DRAFT Report

Report on Rapid Scan of IOTT Member Activities and Priorities November 2013

The following draft report is the result of work commissioned by the Secretariat of the Inter Organizational Task Team on Community System Strengthening (IOTT on CSS). It was developed under the guidance and coordination of the IOTT Secretariat, and it is presented for consideration to the Global Fund to Fight AIDS, TB and Malaria as a deliverable of the IOTT Secretariats contractual obligations (hosted by ICASO). The report is authored by David Traynor (consultant) and it was presented for the consideration and discussion of the IOTT, during its first meeting in November 2013.

The Inter-organizational Task Team on Community Systems Strengthening Report on Rapid Scan of IOTT Member Activities and Priorities
Background:
Established at the Washington IAC in 2012, the broad aim of the Inter-Organizational Task Team on Community Systems Strengthening (IOTT) is to contribute to CSS related knowledge generation and sharing, advocacy and coordination. Membership of the IOTT includes a diversity of stakeholders such as bilateral and multilateral partners and donors; international, regional, national and local NGOs and CBOs; academia; and global governance representatives (GFATM CS Delegations, UNAIDS PCB, StopTB Partnership). Representatives are drawn from across the broader health and development sectors, HIV and AIDS, Malaria and TB. The group currently operates as a semi-formal network with a number of sub working groups established to further specific tasks across key thematic areas such as research, technical assistance and guideline/framework development. Since its formation members of the IOTT have been active in input and guidance in the development of CSS related aspects of the Global Fund New Funding Model (NFM). Responding to a need for further development and clarity in the role of the IOTT and to assist in coordination ICASO has acted as secretariat for the IOTT. A face to face meeting of 25 IOTT member organizations and individuals, and technical partners, was convened in Geneva in November 2013. The overall aim of this meeting was to clarify the scope, mandate and structure of the IOTT and produce a 2-3 year roadmap outlining its role in moving forward the CSS agenda. Meeting objectives included: To identify and map key existing and planned CSS related initiatives of IOTT members To identify and promote synergies with CSS efforts between members and other actors To identify gaps in CSS efforts not being addressed by key partners and agree on how to take them forward To present and review draft papers by the four IOTT Working Groups To discuss next steps to update CSS guidance and modules of the NFM To begin ongoing dialogue on CSS, within the context of NFM, between IOTT members with Global Fund Secretariat key focal points

In preparation for this meeting, and to facilitate discussion and debate, a rapid scan of CSS related activities and priorities was conducted amongst participants. A brief survey was developed and disseminated amongst confirmed attendees in the weeks prior to the meeting (see annex 1). The primary purpose of the survey tool was to capture a snapshot of IOTT member CSS related Page | 1

activities, as well as current and future focus and priorities. Basic information on organizational type was also collated as a first step in making clearer the exact make up of the current IOTT membership. 1 Respondents were asked to detail activities under the following areas. Advocacy (eg: advocacy to national governments to include CSS in national strategies) Policy development, programmatic guidance Program/project development Technical Support Research Information and knowledge sharing

Rapid Scan of IOTT Member Activities and Priorities: Results

This report provides a brief overview of responses as well as summary analysis in each area. While not all participants responded to the survey, the review provides some initial insight into the scale and scope of CSS related work across a section of the IOTT membership. While forming definitive recommendations was outside the scope of this review, it poses a number of questions that might be considered by the IOTT and other stakeholders in the future development and positioning of the platform.

1. Organizational Type
A range of organisational types responded to the survey representing the diversity of the IOTT. Submissions were received by INGOs, local and regional networks, academia, technical partners, as well as multilateral and bilateral partners and donors. IOTT members intersect with other CSS related platforms such as the UNAIDS Task Force on CSS for Treatment Scale Up and the Global Fund Joint Civil Society Action Plan Questions for consideration: a) While the number of responses received to this survey limit the utility of any cross comparison between areas of focus and type of organization, such analysis should be considered in the conduct of a more comprehensive assessment of the IOTT. This would provide for strengthened coordination on CSS broadly as well as assist the IOTT map out existing synergies as well as gaps. b) The current IOTT membership does not include any representation from Government (eg: Health Ministries, National AIDS Programs). Given lack of Government buy in and understanding of CSS as a critical component of effective responses to HIV and other health issues remains as a significant barrier to CSS scale up the IOTT should consider how to strengthen engagement with these actors (through membership or a clear strategy)

It was originally intended that this survey be conducted across the broader IOTT membership. This has not occurred as the future of the IOTT is currently unclear.

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2. Areas of current CSS related activity and focus.

2.1. Advocacy Advocacy efforts are occurring at all levels from the global to the local. While the specific focus of advocacy interventions are diverse, collectively a clear priority is increasing recognition and inclusion of CSS in policies at all levels - from global frameworks and architecture to National Strategic Plans. Importantly, advocacy is occurring across diverse actors including with Governments, global institutions such as the World Bank and IHP, and with broader civil society. As examples: AmREF participates in national Ministry of Health and AIDS council policy setting forum in a number of countries to forward a CSS agenda as well as working at the district and local levels to ensure CS participation. Globally AMREF is a member of the IHP+ CSO Consultative Group and also member of the World Bank HNP CSO Consultative Group. In the WB group AMREF is the lead on CSS. UNAIDS pursues advocacy with national governments for inclusion of CSS in NSPs, investment cases as well as with other partners (at global, regional and national levels) for the prioritization of CSS in the global response to HIV. The agency provides support to civil society and communities in their advocacy for CSS. The International HIV and AIDS Alliance (the Alliance) promotes the inclusion of CSS within Investment Cases, the Post 2015 Agenda and more broadly via engagement and representation across various platforms (TWGs, committees etc). Alliance linking organizations work at the domestic level to advocate for the inclusion of CSS in national responses (particularly in the contexts of responses for key affected communities) ICSS remains active in advocacy on CSS across a range of UN agencies and with other international institutions (eg: the Global Fund) The StopTB Partnership secretariat actively advocates in various forum for recognition of CSS as a critical component in TB responses. It supports and works with Regional Partners on CS and CSS issues with African Parliaments as well as local partners. RATN convenes a regional summit as a platform for advocacy and knowledge sharing on CSS. At the national and community level, we support and facilitate through our member institutions, advocacy platforms for dialogue and cross-sharing on CSS in each of ACA member countries (TWGs, online communities etc.) EHRN: Not specific to CSS only but indeed advocacy towards including community-services for people who inject drugs - regional scope through work in specific countries by providing technical support to national advocacy NGOs

Questions for consideration: a) How can the IOTT platform be used to maximize coordination on CSS related advocacy at and across the national, regional and global levels? b) Is there a need/desire for a collective and common advocacy agenda and strategy? c) How can IOTT member access and engagement in a range of high level processes and platforms be strategically utilized and coordinated?

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2.2 Programmatic and policy guidance It is clear that there is a significant investment in the development and/or dissemination of programmatic and policy guidance across IOTT members. Agencies continue to engage in key programmatic and policy setting processes at all levels and in multiple forum. As examples: The Alliance participated in the development process for the 2010 CSS Framework; convening and facilitating a consultation with civil society actors to assist in its development. The agency has commissioned and/or autonomously developed numerous guidance documents and analysis on CSS (with a particular focus on community mobilization) including; costing community mobilization in the investment framework, the benefits of community mobilization in scaling up EVT and MNCH, strengthening linkages between community and health systems etc. UNAIDS guidance tools include aspects of access to services as they relate to CSS; on CSS specifically; engagement of civil society and communities at national, regional and global levels. UNAIDS guidance is developed through consultations with civil society, cosponsors, governments and other stakeholders. AMREF in Kenya has influenced National AIDS Control Council to integrate capacity building of CSO as an integral part of grant making. AMRRF has developed tools and manuals which have been adopted by NACC. AMREF serves as quality controller for NACC and build capacity of national NGOs for them to train smaller CBOs in organizational development and systems strengthening (ODSS). UNAIDS Programmatic guidance on 1) costing and 2) models of community system demand for and delivery of services.

Questions for consideration: a) To what extent can the IOTT platform be used to maximize coordination and harmonization in CSS related policy and program development? b) Is there a role for the IOTT in supporting its members to disseminate/communicate/share outputs and outcomes of this work? 2.3 Projects and Programs The scale and scope of IOTT member CSS related projects and programs is remarkable even when acknowledging the limitations of the survey and responses to it. For example: SAT is currently working with 80 communities using the SAT CSS Model which is anchored on 4 enablers: Rights, Dialogue, Participation and Governance. AMREF actively advocates for integration of Community Health with CHWs and CBOs/NGOs being part of the formal health system. AMREF supports CHWs to form CBOs and participates in the design, implementation and monitoring of CSS/community health strategies in Kenya, Tanzania, Uganda. KHANA provides assistance and support in organizational and institutional development for CBOs STOPTB manages and coordinates the Challenge Facility for Civil Society as well TB REACH EHRN provides and support Paralegal services/legal education by peers for peers women who inject drugs / selected EECA countries Page | 4

RATN implements the INSTANT Initiative involves RATN - an innovative proposals for small grants up to maximum of USD50000 on HIV and Health CSS projects aligned to the RATN Strategic Plan. The Alliance supports and implements community based HIV, TB and SRHR programmes using CSS as their operational and implementation model. Many Alliance linking organizations act as PRs or SRs implementing Global Fund programmes focused on CSS. For example: Alliance India - CSS programme focused on MSM and transgender communities; Alliance Ukraine - CSS programme working with people who inject drugs across 11 countries in south east Asia and Kenya.

Questions for consideration: a) To what extent can the IOTT platform be used to facilitate knowledge and information sharing on CSS related programming and projects? Could it play a useful role in synthesis and dissemination of associated evaluation and assessment? 2.4 Technical Support The majority of IOTT members responding to the survey indicated that Technical Support on CSS formed a part of their current activities and focus. These activities included the provision of traditional Technical Support via one off consultancies and contracts as well as longer term partnering arrangements and models. The scope and scale is once again remarkable. KHANAs recent TS related initiatives at the regional level include - supporting ISEAN to develop a CSS/SOGI Integration Assessment Tool; supporting CS in implementation of CSS program components; training on CSS for program staff. At the national level (Cambodia) KHANA has supported provided and facilitated, Trainings on clients rights, development reporting systems and tools for CBOs RATN works with its 32 member institutions, developing and delivering technical skills development courses targeted at community health workers, mid-level STI/HIV and health workers, trainers, programme managers and senior policy makers in eleven (11) countries in Eastern and Southern Africa. SAT was a member of the Zimbabwean Concept Note Drafting Team for CSS; The GF has also co-opted SAT Zim to provide technical support in workshops in Uganda and Zambia to strengthen CS participation in the NFM. 9 Countries involved in the workshops; In Malawi SAT working with CCM on Gender Transformative HIV programming approaches. The Alliance promotes and facilitates south to south Technical Support (TS) through seven regional TS hubs hosted by its linking organizations in: Burkina Faso, Kenya, India, Cambodia, Ukraine, Peru and Trinidad & Tobago. The majority of TS delivered via these facilities can be related to Service Delivery Areas identified in the CSS Framework. The regional TS hubs work in close collaboration with other regional and global TA providers including: GMS, German BACKUP Initiative, UNAIDS TSF. UNAIDS provides/brokers technical support to country partners for inclusive processes to 1) develop investment cases that include CSS, 2) convening of inclusive processes for the design, implementation and monitoring of national responses that include CSS, 3) direct support to civil society

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AMREF provides technical support to MOH and NACC in particular in Tanzania, Kenya and Uganda. Our integrated approach to grant making and ODSS is used as a framework. StopTB is not a direct provider of TS but assist through partners in-country, and for civil society under the umbrella of GCTA. EHRN provides technical support to civil society and key population groups around CCM and resolving challenges related to GF-supported project management (5 workshops for civil society and key population representatives engaged as CCM members or SRs or SSRs in GF grants two regional including one on HIV and another on TB; two national seminars followed by a facilitated meeting with CCM and PR leadership)

Questions for consideration: a) To what extent can the IOTT platform be used to strengthen Technical Support coordination on CSS? b) Is the IOTT an appropriate mechanism through which to further develop and refine TS packages for CSS? c) What role can the IOTT play in the broader Technical Support environment to ensure the range of TS providers are including CSS in their own programs? 2.5 Research Research related activities range from operational research to the development and publication of peer reviewed literature. The Alliance has produced a range of peer reviewed research articles and other documents aiming to increase understanding and uptake of CSS in areas such as the linkages between community systems and health systems, the role of community mobilisation in EVT responses; CSS and dual track financing and the GF. UNAIDS plans to review and analyse good policy and practice on successful factors, barriers, and methods of scaling up and sustaining CSS for national responses to HIV. (2014) EHRN has produced analysis with economic case for investment in harm reduction including in involvement of people who use drugs (in 5 countries of EECA with the Global Fund grant support) La Trobe University has conducted research on enablers and barriers to CSS in 3 countries in Southeast Asia AMREF has conducted evaluative studies on ODSS model. SAT conducts / supports operational research in on CSS across the 80 communities it works with. RATN generates and consolidates reliable research-based evidence to support relevance and quality of capacity development programs for example Under the Addressing the Balance of Burden in AIDS (ABBA) project Six (6) ABBA People With Disability studies were successfully implemented in Kenya and while one was implemented in Ethiopia and this resulted in the drafting of Policy Briefs

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Questions for consideration: a) To what extent can the IOTT platform be used to facilitate knowledge and information sharing on CSS related research? Could it play a useful role in synthesis and dissemination of associated publications? b) To what extent can the IOTT platform be used to formulate and pursue a CSS related research agenda? 2.6 Knowledge and Information Sharing Responses to this question in the survey were limited in detail. While it is clear that IOTT members act to share and disseminate CSS related knowledge and information, specifics on modalities and types of knowledge was not reported in any detail (eg: whom is this knowledge/information for and for what purpose and via what means). AMREF share knowledge at national level, in national and local committees and networks and at global level. Additionally, we share at national, regional and global conferences. ICSS acts as an information and knowledge sharing platforms SAT maintains a data base of CSS activities and outcomes in the communities we work STOP TB Partnership functions as Platform for information sharing and management. Eg: GCTA, Global Fund TB Friends, Coordinating Board constituencies, as well as convening meetings for information sharing The Alliance continues to produce and disseminate discussion papers, case studies etc around CSS to support south-south knowledge sharing. These include: 1) Civil Society Success on the Ground: Community Systems Strengthening and Dual-track Financing: Nine Illustrative Case Studies 2)Costing Community Mobilisation Within the HIV and AIDS Response Piloting a method to understand the costs of community mobilization within the proposed UNAIDS Investment Framework, 3) Uganda and Sudan Linking Organisations produced CSS case studies. UNAIDS leads on epi and other strategic information, but is aiming to develop/investigate how it may incorporate knowledge and information sharing on CSS

Questions for consideration: a) To what extent can the IOTT platform be used as a knowledge hub for CSS? b) What would such a mechanism look like? How would it be coordinated and facilitated?

3. IOTT Member Priorities looking forward over 3 years

A final question asked of respondents was to identify what their focus and priorities would be for the coming 3 year period. Answers here could be easily distilled and summarised into 4 specific areas: Page | 7

Advocacy to increase recognition of CSS at the national, regional and global levels (policy frameworks, NSPs etc) Increased resourcing for CSS within national responses Strengthening and expansion of evidence base via operational and other research Capacity strengthening of CS, Governments, technical partners on CSS

These priorities clearly indicate a continuation of work already underway by IOTT members. As aligned with the aims and original purpose of the IOTT, there remains the critical question of how the platform may work to strengthen such activities and act to ensure the whole is greater than the sum of its component parts.

ANNEX ONE: SURVEY TOOL IOTT ON COMMUNITY SYSTEMS STRENGHTENING

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This short and simple questionnaire hopes to map out some of the CSS related work that IOTT members are currently working on. As an initial step in strengthening understanding of the current CSS landscape it will assist to inform the work and agenda of the IOTT moving forward. ORGANISATION NAME Click here to enter text.

TYPE OF ORGANISATION (Choose as many as relevant) Community Based Organisation International NGO Multilateral Partner/Donor Faith based Organisation Bilateral Partner/Donor Technical support agency Key Population Network Other (please specify below) Local NGO PRIMARY AREA OF FOCUS (Choose those relevant) HIV and AIDS Health Tuberculosis Development Malaria Other (please specify below)

LEVEL OF YOUR ORGANISATIONS WORK (Choose those relevant) Local Regional National Global

Please describe the work you do around community systems strengthening under each of the categories below. If the category is not relevant to youjust ignore it!! Be as specific as you can indicating the who (with), how and where of your initiatives. Specify also if your work is local, national, regional... Advocacy (eg: advocacy to national governments to include CSS in national strategies) Click here to enter text.

Policy development, programmatic guidance

Click here to enter text.

Program/project development

Click here to enter text.

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Click here to enter text. Technical Support

Click here to enter text. Research

Information and knowledge sharing

Click here to enter text.

Click here to enter text. Other

Looking forward over the coming 3 year period, what will be your organisational work priorities around community systems strengthening: 1 2 3 4 5 Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text.

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