Action Alert

SEPTEMBER 2009

Supporting civil society engagement in Global Fund grants

OPPORTUNITIES FOR INCLUDING COMMUNITY SYSTEMS STRENGHTHENING (CSS) IN PROPOSALS TO THE GLOBAL FUND TO FIGHT AIDS, TUBERCULOSIS AND MALARIA

This CSAT Action Alert provides information and practical guidance for civil society on including requests for Community Systems Strengthening (CSS) activities in the framework of forthcoming Calls for Proposals by the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM).
From the very beginning, GFATM has been a strong advocate for civil society leadership and participation in implementation and oversight of Global Fund grants.1 The strength of civil society participation in GFATM is well documented. For example, in 2006, 83 percent of programs where civil society organizations acted as Principal Recipients (PRs) received one of the two highest ratings (A or B), and the proportion of civil society organizations with a C rating was lower than with other types of PRs.2 To further increase civil society capacity in managing and overseeing GFATM grants, the Fund provides specific guidance to ensure that capacity building of civil society organizations remains a priority while developing grant proposals, and that it is budgeted accordingly. The Global Fund Board has recommended that requests for funding of measures to strengthen community systems (CSS) necessary for the effective implementation of GF grants be included in grant proposals.

Two key actions you can undertake in this regard:

1. Learn more about CSS, including its goals and components, as well as relevant guidelines and lessons learned. 2. Learn how to include CSS in GFATM applications, including the process of needs assessment and planning relevant interventions. Where CBOs intend to participate in grant development and implementation, it is recommended that

they assess their capacity and take steps to build it as necessary through CSS activities.

Health promotion works through concrete and effective community action in setting priorities, making decisions, planning strategies and implementing them to achieve better health. At the heart of this process is the empowerment of communities - their ownership and control of their own endeavours and destinies. Community development draws on existing human and material resources in the community to enhance self-help and social support, and to develop flexible systems for strengthening public participation in and direction of health matters. This requires full and continuous access to information, learning opportunities for health, as well as funding support.3

The [Global Fund] Board believes that civil society and the private sector can, and should, play a critical role at all levels of the architecture and within every step of processes of the Global Fund, at both the institutional and country levels. This includes their critical roles in the development of policy and strategy and in resource mobilization at the Global Fund Board level, and in the development of proposals and the implementation and oversight of grants at the country level. The Board further expresses its desire for strengthened and scaled-up civil-society and private-sector involvement at both the country and Board levels, while recognizing the respective strengths and roles of the two sectors.4

1. WHAT IS CSS?
Community Systems Strengthening (CSS) refers to the provision of financial, technical and other kinds of support to organizations and agencies that work directly with and in communities. From the Global Funds perspective, most entities in need of such support are local NGOs that comprise and/or provide services to people living with HIV/AIDS (PLHIV), TB or malaria, members of vulnerable populations, and individuals who otherwise have sub-standard access to vital health services. Both civil society and government can and do provide CSS currently in Global Fund grants.5

. Key CSS components

Applicants are encouraged to include community systems strengthening activities/interventions in their proposals where the planned activities/interventions respond to weaknesses and gaps that have been identified as barriers to increasing demand for, and access to, services at the local level for key affected populations (including women and girls), sexual minorities, and people who are not covered with services due to stigma, discrimination and other social factors.6

GFATM outlines the following components of CSS funding: 1. CBO capacity-building development of physical infrastructure to implement programs through ensuring adequate office space, utilities and communication; organizational systems development through strengthening planning, M&E, financial operation and other processes; as well as technical capacity-building through information-sharing and technical support. 2. Partnership-building activities aiming at building networks and information exchange with key stakeholders from civil society, government and other sectors. 3. Ensuring sustainability activities helping make CBO interventions sustainable, ensuring maximum output with existing resources.7

B. Promotion of CSS by GFATM

GFATM believes that CSS supports the overall response to the diseases by integrating community response into the healthcare systems.8 Therefore, aiming at ensuring longterm sustainability of CBOs, GFATM works with Country Coordinating Mechanisms (CCMs) to engage them in CSS. Through GFATM-funded interventions with support from national partners, CBOs are receiving funding and technical support needed to build their capacity to implement and oversee grants. This enables the organizations to develop in the long term to provide prevention, treatment and care services to key populations. To strengthen the role of community-based organizations in GFATM work, dual-track financing (DTF) was approved by the GF Board in 2007. DTF strongly emphasizes inclusion of both Government and NGO PRs in GF proposals. GFATM believes that inclusion of both sectors as PRs has many advantages, including full employment of existing sector resources, improved grant implementation and strengthening of civil society. Experience in countries around the world has shown how community organizations use CSS to successfully implement GFATM grants.

C. Additional information on CSS

Extensive information on CSS and its application in the GFATM framework, including best practice examples, can be found in: A UNAIDS publication on CSS,9 which helps increase understanding of CSS benefits at various levels, supports advocacy and technical support efforts around CSS, and suggests ways to implement CSS. The guidelines include detailed information on priority areas and examples of CSS, community needs assessments, and consultations, GFATM procedures facilitating CSS and relevant indicators. A joint GFATM/International HIV/AIDS Alliance publication on CSS,10 which discusses civil society involvement in all aspects of Global Fund processes in different parts of the world, from Cambodia to Peru to Zambia to Ukraine. The case studies show the range of innovative options that many civil society groups have already identified and implemented within their specific contexts.

2. CSS IN GFATM PROPOSALS

Beginning from GFATM Round 8, applicants are expected to include requests for CSS funding in their proposals. This implies advance planning on the part of CCMs to ensure that they have sufficient time and technical resources to prepare such requests. GFATM is committed to helping CCMs perform this task. If CSS is not included in the proposals for a non-justifiable reason, such proposals will be considered ineligible by the Technical Review Panel (TRP). It is expected that this commitment will result in increased demand for CSS funding.11

a. CSS in the structure of GFATM proposals

Potential grant implementers from community-based organizations are advised to include CSS in different sections of GFATM grant proposal format, namely within Sections 4 (Program Description) and 5 (Funding Request). In the Round 912 GFATM guidelines for proposals, these sections were: Section 4.3 Major constraints and gaps: an opportunity to describe CSS gaps/needs in the context of Health Systems Strengthening (HSS); Section 4.4 Round 9 priorities: an opportunity to highlight CSS priorities based on the gaps described earlier; Section 4.5 Implementation strategy: CSS-related goals, impact/outcome indicators and objectives; lessons learned from implementation experience related to CSS; CSS-related strategies and plans to enhance social and gender equality; plans for partnerships with the private sector regarding CSS; Section 4.7 Program sustainability: here CSS is explicitly discussed in section 4.7.1; Section 4.8 Measuring impact: monitoring and evaluation activities should include CSS; Section 4.9 Implementation capacity: CSS strategies, including plans for improving coordination between implementers and for strengthening their capacity; Section 5 Funding request: gaps in CSS funding; details of CSS budgeting.13

b. Assessment of capacity
Assessment of capacity concerns the capacity needs of both communities at large and the potential grant implementing organizations. A crucial step in capacity assessment and in proposal development is a sound needs assessment. The following needs assessment interventions were recommended by UNAIDS to help the Country Coordinating Mechanisms (CCMs) and potential implementers obtain the full picture of service delivery: Rapid assessment analysis of existing baseline data, mappings and databases of community-level interventions, including profiles for future CSS implementers; Community-wide consultations to make sure that communities understand their capacity needs and CSS priorities; Mapping of partnerships and interventions to identify links between services and systems and networks;

Community-level needs assessment - a combination of the three options listed above important in those countries where HIV is a recent priority, or where civil society is not fully recognized by health systems or government.14

In 2008, the International HIV/AIDS Alliance prepared a detailed framework for analyzing and organizing data regarding community system strengthening. Although intended as guidance for Round 8, it can be used for subsequent grant rounds as well. The framework is a convenient tool to analyze core processes, key capacities and skills, main gaps, objectives and planned activities (including target indicators) across three CSS areas: capacity building, building partnerships and sustainable financing.15 In addition, the Alliance produced a tool for civil society organizations working as PRs or SRs, which describes the principles and procedures for financial gap analysis and budgeting, including recommendations on CSS.16

c. Getting involved in GFATM proposal preparation, including the CSS component

This section encourages you to establish communication with your CCM, in particular with its members representing civil society. According to formal Global Fund requirements, each CCM must include such members, including people living with the diseases.17 These members should be selected in a transparent fashion and should report back to their constituents. If your CCM does not currently have a civil society representative, try to establish communication with the CCM leadership or other members. If for some reason you cannot establish communication with your CCM, contact CSAT at csat@icaso.org for further information. 1. Familiarize yourselves with CSS related materials (resources listed in this alert are intended to be used as reference). 2. Learn about your CCM's plans to apply to GFATM. 3. Find out from your CCM about opportunities for CBOs to get involved in proposal development and partnership opportunities. 4. Discuss with your CCM the process of gap/needs assessment and related community consultations. 5. Following GFATM guidance, discuss the process of including CSS in the proposals with your CCM's civil society representatives. 6. Inform CSAT at csat@icaso.org about the outcomes of this process your experience is important for civil society organizations in other countries.

3. RESOURCES
We encourage you to learn more about Community Systems Strengthening by familiarizing yourselves with key organizations that provide support to civil society organizations, gather and publish information on CSS. Aidspan is a non-governmental organization whose mission is to reinforce the effectiveness of the Global Fund to Fight AIDS, Tuberculosis and Malaria. Aidspan does so by serving as an independent watchdog of the Fund, and by providing services that can benefit all countries wishing to obtain and make effective use of Global Fund financing. Relevant resources include Aidspan Guides, which provide detailed practical advice to those applying for, overseeing or implementing Global Fund grants, including the Aidspan Guide to Round 8 Applications to the Global Fund (updated in 2008).

Volume 1: Getting a Head Start and Volume 2: The Applications Process and the Proposal Form. http://www.aidspan.org/index.php?page=guides Centre for AIDS Development, Research and Evaluation (CADRE) is a non-profit organization working in the area of HIV research, programmer development and communication. CADRE is committed to fast-tracking appropriate and effective responses to HIV and AIDS through informing policy and developing coherent strategic models for interventions. CADRE works in sub-Saharan Africa with a primary focus on southern Africa. The organization has produced a number of publications related to community responses to HIV, including Models for Funding and Coordinating Community-Level Responses to HIV/AIDS (2007). http://www.cadre.org.za/page/1/4/15/39 The Civil Society Action Team (CSAT) is a civil society-led global initiative aiming to coordinate, broker, and advocate for technical support to civil society organizations implementing or seeking grants from the Global Fund to Fight AIDS, Tuberculosis and Malaria. CSAT operates through existing civil society organizations in six regions of the world. The International Council of AIDS Service Organizations (ICASO) was selected as the global host of CSAT. http://www.icaso.org/csat.html The Coalition on AIDS Technical Support (CoATS) aims to make the money work by supporting country partners to make effective use of the increasing amounts of large funds being made available at the global level. Its members include the United States Government (PEPFAR), the German Governments Gesellschaft fr Technische Zusammenarbeit (GTZ), the International Council of AIDS Service Organizations (ICASO), the International HIV/AIDS Alliance, the International Coalition on AIDS and Development (ICAD) and the Brazilian International Centre for Technical Cooperation (ICTC). http://www.unaids.org/en/CountryResponses/TechnicalSupport/gist.asp The Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM), through its Civil Society Team, works to institutionalize the role of civil society as an integral part to Global Fund architecture, processes and functions; increase the involvement of civil society on CCMs and in proposal development and implementation; provide facilitation for increased technical support to civil society; and further identify and support civil society working in advocacy and resource mobilization for the Global Fund. http://www.theglobalfund.org/en/civilsociety/introduction/ The International HIV alliance set up a Global Fund grant support group to provide technical support to all Alliance organizations in Global Fund grant management, and to facilitate lesson-sharing and support rapid skills-building across the Alliance. The group also responds to issues raised by the Coalition on AIDS Technical Support (CoATS) (of which the Alliance is a member.) http://www.aidsalliance.org/sw48271.asp The World Health Organization (WHO), through its HIV/AIDS Programme, provides evidence-based, technical support to WHO Member States to help them scale up treatment, care and prevention services, as well as maintain and increase access to drugs and diagnostics to ensure a comprehensive and sustainable response to HIV/AIDS.

The Joint United Nations Programme on HIV/AIDS (UNAIDS) brings together the efforts and resources of ten UN system organizations in the AIDS response to help the world prevent new HIV infections, care for people living with HIV, and mitigate the impact of the epidemic. Jointly, UNAIDS and WHO produced a resource kit for writing Global Fund HIV proposals for round 9, which includes A guidance tool for including Community Systems Strengthening in Global Fund proposals. http://www.who.int/hiv/pub/toolkits/GF-Resourcekit/en/index.html

END NOTES
1 The importance of community involvement in health program planning and implementation has been
highlighted in various documents, including the Declaration of Alma-Ata International Conference on Primary Health Care (1978), the Ottawa Charter for Health Promotion (1986) and the Bangkok Charter for Health Promotion in a Globalized World (2005). By acknowledging the importance of community involvement, GFATM follows these international agreements and ensures that policies, strategies and plans in individual countries when implementing healthcare projects should facilitate community involvement.
2

GFATM/International HIV/AIDS Alliance. Civil Society Success on the Ground. Community Systems

Strengthening and Dual-track Financing: Nine Illustrative Case Studies. 2008. http://www.theglobalfund.org/documents/publications/progressreports/Dual-Track_Report_en.pdf
3

The Ottawa Charter for Health Promotion. 1986.

http://www.who.int/hpr/NPH/docs/ottawa_charter_hp.pdf
4

The Global Fund 15th Board Meeting. 2007. http://www.theglobalfund.org/documents/board/15/GFBM15-Decisions_en.pdf

5

GFATM/International HIV/AIDS Alliance. Civil Society Success. GFATM Guidelines for Proposals Round 9, Single Country Applicants. 2008. GFATM Factsheet: Community Systems Strengthening. 2009.

http://www.theglobalfund.org/en/rounds/9/single/#guidelines
7

http://www.icaso.org/CSATworkingfiles/UpdatedCSSFactSheet.pdf

European Parliament hearing on the result and the impact of the Global Fund to Fight AIDS, Tuberculosis and Malaria. Recommendations by the International HIV/AIDS Alliance. 2007. http://www.stopaidsalliance.org/files/SAA/Resources/SAA%20Policy%20Documents/Global%20Fund%20 position%20paper%20Alliance.pdf
9

UNAIDS. Supporting Community-Based Responses to AIDS: A guidance tool for including Community Systems Strengthening in Global Fund proposals. 2008. http://www.who.int/entity/hiv/pub/toolkits/3-61_CSS_Feb09.pdf
10

GFATM/International HIV/AIDS Alliance. Civil Society Success. ICSS. Increasing Civil Society Impact on GFATM. Strategic Options and Deliberations. P. 2 (2007).

11

http://icssupport.org/PDF/CSreport_part2.pdf

At the time of writing it was not clear if the same structure of the GFATM grant proposal would be used for Round 10 and beyond.

12

 13 International HIV/AIDS Alliance. A framework for analysing and organising data regarding community
system strengthening in Round 8. 2008. http://www.icaso.org/CSATworkingfiles/CSS_analysis_framework_Eng_140508Alliance.pdf
14

UNAIDS. Supporting Community-Based Responses to AIDS International HIV/AIDS Alliance. A framework for analysing and organising data.

15

16

International HIV/AIDS Alliance. Budget development as a civil society PR or SR in Global Fund Round 8 proposals (2008). http://www.icaso.org/CSATworkingfiles/TrainingReport_on_CSS_Nairobi_November2008.pdf

17

GFATM. Clarifications on CCM Minimum Requirements. Round 8. (2008).

The International Council of AIDS Service Organizations (ICASO) is the global host for the Civil Society Action Team (CSAT) For CSAT-related information, contact us at csat@icaso.org or read about the work of CSAT at http://www.icaso.org/csat.html

International Council of AIDS Service Organizations (ICASO) International Secretariat 65 Wellesley Street East, Suit 403 Toronto, ON, M4Y 1G7 Canada t: +1 416 921 0018 f: +1 416 921 9979 icaso@icaso.org www.icaso.org