The Role of Civil Society in Global Health Activities Milton B. Amayun, MD, MPH Sr. Technical Advisor, The Hope Initiative World Vision International CCIH Annual Conference May 27, 2007

Civil Society - Definition Organized activity that acts at the interface between government and the general population Organized activity that acts at the interface between government and the general population Civic action not sponsored by the state Civic action not sponsored by the state Organizations created and run by the people for the people Organizations created and run by the people for the people Separate from both government and commercial sector Separate from both government and commercial sector

Usual processes Voluntary Self-governed Self-sustained Follows democratic processes Usually citizen-led, service-oriented, nonprofit Outside state control

What civil society includes NGOs, CBOs FBOs, including the Church Professional associations Trade unions Communities affected by targeted conditions, e.g., AIDS, TB, Malaria, disability

Why civil society? Normally not dependent on political changes Normally not dependent on political changes Reaches marginalized populations much better than government institutions Reaches marginalized populations much better than government institutions Outside the government bureaucracy; can be more efficient Outside the government bureaucracy; can be more efficient Church more sustainable than government Church more sustainable than government Promotes diversity Promotes diversity Encourages accountability Encourages accountability

Weaknesses of civil society Issues driven; many do not last long Issues driven; many do not last long Often fragmented; coordination needed Often fragmented; coordination needed Uneven levels of transparency and management expertise Uneven levels of transparency and management expertise Technical expertise varies Technical expertise varies Financial sustainability always at risk Financial sustainability always at risk Can be entangled in politics Can be entangled in politics

Civil society participation in the Global Fund to fight ATM Fundamental to GFATM’s new public-private paradigm Required in proposal preparation and Country Coordination Mechanisms’ governance Represented in GFATM Board by 3 members Basic element of accountability Adds different (citizen-driven, non- governmental) perspectives to programs

Examples of civil society involvement in GFATM Fiduciary control: Principal Recipient in many countries Fiduciary control: Principal Recipient in many countries Service delivery: Implementor or sub- recipient for projects Service delivery: Implementor or sub- recipient for projects Member of civil society delegation to the Board Member of civil society delegation to the Board Advocate for funding Advocate for funding Participant in M & E, e.g., on high-level global commitments Participant in M & E, e.g., on high-level global commitments

Recommendations, 1 FBOs must recognize their role as civil society participants, especially their value add contributions to technical, financial, management, and ethical areas of programs and projects FBOs must recognize their role as civil society participants, especially their value add contributions to technical, financial, management, and ethical areas of programs and projects Special leadership areas to be built: Advocacy, M&E and Skills Transfer Special leadership areas to be built: Advocacy, M&E and Skills Transfer Common manuals for training in above areas should be developed early Common manuals for training in above areas should be developed early Ideal: A global network of FBOs building on each other’s uniqueness and strengths Ideal: A global network of FBOs building on each other’s uniqueness and strengths Common purpose: Collaborate on issues that advance the health and poverty agenda Common purpose: Collaborate on issues that advance the health and poverty agenda Joint evaluations to ensure cross-learning Joint evaluations to ensure cross-learning

Recommendations, 2 Recommendations, 2 Networks for shared information and resources, but differences in adaptation allowed to surface Networks for shared information and resources, but differences in adaptation allowed to surface Networks could be national, geographic or based on functional leadership – or a combination of both. Networks could be national, geographic or based on functional leadership – or a combination of both. Mechanism for continuous interaction should be designed; point persons designated as hubs for information-sharing Mechanism for continuous interaction should be designed; point persons designated as hubs for information-sharing Bi-annual meetings a minimum Bi-annual meetings a minimum Other possibilities to look at: listserves, registries Other possibilities to look at: listserves, registries Networks should not be limited to technical NGOs; larger development- or health-focused NGOs must be part of the mix Networks should not be limited to technical NGOs; larger development- or health-focused NGOs must be part of the mix

Specific Roles of FBOs in Global Fund Processes at Country Level Proposal writers, consortium leaders/members Proposal writers, consortium leaders/members Data-gatherers and providers Data-gatherers and providers Implementors/Sub-recipients Implementors/Sub-recipients Country Coordinating Mechanism members Country Coordinating Mechanism members Civil society delegation members Civil society delegation members Principal Recipients (for FBOs with experience in handling large amounts of foreign currency) Principal Recipients (for FBOs with experience in handling large amounts of foreign currency) Technical Consultants Technical Consultants Evaluators Evaluators