Involvement of GRASSROOTS
Civil Society in GFATM – Lessons from Kenya
Kenya, with its population of 30
million, is among the sub-Saharan nations that has been hardest hit by AIDS, TB
and malaria. AIDS has left up to 1.5 million dead and another 1.2 million
orphaned; we’ve had a five-fold increase in TB case notification in recent
years; and malaria kills some 26,000 children each year. These diseases present
a monumental obstacle to Kenya’s
development. Against this backdrop, the Global Fund could have been a magic bullet.
Instead, Kenya’s
approach to the Fund has produced a string of disappointments.
Since 2001, a Joint Interagency Coordinating Committee (JICC) has
served to coordinate Kenya’s
Global Fund efforts and submitted proposals to the each of the first four
Global Fund Rounds. The First Round application was a failure: The Fund
criticized the TB component for offering “no mention of activities” and advised
Kenya
to “submit a proper proposal.” The Fund complained that the HIV component had
no work plan, strategies, or basis for its budget calculation, while the
malaria component was “unclear on the role of NGOs.” The faults in the proposal
directly reflected the faults in the process: though a few NGOs signed the
final document, there was no widespread engagement by civil society in crafting
the proposal. In fact, while the JICC’s proposal was
rejected, the Global Fund took the unusual step of funding two NGO proposals,
submitted independently of Kenya’s
CCM.
The Round 2 application, though
ultimately successful, still gave only vague details of what role civil society
would play in implementing the grant, and how funds would be allocated. The
situation worsened when the director of the National AIDS Control Council
(NACC), which served as a sub-principle recipient for Global Fund grant, was
indicted for fraud related to her salary package, and NACC itself came under
investigation for some irregular procurement activities. None of the
questionable practices involved Global Fund money, but the investigations undermined
the Fund’s confidence in NACC’s ability to cleanly disburse the funds. This was
rapidly corrected with a new management in place at NACC. But the fact remains
that two years after the application was approved, NGOs are still struggling to
better gain access to this money, with others still awaiting disbursement of approved
money.
When Kenya’s
Round 3 application was submitted without having remedied the minimal civil
society engagement, the Fund rejected the HIV/AIDS and integrated components,
another blow to confronting Kenya’s
health crisis. At that point, many real change agents within Kenyan civil
society decided to take matters into their own hands. NGOs had been meeting as
early as 2001 to discuss problems with the Round 1 application and the general
lack awareness of the existence of the fund, and to lobby for greater access to
information and a stronger collaborative role in proposal writing. These
efforts, convened by the Kenya AIDS Watch Institute, met with some success: 45
organizations collaborated on a Round 2 proposal to the JICC, and NGOs and
other community organizations won two seats on the 34-member CCM. Late last
year at
a meeting of over 200 CSO these ad hoc efforts were formalized as
civil society coordinating body, KECOFATUMA, or the Kenya Consortium to Fight
AIDS, Tuberculosis and Malaria.
KECOFATUMA now serves as the advocacy arm of more than 500 NGOs,
community and faith-based organizations, and private sector groups dealing with
AIDS, TB and malaria in Kenya.
The coalition’s goals are to increase the information flow from donors and
government to and from grass roots organizations, to root out fraudulent or
dishonest organizations and improve the image of Kenyan civil society, and to
increase the ability of Kenyan civil society to mobilize resources both locally
and internationally.
With regard to the Global Fund in particular, KECOFATUMA has
pushed for reforms in CCM representation, asking that members be elected by
constituencies to sit on the CCM, rather than selected by government. And
KECOFATUMA is now advocating for a consultative process that would allow Kenya
to produce a country proposal for the Fund based on needs, rather than the
accumulation of microproposals that don’t share a
joint strategy.
Professor
Josh Ruxin of the Earth Institute, Columbia University
and Kofi Anan’s UN Millennium Project addresses the
Conference. Prof Ruxin
is an expert on the Global Fund process.
Since late 2003, KECOFATUMA has begun
to build a national profile, receiving national media coverage for its visit,
during the IDD festival, to a Muslim-run orphanage in a Nairobi slum, and for its silent march past
the President during World AIDS Day, with a contingent of AIDS orphans and
caregivers bound at the wrists by red ribbons. Our member organizations also
build our visibility by circulating fliers at major public events.
With modest donor assistance from NACC, GTZ (the German Technical
Cooperation), and others, KECOFATUMA was able to launch a project to explain
the Global Fund process to NGOs and community organizations, demystify the
application process, and offer technical assistance for organizations that
sought to apply for funds. As part of this, KECOFATUMA hosted a National
Conference at Ufungamano House in Nairobi on February 16 and 17, 2003.
Despite a breakdown of the public transport system that left Nairobi at a virtual
standstill, more than 700 individuals from some 600 organizations turned out.
Though this effort came from the grass roots, the Kenyan government
participated fully: Charity Ngilu, the health
minister and CCM chair, and a representative from both the
ministry
of home affairs and Health, both came to address the
crowd, as did representatives of NACC, Unicef,
and the CCM. Each speaker assured participants of the JICC’s
(Now the CCM) seriousness about carrying out GFATM in a participatory manner.
They also offered concrete guidance on how to write a successful proposal for
the Fund, and provided paper copies of Global Fund documents to groups without
effective Internet access. Speakers responded to questions from the floor that
had emerged from community constituencies. Health minister Hon. Ngilu also made a major announcement: For Round 4, Kenya
would adopt a strategy of calling for microproposals
from which a broad country proposals would be
constructed—the first time the government had openly invited civil society in
on the Global Fund process. At the end of the two days, the veil over the Global
Fund had been lifted.
Following the conference, several of the more, well resourced
groups chose to prepare full proposals and forward them directly to the JICC/
CCM. But KECOFATUMA developed a simple, five-page document called a “project
concept tool,” to encourage smaller NGOs and community groups to enter into the
process as well. More than 400 groups filled out the project concept tool,
laying out their location, constituency, areas of interest, and proposed
activities, and sent the form on to KECOFATUMA. From these concepts, KECOFATUMA
wrote three proposals (one on each targeted disease) that summarized the
intended civil society response, couched within a comprehensive support and
monitoring structure, and passed them onto the JICC for inclusion in Kenya’s
country proposal. The KECOFATUMA proposals covered 83 percent of the districts
in Kenya
and cut across all the priority areas of the Global Fund. Unfortunately this
ambitious plan did not take off as the country lost that round.
KECOFATUMA’s plan is to increase CSOs
visibility under GFATM includes evaluation at every step. Beyond that,
KECOFATUMA will provide ongoing support for capacity building and
implementation, and a system for monitoring and evaluation of Global Fund
monies. KECOFATUMA’s structure has built in far more
accountability than the CCM itself.
The JICC, meanwhile, has begun its own reforms. To streamline the
body and make it more proactive, the JICC shrank its membership from 35 to 16
and diversified it, bringing the government/civil society/private sector
balance much more in line with Global Fund recommendations. There are plans underway to
more clearly define the role of the CCM as distinct
from that of the JICC which is
ideally a broader health sector body. The CCM also agreed to
reforms, asking the Civil Society to carry out elections for that body’s NGO
representatives, which, after some false starts, will take place quite soon.
Kenya’s Global Fund process has not
been perfected, by any means. For Round 4, the CCM hired consultants to draw up
the country proposal, and once KECOFATUMA submitted its consortium proposal, we
were never consulted by the CCM or its consultants again. As the projects in
the KECOFATUMA proposal were integrated into the country proposal, many of them
were scaled down, which would have required complicated adjustments by
implementing organizations.
Our vision at KECOFATUMA is that the process should be reversed:
the CCM should begin by identifying clear needs, and then invited implementing
organizations to tender for the proposal components. This would better match
the country proposal to national health needs, and it would also remove the
need to scale down proposals when they receive insufficient funding. At the
final stages, the CCM must engage civil society in writing the Country
Coordinated Proposal, allowing for an inclusive, mutually agreed-upon country
proposal.
But for all these challenges ahead, KECOFATUMA has set a precedent
in Kenya
for involving wider stakeholders and having government and civil society engage
each other in open forums. If our plan to introduce an overarching mechanism
for coordination, monitoring and evaluation within civil society is adopted
soon, many of the problems of government and civil society coordination could be
solved for future rounds. During the process KECOFATUMA has come to believe
that a cooperative approach between NGOs, CBOs, FBOs, government and even the private sector is not just
the best way to approach Global Fund, but the best way to fight AIDS, TB and
malaria. If over the coming years Kenya can produce an example of how to apply
for Global Fund and implement effective interventions it will be testimony to
the commitment of influential stakeholders to change and the hard endeavors of
many to stand and be counted.
Minister for Health Hon Charity Ngilu (second right) and Prof. Edward Karanja,
(right) make notes as Conference Chair, James Allego takes questions from the floor during one of KECOFATUMA’s
National CSOs meetings.
More on KECOFATUMA Here>>>