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Mid-Term Review of the Civil Society Action Team (CSAT)

How is CSAT making progress and achieving results?

This report presents a summary of the results of a Mid-Term Review (MTR) of the Civil Society Action Team (CSAT) - a civil society-led global initiative to coordinate, broker and advocate for technical support to civil society organizations (CSOs) implementing or seeking grants from the Global Fund to Fight AIDS, TB and Malaria (the Global Fund). CSAT is coordinated by the International Council of AIDS Service Organizations (ICASO). It currently has 7 Regional/Sub-Regional Hubs hosted by established regional CSOs in:
West and Central Africa: African Council of AIDS Service Organizations (AfriCASO) Eastern Africa: Eastern Africa National Networks of AIDS Service Organizations (EANNASO) Southern Africa: Southern African AIDS Trust (SAT) Middle East and North Africa: Association de Lutte Contre SIDA (ALCS) Asia Pacific: Coalition of Asia Pacific Regional Networks on HIV/AIDS (7Sisters) Eastern Europe and Central Asia: Eurasian Harm Reduction Network (EHRN) Caribbean: Caribbean Vulnerable Communities Coalition (CVC)

The MTR was carried out in June August 2011, mid-way through CSATs five year mandate (2008-13). It covered the period February 2008 June 2011. The process Figure 1: Areas for CSAT Mid-Term Review involved a range of internal and external stakeholders and used a combination of methods: a literature review of over 20 resources; 27 stakeholder interviews; an e-survey of country beneficiaries (with 37 respondents); and a visit/indepth review of one Hub (for Southern Africa). The Review aimed to assess CSATs progress to date and make recommendations for the future. It focused on several aspects of CSATs work [Figure 1]. However, this summary report only focuses on CSATs effectiveness.
Area 1: Relevance Question: Is CSAT meeting the needs of its stakeholders and beneficiaries? Area 2: Effectiveness Question: Is CSAT making progress and achieving results? Area 3: Efficiency Question: Is CSAT operating well and making good use of resources?


Effectiveness: Is CSAT making progress and achieving results? The MTR found that, while the quantity and quality of work varies across the initiative, CSAT is generally making good progress against its objectives. Its core areas of work (strategic information, capacity building, engagement and advocacy) especially when applied in combination can provide a strong package of support to CSOs. To date, CSAT has framed its support around: 1. Civil society engagement in Global Fund governance at the country level; 2. Civil society engagement in Global Fund proposal development; 3. Improving grant implementation by CSO recipients of the Global Fund; and 4. CSO advocacy related to the Global Fund. Overall, most support appears to have focused on the first two areas. However, demand for the latter two (especially implementation) are likely to increase dramatically. The issue of attribution is challenging for CSAT as facilitation can be difficult to measure and the initiative is often part of processes involving multiple partners. However, CSAT is clearly contributing to important results. CSAT has played a critical role in the provision of strategic information about the Global Fund increasing understanding about both the basics of the mechanism and specific opportunities for civil society. It has disseminated information to both a larger number and greater diversity of CSOs (especially key populations) and used a variety of methods).It is praised for breaking down complex information into simpler formats and local languages.
Figure 2: The concept of brokering technical support

Within capacity building, the brokering of technical [Figure 2] support remains central to the concept and practice of CSAT. It involves a wide spectrum of support (from helping CSOs to define their needs to match-making with technical support providers). CSATs reports to donors document multiple examples of such support each year. Meanwhile, while not an original function, the provision of technical support has become a role for some CSAT Hubs. While controversial (in terms of the time involved and the implications for other work), this has contributed to some of CSATs strongest and most clearly attributable results.

The concept of brokering is broad in some cases it is simply a matter of putting CSOs in touch with technical support providers, but often there is an additional dimension of needing to find funding for the technical support. In addition, many technical support systems do not have specific mandates to work with CSOs, and because the community sector is heterogeneous, targeting support can be problematic. Brokering therefore sometimes requires long periods of negotiation and bringing together several different parties. CSAT Annual Report 2009

CSATs support to civil society engagement in Global Fund processes and governance is an area of particular success. As shown in a range of countries CSAT has helped to increase the involvement of CSOs (notably key populations) in Country Coordinating Mechanisms (CCMs) and improve the quality of their representation. Likewise, advocacy also remains a central component of CSAT. The project brings particular potential to maximize the country-regional-global chain with the Hubs and ICASO bringing CSO issues to the global table, for example of the Board of the Global Fund.


Here, issues for attention include the balance between: brokering and providing technical support; and addressing CSOs needs that are shorter-term and specific to the Global Fund or longer-term and more general (e.g. strategic planning). They also, critically, include how CSAT could better measure and articulate its effectiveness (quantitative and qualitative) and how - with limited capacity it can fully engage in shaping global structures for technical support.
Indications of CSATs progress on overall effectiveness include: Increasing the scale of Global Fund resources and programs for civil society, including key populations by providing CSOs with a package of strategic information, capacity building, engagement and advocacy. Example: CSATs Hubs have supported CSOs through combining four core areas of work and addressing the specific needs of civil society in relation to the Global Fund. In Round 10 alone, CSAT contributed to raising $491 million dollars for interventions by and for key populations (through 7 country and 4 regional proposals). Indications of CSATs progress on brokering technical support include: Increasing the appropriateness and quality of technical support for CSOs involved in the Global Fund by being an intermediary and facilitating dialogue between individual CSOs and technical support providers. Example: In 2010, the CSAT Hub in the EECA region provided opportunities for CSOs interested in CSS and the MARPs channel to meet and directly interact with technical support providers. It combined this with brokering support for specific countries, such as for CSOs in Belorussia in relation to the MARPs channel for Round 10. Increasing the appropriateness and quality of technical support for CSOs involved in the Global Fund by providing a comprehensive brokering service to CSOs. Example: In 2010: in East Timor, the CSAT Hub for AP worked with UNAIDS and the TSF to identify CSOs needs for technical support; in Peru, the Hub for Latin America supported sex workers to develop a request for technical support. Increasing the inclusion of civil society issues in proposals to the Global Fund by brokering technical support to CSOs involved in the development process. Example: In 2008, the CSAT Hub for Latin America brokered technical support from the International Centre for Technical Cooperation (ICTC) to support an LGBT network in Bolivia to prepare components on work with sexual minorities for the countrys proposal to the Global Fund. Increasing the inclusion of CSOs as recipients of the Global Fund by brokering technical support for individual organizations. Example: In Moldova, the CSAT Hub for EECA brokered support from the Ukrainian Network of People Living with HIV to the Moldovan League of People Living with HIV (a newly formed organization). The Network shared its lessons (as a former PR and built the organizational capacity of the League which was taking responsibility for managing sub-grants to benefit people living with HIV.


Indications of CSATs progress on providing technical support include: Increasing the inclusion of civil society issues in proposals to the Global Fund by providing direct support to CSOs involved in the development process. Example: In Zimbabwe, with technical support by the UNAIDS TSF too costly, the CSAT Hub for Southern Africa provided direct assistance to the countrys drafting team to integrate CSS into the proposal for Round 10. Increasing the involvement of CSOs in Global Fund governance and decision-making by directly facilitating processes among civil society. Example: In Indonesia, the CSAT Hub for AP collaborated with the CCM and facilitated the selection of civil society PRs for the Round 8 proposal (which included a CSS component). The Network of People Living with HIV were invited to join the CCM and included in the proposal. CSATs work - in collaboration with ITPC and OSI - included developing a curricula and holding a workshop on meaningful involvement. The Hub has since participated in the development of a new National AIDS Strategic Plan. Increasing the performance of Global Fund programs by CSOs - by providing opportunities to exchange lessons and build capacity. Example: In 2008, the CSAT Hub in WCA hosted a workshop on grant performance by CSO recipients of the Global Fund. It involved representatives (including CSO PRs and members of CCMs) from 23 countries and provided a forum to share lessons on improving grant management and performance. Resolving specific crises related to Global Fund grants within countries by providing neutral facilitation. Example: In Mauritania, CSAT Hubs MENA and WCA provided strategic information and intensive, longterm assistance, supported by GIZ, to help CSOs play their part in resolving the suspension of the countrys grant from the Global Fund. This helped the sector to develop guidelines to elect CSO representatives for a new CCM. Indications of CSATs progress on enhancing advocacy include: Promoting national action on opportunities and barriers for civil society in relation to the Global Fund by supporting CSOs to carry out country-level advocacy. Example: In 2009, CSAT supported national advocacy in over 20 countries, including through the provision of strategic information and capacity building on advocacy skills and strategies. Promoting priority, regional issues for civil society related to the Global Fund by advocating on behalf of CSOs to relevant decision-makers. Example: In 2010, the CSAT Hubs in the EECA and MENA regions organized a campaign to oppose the Global Funds new eligibility criteria. One result was that the Minister of Health for Morocco wrote to the Minister of Health of Yemen (the regions Board Member of the Global Fund) to encourage a joint position on the issue. Strengthening the content and messages of CSO advocacy on the Global Fund by gathering evidence. Example: In 2010, EANNASO used the results of a survey to advocate to governments and development partners to provide more and better technical support to CSOs, as well as to inform ongoing lobbying of the


Global Fund Secretariat and technical support stakeholders). The survey was also used to inform a meeting with the regional TSF to develop a partnership for technical support for CSOs and to develop technical support guidelines. Enhancing joined-up CSO asks to the Board of the Global Fund by building the national-regional-global advocacy chain. Example: CSAT Hubs and their constituents, for example in the EECA and MENA regions, have increasingly become members of and engaged in the Civil Society Delegations to the Board of the Global Fund. As the Global Host, ICASO has complemented this by promoting the issues and profile of CSAT through its work within the governance of the Global Fund, such as through membership of the Policy and Strategy Committee. Shaping key opportunities for civil society related to the Global Fund by engaging in project-wide advocacy on specific issues and processes, notably CSS. Example: All of the CSAT Hubs were involved in processes to shape the Global Funds Framework for CSS. For example, those for the AP and EECA regions successfully advocated for greater attention to key populations and the specific technical support needs of CSOs with both addressed in the final document. Indications of CSATs progress on facilitating civil society engagement include: Opening doors to CSO involvement in Global Fund decision-making - by building understanding and commitment to the sector among CCMs. Example: In 2010, CVC, in partnership with ITPC, supported the Civil Society Forum of Jamaica to make recommendations to the CCM on why and how it should involve CSOs, especially key population groups. Work is underway to commit the CCM to reserve seats for men who have sex with men and sex workers. Increasing the number and quality of civil society representatives on Global Fund CCMs by developing transparent and accountable processes.

Example: In Morocco, the CSAT Hub for the MENA region worked with the CCM to develop a transparent and democratic system to elect 4 civil society representatives. The process included using a CSO network website which will also be used by the sector to discuss issues related to the CCM and oversee the countrys grants from the Global Fund. Enabling CSOs to make informed decisions about becoming recipients of the Global Fund by building awareness about, and capacity in, the roles and responsibilities involved. Example: In the Caribbean, the CSAT Hub made a documentary to tell the story of CVCs journey to becoming a PR of the Global Fund. It showed what steps were involved, what partnerships were built and what changes the organization had to undertake. Increasing the number of CSOs acting as PRs, SRs or SSRs of the Global Fund by increasing the confidence, capacity and profile of such organizations. Example: In the WCA region, CSAT has played a key role in breaking the myth that CSOs lack the capacity to implement grants from the Global Fund. Its work combining providing strategic information, technical support and advocacy - has contributed to more CSOs (including networks of PLHIV) becoming PRs in several countries.


Indications of CSATs progress on making a difference to key populations include: Increasing the number and range of key population groups involved in national Global Fund processes. Example: Across the regions, CSAT Hubs have supported key population groups to become involved in Global Fund processes and decision-making, often for the first time. For example, the LA Hub supported sex workers in Peru to become members of their CCMs. Securing resources for HIV programs targeting key populations by increasing the inclusion of relevant interventions in country proposals to the Global Fund. Example: In Round 10, CSAT supported proposals addressing key populations in 13 countries. Of these, 7 were approved, with 5-year grants totaling $445 million. Securing support for key populations neglected in country proposals to the Global Fund by supporting the development of regional proposals. Example: In Round 10, CSAT supported the development of 5 regional proposals addressing key populations. Four were approved, with the 5-year grants totaling $46 million.


The MTR drew extensive conclusions about CSATs past performance and future directions. These include that CSAT offers many strengths. These include that it: is a timely and relevant initiative, with a unique and critical niche and a strong organizational model; is hugely ambitious, but increasingly achieving results; provides a comprehensive package of support to CSOs; has particularly achieved results in the engagement of civil society in Global Fund governance; has championed key populations (providing support that no one else would); and works best when it maximizes a joined-up approach (using its national-regional-global chain of issues and influence). The conclusions of the MTR also, however, emphasized that CSAT has areas for attention. These include the need to address CSATs: measurement and demonstration of results; low and often misunderstood profile; tension between brokering and providing technical support; heavy dependence on individuals and inadequate budget. In summary, CSAT faces a new era which while including significant challenges presents opportunities for defining a strong future direction.


The findings and conclusions of the MTR identified many issues for CSAT to consider within its future strategic direction. As priority actions for the short-term, CSAT should: 1. Undergo a period of consolidation rather than dramatic change: CSAT should maintain and strengthen its existing objectives and maximize its model (especially in terms of the institutional support and additional resources provided by the Host Organizations). It should also continue to do what it does best - focusing on its core areas of work: strategic information, capacity building, engagement and advocacy. 2. As a matter of urgency, identify a new Host Organization to re-launch the CSAT Hub for Latin America: This decision should be informed by Aid for AIDS and other stakeholders in the region andinclude discussions about whether to focus on a Sub-Regionand what role CSAT can best play (for e.g., considering issues of eligibility for the Global Fund. 3. Maintain a strong focus on key populations, including supporting such organizations to fulfill their existing roles within the Global Fund and maximize emerging opportunities: In addition to continuing to target its core work to key populations, CSAT should: Champion the needs of key populations that become PRs or, in particular, SRs or SSRs, of the Global Fund mobilizing appropriate support (off the radar of other support providers); Continue to promote the core opportunities for key populations by the Global Fund - reaching a greater number and diversity of such groups. Support key populations to negotiate and fully engage in the Global Funds reform agenda, including its changing architecture and policies. This includes supporting groups to play a full role in the development of NSAs or advocacy on issues such as counterpart funding. 4. More strongly and proactively engage in the development of strategies and mechanisms to improve and harmonize the provision of technical support at all levels: Of particular importance, ICASO should bring the issues and concerns of civil society to the table during full engagement in the development of a new GIST and the roll-out of initiatives such as COATS. It should also passionately advocate for full attention to CSS issues within the development of global platforms on HSS. 5. Very cautiously explore the further provision of technical support by CSAT Hubs: First and foremost, CSAT should focus on the brokering of technical support. It could, however, explore the provision of support in instances that meet specific, transparent criteria, such as when after communication with all technical support providers - no other form of appropriate support is available or accessible and when assurance is provided that the Hub has the relevant expertise and will receive appropriate funding for the work.