofmismanagement;yetthiswasanoccurrenceofyearsback;thoughthereareabsorption

andbureaucracyissues,overallGlobalFundoperationsinUgandaarefarbetterandtherearelotsofsuccess

storiestoshare.TheCCMshouldthereforeinvestindisseminatingitssuccessstoriesuptograssrootslevelfor

improvedvisibilityandsupportbythekeystakeholders(esp.affectedcommunities).

11. GlobalfundshouldnegotiatewithGOUtosupportthereviewprocessofprocurementpoliciesandguidelines

toenhancefundsabsorptionandeffectiveservicedeliverytotheaffectedpersons.

12. PRsshouldrevisethesub-grantingmodalitiestoencourageconsortiumsandownershipinthewritingprocess.

ItisevidentthatmostCSOshireconsultantstodesignforthemproposalsandintheendtheyfailto

conceptualisethemhencedelayingimplementationandabsorptionrateofthefunds.PRscansimplifyRFAsbut

putconditionsforapplicationstobeinconsortiumofabout20CSOsandonlyupscalequalificationsforthe

leadagency.

13. Thereisneedtodesignspecificsystemsdevelopmentgrantstobuildthecapacityofkeypopulationnetworks.

CurrentlytheGlobalFundGrantisover95percentactivitybasedanditoverridestheextremelyweeksystemsof

KPCSOs,hencelimitedabsorptionofGlobalFund.Thereisamis-matchbetweenactivityfundingandsystems

toabsorb/supportimplementation

14. ThereisneedforimprovedtechnicalassistanceopportunitiesbyGlobalFundtoenableCivilSociety

Organisations(affectedcommunities)packageordocumenttheirexperiencesandlessonstothestandard

required

withinGlobalFundgrantconceptdevelopmentandnationalstrategicplanformat.Otherwisetheprioritiesof

theaffectedcommunitieswillcontinuetomissbothinthenationalstrategicplansandGlobalFundconcepts.

Recommendations

The Uganda Civil Society and Communities CCM Shadow Report

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Notes

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Contact Details

Prosper Byonanebye (SocialJusticeforHealthHIVandGender-UGANET):prosperbyonanebye@gmail.com

Jacqueline Alesi(UgandaNetworkofYoungPeopleLivingwithHIV/AIDS-UNYPA): alesi@unypa.org

Katende Dan (UgandaHarmReductionNetwork-UHRN):uhrnetwork@gmail.com

Olive Mumba (EANNASO):mumba@eannaso.org

Phillipa Tucker(AIDSAccountabilityInternational):phillipa@aidsaccountability.org

The Uganda Civil Society and Communities CCM Shadow Report

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