In this audit, the OIG reviewed the role and the effectiveness of the Country Coordinating Mechanisms (CCM), a central element to the Global Fund’s commitment to country ownership. The OIG found gaps in CCM performance in coordinating and overseeing grants. The auditors also identified significant problems with the implementation of CCM policies and procedures at the Global Fund and in country, particularly regarding the long term sustainability of the mechanism. The Global Fund is addressing these issues with a number of planned corrective actions.
CCM are country-level multi-stakeholder partnerships that develop and submit grant proposals to the Global Fund based on priority needs at the national level. After grant approval, they oversee progress during implementation. CCMs include representatives from both the public and private sectors. At present, there are 119 CCMs and 25 Regional Coordinating Mechanisms across the Global Fund portfolio of 124 countries. US$44.5 million has been disbursed as of October 2015 to support CCMs. This translates into average annual funding of US$6.4 million, ranging from US$8,000 to US$346,000 per country per year.
In the audit, the OIG reviewed key documents from a representative sample of 50 CCMs as well as data in seven countries (Ghana, Honduras, Indonesia, South Sudan, Tanzania, Pakistan and Uzbekistan) that were part of the its 2015 annual audit plan. The OIG also received more than 800 responses to questionnaires and interviewed over 200 people from the Board and its committees, CCMs, Global Fund staff, implementers and eight development partners.
In all seven sample countries from the 2015 OIG audit plan, the OIG noted weak coordination and stakeholder engagement with other health forums or structures, particularly with regard to strengthening health systems. In five of out the seven countries, the CCM was not integrated into national systems. Additionally, oversight continues to be weak in CCMs with the absence of oversight committees and little feedback from key populations. The Global Fund does not have a policy on sustainability and the role of CCMs in post-transition disease programs. Only one out of the nine countries from which the Global Fund has withdrawn has retained its CCM.
In assessing the effectiveness of CCM policies and procedures at the Secretariat and country level, the OIG found multiple issues in overall performance management. Only 9% of the CCMs assessed are fully complaint with the relevant eligibility criteria (as at October 2015). Additionally, there is a lack of clarity of roles and accountabilities within the Secretariat, particularly relating to addressing the performance issues of CCMs. Furthermore, at the country level, performance frameworks are largely structured around basic input indicators, such as the number of meetings held, instead of metrics to measure quality and timeliness in the performance of key CCM functions.
Although significant improvement has been made to involve civil society and affected communities in designing and implementing programs, almost half of the 50 CCMs reviewed were not fully compliant with the requirement for non-governmental constituencies to directly and transparently select their representatives.
The Secretariat has committed to the following actions to strengthen the role and effectiveness of CCMs: assigning clearer responsibilities to CCMs, developing a mechanism to strengthen oversight, devising a structured process to integrate CCMs into national systems, and ensuring civil society and key populations engage more meaningfully with the CCM. The Secretariat will also update CCM guidelines to include plans to sustain CCMs or find alternative mechanisms once the Global Fund withdraws from a country