Country Coordinating Mechanisms Evolving CCMs to align with the Global Fund Strategy

1. Country Coordinating MechanismsEvolving CCMs to align with the Global Fund Strategy Presentation to Board January 2018

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4. What is the ‘CCM Evolution’? • In order to strengthen the Global Fund’s business model, the Global Fund Secretariat has been asked by the Global Fund Board to examine how to evolve the current CCM model to better deliver on the Global Fund strategy 2017-2022. This has also been part of the recent “CCM Audit” released by the Office of the Inspector General (OIG). • Overall Objective: to ensure that current CCM practices can inform the exercise (‘learning from the past’), while ensuring the new CCM model would allow CCMs to best deliver on the new strategy (‘setting up the vision’). It also includes how to differentiate CCMs. The project will lead to a revision of the ‘CCM Guidelines and Requirements’, which will come to the Global Fund Board for approval in May 2018.

5. Where are we with the project: Phases Completed Ready for consultations (CCMs, committee members) before Board Committee Meetings. 4 4

6. What are the Next Steps? 5 5

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8. What are the different CCM Models? • We are proposing 3different groups for differentiation for CCMs and the evolution of the current Regional Coordination mechanism (RCM)– based on both the analysis of CCM functionalities and feedback from the CCM regional consultations (conducted in August and September 2017):

9. 2. “Transitioning Countries” • 3. “CCMs in Challenging Contexts” • 1. Pivotal CCMs What are the different CCM Models? 1. Countries that have at least one disease that is “severe” or “extreme” and where Global Fund pays for a large share of the national response* (about 25 countries) 2. Countries that are preparing to transition from Global Fund financing, either higher income countries or where there is a relatively “low” disease burden, and often where the Global Fund investments are low compared to national government funding (Global Fund relevance). Some of these countries are currently receiving or are projected to receive transition funding in less than two allocation periods. This group is composed of two sub-groups: a) Transitioning Now: 3 components receiving transition funding, or are not eligible. (about 10 countries) b) Preparing for Transition: All Upper Middle Income countries, regardless of disease burden, and lower middle income countries with a disease component that is low or moderate disease burden (about 50 countries) • 2. “Transitioning Countries” 3. This group is composed of three sub-groups (about 23 countries): a) Challenging Standard: CCMs in countries that are under “Additional Safeguard Policy” or categorized as “Challenging Operating Environment” which are neither “Chronic Instability” nor “Acute Emergency” b) Chronic Instability: CCMs in countries with precarious security situation relating to periodic political strife, governance change or weak leadership or localized conflicts as defined in the “Challenging Operating Environment” OPN c) Acute Emergency: CCMs in countries with humanitarian crises due to armed conflict, emerging disease threats or outbreaks or natural disasters as defined in the “Challenging Operating Environment” OPN (currently no country, but allows for cases like Ebola crisis, civil war outbreak or natural disaster) * These are countries with High Disease Burden and Global Fund Relevance. The GF relevance is calculated based on “GF investments” compared to what the national government is funding.

10. The objective for the different CCM models • Transitioning CCMs: • Focus on ensuring linkages with the national response, including representation of key populations, and that the government is planning to take over Evolved Transitioning CCMs Model: Addition of transition-specific activities, at two levels of intensity, depending on how soon Global Fund financing ends CCMs in Challenging Contexts: Focus on adapting to coordinating activities (e.g. humanitarian) needed in their context, and preserving stability Pivotal CCMs: (High Disease Burden & Global Fund Relevance) Focus on optimal internal functioning, robust program oversight and CCM integration Current CCM Model Evolved CCMs in Challenging Contexts Model: Evolved Pivotal CCMs Model: More emphasis on building a highly engaged, and strategic body that stimulates strong performance of GF programs, and the wider health landscape, to progressively encourage governments to fund them Given flexibility in adhering to Global Fund requirements

11. Country assignment to CCM models Countries could be assigned to one of the 5 different categories using a ‘Two-Step’ methodology: Revising Assignments 1. Data Analysis 2. Context-based validation Revising Assignments Data Analysis Context-based validation • The countries that will be accessing Transitioning funding in 6 years or less are mapped as “Transitioning”. • Then, countries that are either “Challenging Operating Environment” (COE) or under “Additional Safeguard Policy” (ASP) are automatically mapped in “Chronic Instability” or “Challenging Standard”. • The other CCMs are mapped in “High Burden/High GF Relevance” model. • In principle, countries would be assigned into their CCM model every 3 years. Revisions can be made on an exceptional basis within the 3 year period, for example for acute emergencies, at the request of CTs and/or CCMs • Country Team, following input received from CCMs, agree on the “data analysis” categorization (to endorse or adjust it). Only minor adjustments are expected. In case of disagreement, a panel composed of CCM experts and chaired by the CCM Hub will take the final decision.

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13. Level of Ambition: 3 Options for Implementation Choice from 3 Scenarios As the budget to implement the “CCM Evolution” is uncertain, the Global Fund Secretariat will propose to the Board and its committees 3 different options to choose from:

14. Level of Ambition: 3 Options for ImplementationComparing potential options * Individual items can be moved from one option to the other ones. ** Implementation for CCMs “High Burden / High GF relevance”, “Challenging standard” and “Chronic Instability” only. *** When expertise is not available through CCM members, the CCM may decide to engage professionals as oversight committee members (5 working days/month).

15. Thank you!