Civil Society and the Global Fund: Grant Performance Workshop CCM processes

Concept Paper

Tunisia
Morocco

Syria Lebano nOPT Iraq Jordan Libya Egypt Saudi Arabia

Iran

Algeria

Bahrain Qatar UAE

Afghanistan

Oman Sudan
Yemen

Round 1
Somalia

Djibouti

1. Requesting Entity

Initiative

The Civil Society Action Team (CSAT), ALCS Maroc Nadia RAFIF AfriCASO Coordinateur Rgional du CSAT pour lAfrique du Nord et le Moyen Orient alcsmarrakech@gmail.com Tel/ fax : +(212) 24 43 98 43 www.alcsmaroc.ma

Contact

CSAT Mandate

A civil society-led initiative, CSAT aims to coordinate, broker, and advocate for technical support to civil society organizations implementing or seeking grants from the Global Fund to Fight AIDS, TB and Malaria (Global Fund).

CSAT Objectives

1. To mobilize national level civil society organizations to engage with Global Fund o 2. To advocate for participation of key affected populations in HIV&AIDS programs funded by the Global Fund 3. To improve access of Civil society organizations to technical support and capacity building

1. Contextual Background MENA REGION

Background The Middle East and North Africa [MENA]1 and the Eastern Mediterranean Region [EMR] region present a diversity of realities in terms of socio-economic development, HIV epidemiology, political systems, including policies and attitudes towards HIV, and access to services, all of which impact the response to HIV at the national level. There is no single epidemic in MENA: HIV prevalence estimated 0.3% with notable variations. The limited information available for the Middle East and North Africa indicates in 2007 that some 380 000 [280 000510 000] people were living with HIV in 2007, including the estimated 40 000 [20 00060 000] people who were newly infected last year. Although overall numbers of reported HIV cases in the region remain small, varying combinations of risk factors are associated with the regions epidemic. There is increased evidence of diverse epidemics across geographical areas within the country with higher level of infection and risk behaviors among most at risk of populations. There is also evidence of overlapping risks between different patterns of sexual transmission as well as with drug injection and emergence of concentrated epidemics among populations and specific settings in MENA. 5% of all reported AIDS cases is attributed to homosexual relations, between 6.5% and 25% in Egypt, Lebanon, Oman, Morocco and Tunisia. 0.85% of all reported HIV tests among MSM are positive. Concerning the IDU, 11% of the cumulative reported
The UNAIDS MENA region includes the following 22 countries: Afghanistan, Algeria, Bahrain, Djibouti, Egypt, Iran, Iraq, Jordan, Kuwait, Lebanon, Libya, Morocco, Oman, Palestine, Qatar, Saudi Arabia, Somalia, Sudan, Syria, Tunisia, UAE, and Yemen. In addition, the EMR of WHO includes Pakistan. CSAT MENA will focus on 14 countries ( GF recipients (all the eligible countries) : Algeria, Djibouti, Egypt, Iran, Iraq, Jordan, Morocco, Palestine, Somalia, Sudan, Syria, Tunisia, Yemen, Pakistan)
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Concept Paper prepared by Nadia RAFIF, January 2009

AIDS cases are due to IDU and the rate of positive HIV tests in those ever reported tested between 1995 2007 is 1.67%. The region estimated number of IDU (midpoint) is about 979,000. The package of intervention varies a lot between countries, from countries which have a comprehensive response and recognize Hiv within national priorities (Algeria, Djibouti, Morocco, Soudan, Iran), those who adapted and potentially effective response (Jordan, Tunisia, Yemen), those who overcoming key political obstacles (Egypt, Gulf Countries, Libya) and those who face security and post-conflict context facing devastating impact of conflicts, humanitarian crisis and security challenges (Afghanistan, Iraq, and Occupied Palestinian Territories, Somalia). Anyway, there are an increasing number of countries who addressed those issues: specifics strategies for MSM in Morocco and Pakistan (start in Algeria, Egypt and Tunisia), for IDU in Morocco, Pakistan and Iran, and intervention among Female sex workers occurred almost in all the countries. The lack of political commitment, or the translation of expressed commitment into action, constituted an immediate obstacle to scaling-up towards Universal Access. This is often due to the perception that HIV is not a real issue in this region and/or that socio-cultural attitudes and beliefs impede high level leadership. Accessing and including vulnerable groups is often constrained by the legal and social environment [criminalization and/or non acceptance of the presence of drug users, sex workers, men who have sex with men, etc.] These aspects of vulnerability that are linked to individual behaviours are not always easy to address in this region, as in many others, but we must find ways to address them and find appropriate solutions that are adapted to the local context. Nonetheless, the Region has an opportunity to act now, before the AIDS epidemic escalates. Securing external funding is also particularly challenging in the Middle East and North Africa due to limited support from external donors. And the major donors operating in the region is the Global Fund to fight AIDS, Tuberculosis and Malaria which has now become one of the main sources of AIDS funding for the region. The availability of Global Fund resources in the region have created a new reality and represents a critical turning point in the national responses in the Middle East and North Africa, said Oussama Tawil, Director of UNAIDS Regional Support Team for the Middle East and North Africa. This is essential in particular in a context where the allocation of public resources remains relatively limited and primarily oriented to health care responses and other donor resources generally still represent limited support. Global Fund in MENA Region Currently, 16 out of the 22 countries in the Middle East and North Africa meet the eligibility criteria for Global Fund support. Amongst these, all are presently implementing programs funded by the GFATM and have succeeded in obtaining funds, amounting to a total of Approx. US$ 651 million (60 grants) from GFATM for HIV in MENA over the last four years. The Global Fund, since Round 8, allows greater involvement of CSOs such as Dual Track Financing, Community Systems Strengthening, their reinforcement into the national CCM, a focus on key affected populations in a bid to open more channels through which resources will be channeled to those most in need. CSOs potentially play a huge role in making the money work, having established networks and proven gains against the HIV/AIDS epidemic. However, to play this role well, they require capacity building in many forms. In the Middle East and North Africa region, civil society organizations still have a limited input into the AIDS response in the MENA region. Among the reasons for this, is their limited capacity and experience in AIDS prevention, care and support. There is also considerable reluctance or appreciation on the part of governments to consider a more active contribution of civil society to national efforts. This is in large part a reflection of the status of the situation of the civil society movement in countries. The poor functioning of, or lack of civil society organizations in this sub-region, which is a result of deficient capacity, prevailing stigma and discrimination, and the non-recognition of civil society organizations by governments, has serious crosscutting effects on the response to AIDS at national level. The lack of inclusion of people living with HIV is also a serious impediment to scaling-up. However, some achievements are remarkable in the past few years, as for example the expanded acknowledgement and targeted interventions to MARPs (10 countries), the revitalization of the Arabic network (Ranaa), the creation of numerous associations of people living with HIV and AIDS (Algeria, Morocco, Tunisia) and the increase participation of the people living with the three diseases into the Aids response. But most of them are still fragile. Civil Society Action Team, CSAT, was created in 2007 to help civil society obtain necessary training and funding to fully participate in the national responses to HIV and AIDS. CSAT is a civil society-led global
ALCS 2 Concept Paper prepared by Nadia RAFIF, coordinator of the MENA region February 2009

initiative supported by UNAIDS and other multi-lateral and bi-lateral organizations through the Global Implementation Support Team (GIST). CSAT is assisting NGOs to assert themselves politically and technically to implement quality contributions to the HIV and AIDS programs One of CSATs priorities is to strengthen involvement of community groups in CCMs, in particular, of key populations. CCMs call transparent the fact that civil society representatives sit in their meetings and are allowed to vote. Too often this presence is passive and used as an element of CCM compliance with the Global Fund requirements. Governments have used this passive presence to justify their control over funding and implementation of national projects. Local and national NGOs often lack training, funding and political experience to do a good job in representing their constituency. Civil society meaningful presence in CCMs requires clarity in their roles, pride in their know-how, and a clear understanding of the expectations of their constituency. In their supervision of Principal Recipients (PRs) in the CCM, representatives of civil society must have access to all necessary information. Most of NGOs in MENA region do not want to disclose internal problems they face in their CCM. They are intimidated by their official partners. Even if almost all the countries tend to respect the 40% civil society component GF request in their CCM, the SRs do not know what happened into their CCM, and they are not involved into the development of the requests, and implementation.They dont know their righst. As a result, key affected populations have no opportunity to participate in program development, to contribute to proposal writing and to access funding from the GF. Community based NGOs, working with key affected populations, are often not part of the CCM, for many reasons. CSS Concept is unclear and participation of the community sector is limited to representatives of people living with HIV, and often is tokenistic. Because of the cultural context, commercial sex workers and MSM are not formally represented at all. Civil Society as PRs: Since the 8th call for proposal of the GFATM in March 2008, NGOs have a broader possibility to contribute to national project and become PR of the Global Fund grants thanks to a dual track financing. However, to fully benefit from this opportunity, NGOs worldwide will need to be reinforced on several aspects: - Develop projects in accordance with real community needs while keeping global and national consistency; - Establish key monitoring and evaluation indicators; - Respect the timetables of the project once accepted, or justify any necessary change; - Establish a reliable system of financial accountability; - Build NGO alliances in order to gather collective intelligence and skills. As a snapshot of the MENA region, amongst all the 14 countries of the region with Global Fund HIV/AIDS grants, no one of them have civil society as PR, excepted 3 of them where international organizations are PR). Civil society organizations need support to effectively perform their various activities. Until now, providers of technical support had little knowledge of local and national NGOs challenges - in fact, they were not clearly expressed. As a consequence, there were often misfit and disappointing outcomes. Especially in the MENA region, where TSF does not exist and where most of the technical partners are not implemented. Civil society organizations need support to effectively perform their various activities: Civil Society Action Team, CSAT, was created to help civil society obtain necessary training and funding to fully participate in the national responses to HIV and AIDS. CSAT is assisting NGOs to assert themselves politically and technically to implement quality contributions to the HIV and AIDS programs. - Obtain necessary training and funding to interact with their constituency; - Set priorities and offer solutions with regard to community needs, and express the needs of the most marginalised populations; - Negotiate consensus within their constituency and with other stakeholders; - Identify NGO innovations relevant to HIV program development and implementation. The TS needs of the region are mapped through collaboration with WHO (HIV, TB, Malaria, HSS), UNODC, UNDP, UNFPA, UNICEF at regional level but they have to cover ALL the demand and the challenges are multiple. There is an increased and diversified demand for TS, and a lack of harmonization and coordination between agencies. Even if they recognized the need of mobilize resources to strengthen the capacity of civil society and people living with HIV in terms of management and implementation, it is still insufficient in term of concrete action. All these necessary changes will require a big effort of technical support that must be tailored for civil society specific needs. CSAT is promoting a two-prong approach:
ALCS 3 Concept Paper prepared by Nadia RAFIF, coordinator of the MENA region February 2009

training for civil society to perform the above roles: training for providers to work with civil society to make technical support timely, relevant, costeffective and specific to civil society needs. Civil society faces a big challenge of shaping the answers within its own constituencies, relying on national and local non-governmental energies. These energies need to be identified and empowered with facilitation, training and funding. There should be an NGO way to excellence. -

2. Description of Workshop

Workshop Title and objectives Civil Society and the Global Fund Grant performance workshop and CCM Processes Justification The Global Fund has placed emphasis on a greater involvement of civil society in its processes. This is evident by the place of dominance given to Community Systems Strengthening and Dual Track Financing in the Round 8 application literature and various reports and publications2. In the MENA region, there are currently no civil society organizations already taking full advantage of those opportunities. Based on the feedback of The Technical Evaluation Reference Group of the Global Fund (TERG), many points emerged that support civil society participating more actively in Global Fund processes. One of the TERGs partnership recommendations calls on its global and in-country partners to provide greater and more strategic technical support to civil society, support the development of CSO networks and communicate in a more transparent way about the work of the Global Fund. At the point of grant application, many civil society organizations report not knowing where to source technical support, how to fund it and more fundamentally what it may take to get involved at the PR, SR, SSR or CCM level. There is an obvious lack of credible information and understandable information. At the level of the grant portfolio, the more common civil society grant weaknesses documented in the Global Fund performance reports have to do with PR oversight of SRs, Monitoring & Evaluation, timeliness of reporting in-country, late disbursements in-country leading to tardy expenditure and human resource constraints. This must refer to lack of communication and lack of technical support In our region, civil society can be divided into 4 categories: NGO or support groups, very active on the field and especially in addressing key affected populations, but are not part of CCM. These organizations need to be informed on the GF processes and empowered to shape their experience and make it fundable for GF grants. Countries facing problems for implementing grants, especially the ones who face problems within their own CCM. These organizations would benefit of exchanging their experience with other NGO and draw some regional best practices helpful for most of them. Countries where Civil society SR expressed its interest to be PR in a medium term (Morocco, Egypt, Algeria).These few organizations need to be informed and helped to access to TS needed to make them credible and effective PRs Countries where working with key affected population is difficult and who plan to address them through regional proposal, or others funders. The creation or reinforcement of existing networks is necessary to draw good proposals. CSAT Hub from the MENA region played this year an important advocacy role towards key stakeholders in order for civil society to be involved in Global Fund opportunities, and receive quality technical support. Step by step the CSAT Hub succeeded to gather allies around those issues. Furthermore, CSAT established partnerships for on-going collaboration. Regional Support Team, president of the main Network of the region, and main NGO agreed to consider CSAT as an essential partner, for all the questions regarding brokering technical support and to strengthen civil society in the region. Discussions have been started in order to establish a common action plan regarding civil society for 2009.
E.g. Civil society Success on the Ground. Community Systems Strengthening and Dual Track Financing: Nine Illustrative Case Studies by The Global Fund to fight AIDS, Tuberculosis and Malaria and The International HIV/AIDS Alliance. ISBN 92-9224-114-1
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Concept Paper prepared by Nadia RAFIF, coordinator of the MENA region February 2009

As one of the main organization from the region, ALCS Hub will help them in the long run to contribute to and even lead in the national HIV response. As such, ALCS through its CSAT hub, proposes to collaborate with UNAIDS Regional Support Team and host a workshop on civil societys Global Fund grant performance. The main thrust will be to gather civil society organizations together to share their scenarios and positive problemsolving experiences with their peers and the larger regional group. We are well aware that this workshop will not solve all the problems but it should be a meaningful strep towards informing, networking and sharing best practices. Workshop Objectives Primary Objective: Scaling up the mobilization of national level civil society organizations to engage with Global Fund Secondary Objectives: 1/ to inform participating NGOs about GF processes (CCM, PR application, dual track financing, community system strengthening) 2/ to provide a forum of discussion of existing experiences (CCM participation, relationships between PR and SR and SSR) 3/ to start designing best practices and mapping TS needs (organizational development, program development, financial management and reporting, and M&E) Workshop Outputs The following outputs are expected: Assessment of technical support needs to enable NGOs to participate more effectively in their CCM List of key problems faced by civil society to improve grant performance Assessment of technical support needs for grant implementation, List of next steps per country for 2009+2010 Workshop report by ALCS/ CSAT hub with follow-up Monitoring Plan with partners

Workshop Outcomes The following outcomes are expected Empowering NGO for CCM representation Empowering NGO to write and implement part of country proposal in their areas of expertise Sharing information about improving CCM processes Sharing information that is useful for civil society already engaged with the Global Fund as well as create awareness for those networks/organizations planning to get involved at the PR, SR, SSR. Sharing best practices among civil society who have implemented programs addressing key populations. Providing info on the opportunities for civil society as well as the sources of technical support readily available for Round 9 and 10 applications. Enhancing skills on the use of technical assistance. Building a South/South dialogue on common grant implementation, challenges and accessible problem-solving. Draft Advocacy strategy for CSAT MENA regional hub to pursue. Workshop Participants 3 Civil society representatives from 14 countries from the Middle East and North Africa region: 42 representatives 1 regional Network: 2 ALCS Hub Secretariat and Regional staff: 5 CSAT globally consultancy : 1 Partners: 2

TSF Ouagadougou (technical partners): 1 International HIV AIDS Alliance: 1

ALCS 5 Concept Paper prepared by Nadia RAFIF, coordinator of the MENA region February 2009

UNAIDS (technical partners/resource personnel): 2 WHO (technical partners/resource personnel): 1 Global Fund, Morocco: 2 Aides France/ Amedis: 2 Translation team: 4 Proposed Topics The following session topics are proposed: Round 9 opportunities for civil society and CS advocacy with the Global Fund CCM processes and representing civil society on your CCM Community System Strengthening Dual track financing Making it work Becoming a civil society PR for the first time Restructuration of national CCM : the Moroccan case Conflict resolution methods - PRs/SRs/SSRs How to address key affected populations? Management of SSRs by SRs Good practice and Creative options Disbursements, records and reporting Financial management Multiple countries, multiple governments Managing regional grants How to write a technical support plan

Info sheets/resources to be included in participant folder: Global Fund in-country architecture FPMs, LFAs, CCMs, PRs, SRs and SSRs: who are they and what is their role? Global Fund proposal review timeline and procedures So Global Fund approved your proposal what next? Community System Strengthening guidelines Role of Civil Society into CCM guidelines Ending phase 1 and about to start phase 2 what are the possibilities? List of useful websites CSAT flyer CSAT Round 9 Alert NGO Code flyer Participants list and contact info Language: English, French and Arabic, with simultaneous translation provided for Anglophone, francophone and Arabic speakers Workshop Delivery Partners ALCS Aides rseau AMEDIS Grant implementers (civil society and multilaterals) UNAIDS/ Regional Support Team TSF West and Central Africa WHO Global Fund Geneva Local Agent of the Global Fund, Rabat, Morocco Workshop Sessions Good information presentation should be make to level up all participants to the same shared info and vocabulary Case studies will be presented by various civil society networks/organizations, which will likewise have the responsibility of designing a break out group exercise.
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Group discussions A slot of 1.5 hours will be allotted per session for case study sessions - this will be approximately divided as follows: - PowerPoint presentation, sharing case experience, challenges and successes (15 minutes) - Brief question and answer session. (10 minutes) - Group break out exercise to discuss scenario on hand outs and identify steps to resolve problems and/or bring about better grant performance. Break out exercise to be prepared before hand as a hand-out for groups. (20 minutes) - Reporting, question & answer and discussion (35 minutes). Technical partners will assist CSAT hub and Sub-Regional Secretariat staff in facilitating the sessions. Support to Logistics and Documentation Coordination and administration: ALCS/ CSAT Hub, Planning, design and material support: ALCS/ CSAT UB, UNAIDS, TSF, CSAT International hub at ICASO, AIDSPAN, Alliance, Global Fund clusters (Fund Portfolio Management, Civil Society, Partnership, Ph. 2 Renewals) Workshop dates April 14-16, 2009 Workshop location Marrakech, Morocco Financial support request GMS AIDES France/ rseau AMEDIS CSAT Middle East and North Africa

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Concept Paper prepared by Nadia RAFIF, coordinator of the MENA region February 2009

Civil Society in MENA and the Global Fund: Grant Performance & CCM Processes Workshop

Marrakech 14, 15 &16 April 2009

Draft Agenda

Tuesday April 14
08.00 09.00 09.15 Registration Opening & Welcome Presentation of the objectives and the program of the workshop Nadia Rafif, CSAT-MENA coordinator, ALCS Introduction of the participants What is the Global Fund? (GMS) Questions & Answers

09.30 10.00 10.20

10.40 11.00 11.20 11.40

Coffee break CCMs and PRs structure and functions (GMS) Civil Society participation in CCMs: Case study from Morocco (civil society speaker) Internet: an innovative voting process to revise CSO membership in Moroccan CCM Tanmia representative Representing Civil Society in CCMs Case study from Yemen (civil society speaker) Discussion

12.00 12.30

13.00 14.00 Lunch 14.00 14.40 15.10 Civil Society Involvement in Global Fund Grants (1) Understanding the Global Fund processes for grant implementation: key entry points for civil society (GMS) Most common reasons of grant failures (GMS) Discussion The challenge of implementation and impact on civil society Case study Algeria (Aniss) or Egypt (Caritas) (civil society speaker) Coffee break Group sessions 1/Country CCM Analysis regarding GF requirements 2/Participation of civil society in CCM 3/Difficulties faced by CS in grant implementation and how to address them Conclusion of Day 1 Social Event

15:30 16:00

18:00 20:30

Wednesday April 15
9:00 9:15 10:00 10:30 11:00 12:00 Summary of Day 1 Presentation of group sessions Discussion Coffee break Civil Society Involvement in Global Fund Grants (2) Capacity requirements for PRs and SRs in grant management (GMS) General management, financial and M&E systems Discussion (GMS)

12:30 13.30 Lunch 13.30 Experience of civil society as intermediary recipient (SR oversight of various SSR, good practices and creative options) Case Study AMSED, Morocco (Civil society speaker) Experience of civil society as PR (Alliance) Civil Society as Principal Recipient in MENA: Realistic solution? (Civil society speaker) Community system strengthening and how to integrate it into proposals for funding (ICASO/CSAT and Alliance presentations) Discussion Regional proposals Presentation by Menhara Network on Harm reduction National strategy application, what does it mean ? (ICASO/CSAT) Coffee break

13.50 14.10 14:30

14:50 15:15 15 :35 15.50

16:15

Group sessions - Developing objectives and strategies for CSS - Keeping the Focus on Key Populations Presentation of group sessions and discussion Conclusion of day 2

17:45 18.00

Thursday April 16: Civil Society and Partners Meeting

09:00 09:15 09:45 10:30 11:00 12:00 Introduction of participants Presentation of conclusions of the 2 first days Discussion Coffee Break Presentations of Partners and their role in support of CS Questions & answers Lunch

13:00-14:00 14:00

Group sessions: Assessment of CS technical assistance needs Coffee served during the workshops Presentation of group sessions Discussion How to write a technical assistance request? Recommendations & Conclusions End of the meeting Dinner

16:00 16:40 17:30 18:00 18 :30 20 :30