Community Systems Strengthening
(CSS)
An introduction to the Global Fund Community Systems
Strengthening Framework
Outline
1. CSS in the context of the Global Fund
2. Introduction to the CSS Framework – a tool
developed by the Global Fund and its partners
3. Next steps, and towards Round 11
Community Systems Strengthening
Requesting funding for community-level activities has always
been possible.
In 2008 the Board of the Global Fund requested routine inclusion
in proposals of measures for strengthening of community
systems, including Initiatives that contribute to the
development and/or strengthening of community-based
organizations , in order to:
• Improve knowledge of, and access to, improved health
service delivery
• Achieve improved outcomes for HIV, TB and malaria
prevention, treatment, care and support programs
Challenges around CSS for Civil Society
• Lack of awareness by beneficiaries and CCMs of
the existence of the CSS opportunity
• Lack of evidence-based documentation and
related indicators to show impact of CSS
• Confusion and overlap between HSS and CSS
• Lack of resources and appropriate technical
assistance to help civil society contribute good
CSS components to proposals
Community Systems Strengthening
Aim of CSS and the Framework
“The CSS Framework is aimed at strengthening community
systems to contribute to key national goals and to ensure that
people’s rights to health are realised. This includes
prevention, treatment and care, mitigation of the effects of
major diseases and the creation of supportive and enabling
environments in which these systems can function.”
The CSS framework is intended to help countries include
funding for community organizations and activities in their
proposals.
How does CSS work?
• Community Systems Strengthening areas of activity may
include a focus on:
– Building capacity of the core processes of community-based
organizations to provide an increased range, or quality of services.
– Building partnerships at the local level to improve coordination, enhance
impact, and avoid duplication of service delivery.
– Sustainable financing, including a focus on supporting initiatives to plan
for and achieve predictability of resources over a longer period of time with
which to work for improved impact and outcomes for the disease(s).
Community Systems Strengthening
Six Core Components in CSS Framework
1.
Enabling environments and advocacy
2.
Community networks, linkages, partnerships and coordination
3.
Resources and capacity building
4.
Community activities and service delivery
5.
Organisational and leadership strengthening
6.
Monitoring & evaluation and planning
+ Menu of Service Delivery Areas
+ Examples of Activities
+ Menu of recommended Indicators
Service Delivery Areas (SDAs)
• Examples of possible SDAs are proposed for each
core component
• Proposals can include these SDAs, or others can
be developed according to the context and
intended services
• SDAs can be included in Global Fund proposals
or applied in other planning tools.
SDAs in detail
1. Enabling environment and advocacy:
SDA1: Monitoring and documentation of community and government
interventions
SDA 2: Advocacy, communication and social mobilization
2. Community networks, linkages, partnerships and
coordination:
SDA 3: Building community linkages, collaboration and coordination
3.
Resources and capacity building
SDA 4: Human resources: skills building for service delivery, advocacy and
leadership
SDA 5: Financial resources
SDA 6: Material resources – infrastructure, information and essential
commodities
SDAs in detail (cont’d)
4. Community activities and service delivery:
SDA 7: Community-based activities and services –
delivery, use, quality
5. Organizational and leadership strengthening:
SDA 8: Management, accountability and leadership
6. Monitoring & Evaluation and Planning:
SDA 9: Monitoring & Evaluation, evidence-building
SDA 10: Strategic and operational planning
Community Systems Strengthening
Service Delivery Areas and Goals
Core Component
SDA
Goal
I. Enabling Environment & Advocacy
Monitoring of community &
government interventions
CBOs analyze and document relevant issues.
II. Community Networks, linkages,
partnerships and coordination
Building community linkages,
collaboration and coordination
Functional networks, partnerships between
community actors and national programs are in
place for effective coordination.
III. Resources & Capacity Building
Human Resources
Financial Resources
Material Resources
Knowledge of community health, rights, social
environments; core funding secured with
sound financial management; functional
systems to forecast, quantify and manage
infrastructure.
IV. Community Activities & Service
Delivery
Delivery, use and quality of
community-based activities and
services
Effective, safe, high quality services are
equitably delivered to those in need.
V. Organisational and leadership
strengthening
Management, accountability
and leadership
Community actors provide leadership in the
development, operation of programs.
VI. Monitoring & Evaluation and
Planning
M&E and evidenc building
Relevant data is collected, analyzed, used and
shared and it informs strategic planning.
Community Systems Strengthening
Examples for Indicators
SDA 1: Monitoring and documentation of
Number/percentage of CBOs that have been involved in joint
community and government interventions
program reviews or evaluations in the last 12 months
SDA 2: Advocacy, Communication and Social
mobilisation
Number/percentage of CBOs that implemented a costed
SDA 3: Building community linkages, collaboration
and coordination
Number/percentage of CBOs that are represented in national
or provincial level technical and policy bodies
SDA 4: Human resources: skills building for service
delivery, advocacy and leadership
Number/percentage of volunteers working for CBOs that are
provided with a stipend/allowance
SDA 5: Financial resources
Number and percentage of CBOs that have core funding
secured for at least 2 years
Full CSS Framework:
communication and advocacy plan in the last 12 months
http://www.theglobalfund.org/documents/civilsociety/CSS_Framework.pdf
The Challenge: Measuring Impact
Ultimately, we are trying to measure the impact of Global Fund
grants (and national AIDS programs) by using indicators such as:
1) Reduced HIV transmission (reduced incidence)
2) Reduced Mortality (i.e. keep people alive)
3) Improved health of target populations
The Challenge: Measuring Impact
Community-based organizations are essential actors in:
1.Delivering services to target populations
2.Linking and referring between services (e.g., VCT, ART)
3.Providing support and information (e.g., counseling, BCC)
4.Documenting barriers to effective interventions, and
5.Advocating for improved policies and policy implementation,
However, from an M&E perspective strengthening of community
systems/groups (CSS) has a secondary rather than direct effect on
project outcomes.
CSS: Indirect but Still Essential
Input
Strengthening interventions
Output
Impact
Quality services
are available
and used by the
community
Health is
improved at the
community
level
CC 1: Enabling environments and
advocacy
CC 2: Community networks,
linkages, partnerships and
coordination
CC 3: Resources and capacity
building
CC 4: Community activities and
service delivery
CC 5: Organisational and
leadership strengthening
CC 6: Monitoring & evaluation
and planning
Linked: Health and Community Systems
Like Health Systems, Community Systems are critical to effective
service delivery. They are often part of a continuum of care,
such as when peer outreach workers refer PLHIV to testing or
care centers, health systems deliver medical care, and then
peer counselors deliver follow-up information and counseling.
Health System
Community System
VCT/ART
Refer to VCT/ART
Refer to
MMT/NSP
MMT
NSP
Impact
Counselling
Counselling
Reduced HIV+
VCT
Reduced
Mortality
ART
Reduced
Mortality
Measuring long-term Impact of CSS
Many of the activities in the CSS Framework are linked to important
outcomes, but it is very hard to quantify a clear causal relationship.
For example:
CSS Activity: Training for treatment counselors
Long-term impact: leads to faster ARV uptake and improved
adherence, leading to decreased mortality.
CSS Activity: Training for peer outreach workers
Long-term impact : increased coverage of outreach to IDU,
increasing referrals to harm reduction services and reducing HIV
transmission.
CSS Activity: Provide stable salaries for CBO staff and volunteers
Long-term impact : Stable and effective outreach and provision of
services, data collection, and monitoring of project outputs.
Analysis on Community
Systems Strengthening (CSS)
Round 10
CSS and the Global Fund
• The Global Fund recognizes that strong, sustainable
community-based organizations are key to ensuring program
impact, sustainability, equity, and results for HIV, tuberculosis,
and malaria prevention, treatment, care and support efforts.
• For this reason, from Round 8 onwards, the Global Fund began
explicitly encouraging applicants to routinely include measures
to strengthen community systems that are relevant to in-country
contexts both for new and continued funding.
• Community System Strengthening (CSS) refers to initiatives that
contribute to the development and/or strengthening of
community-based organizations in order to improve knowledge
of, and access to improved health service delivery.
CSS Framework
In Round 10 applicants could refer for the first time to the CSS
Framework to include CSS in their disease proposals or crosscutting HSS funding requests.
• The framework provides a detailed description of the CSS
rationale and core components.
• It includes a number of recommended CSS indicators to
enable measurement of progress in CSS over time.
• Thanks to this we are now able to capture the level of
funding directed to CSS activities.
Methodology
The report provides an analysis on the amounts requested and types of CSS
activities that were proposed by applicants in Round 10.
Categories the analysis
examines:
1. All proposals received
Sub-Categories:
Global Fund Cluster
• LAC, MENA, SWA, WCA, EAIO, EECA,
SA and EAP
2. Proposals recommended for
funding (Cat 1, 2, and 2B)
Income Level
3. Financial Analysis
Sector
• Lower Income, Lower Middle Income,
Upper Middle Income and Mixed
• Gov, Non-Gov, DTF
4. Indicators and core
components (as indicated in the
CSS Framework)
5. Survey completed by
applicants in regards to CSS
Components
• HIV, HIV (MARPS), TB, Malaria, HSS
Outcome and CSS for all proposals received
49% of the 189 Round 10 proposal parts received included
CSS activities.
Outcome and CSS for recommended proposals
44% of the 88 proposal parts recommended for funding by
the TRP included CSS activities.
CSS by Region
Proposals from LAC (71%) included CSS activities significantly more
often than the other regions (25% - 56%)
80%
71%
70%
56%
60%
50%
50%
50%
48%
48%
43%
40%
25%
30%
20%
10%
0%
LAC
MENA
SWA
WCA
EAIO
SA
EECA
EAP
CSS by Disease
The percentage of funding requested for CSS-related activities in HIV
(MARPs) proposals is significantly higher than the other disease
components.
25.00%
24.52%
20.00%
15.00%
10.00%
4.96%
5.00%
2.05%
1.62%
1.62%
0.00%
HIV (MARPS)
HSS
HIV
TB
Malaria
CSS by PR Sector
The percentage of CSS activities allocated to PRs from the government
sector was highest, followed by the non-government sector and DTF
proposals.
CSS by SDA for all proposals including
CSS activities
The SDAs regarding Human Resources (SDA 4), Community activities and
services (SDA7), and Community networks, linkages, partnerships and
coordination (SDA3) were mentioned most often. The SDAs mentioned least
often are SDA 5 – Financial Resources and SDA 10 – Strategic Planning.
Conclusions
• Awareness of CSS is uneven
– Throughout the regions
– Throughout the diseases
• Capacity concerns are still prominent with regards
to Civil Society PRs
– Capacity building should remain a priority
• Launching the CSS Framework for the first time
– Service Delivery Areas (SDAs) were used frequently
– Use of indicators less uniform
– Generally good feedback received from applicants in survey
Further action by the Global Fund
• Analyze in more detail the feedback of the
Technical Review Panel (TRP) to inform future
technical assistance on CSS
• Take lessons learned to improve CSS Framework
and guidance on the use of CSS Framework
Next Steps
• Understanding the results of the analysis of CSS
components included in Round 10 proposals
• Review and update of indicators
• Further information and training
Share your views and experience:
Michael.OConnor@theglobalfund.org
Ntombekhaya.Matsha@theglobalfund.org
Further Information
• The CSS Framework on the Global Fund website:
www.theglobalfund.org/documents/civilsociety/CSS_Framework.pdf
• UNAIDS Guide on CSS:
http://data.unaids.org/pub/BaseDocument/2010/201007_unaidscss_en.pdf
• Technical Support: UNAIDS TSF, GTZ, RBM, Stop TB
and civil society specific: CSAT