Monday, March 8, 2010

On the Community Systems Strengthening Framework (CSSF)

Dear Nabeel

The Community Systems Strengthening Framework (CSSF) has serious weaknesses in concept that need to be addressed. The CSSF is very much a product of the "establishment" that overseas the global health environment that is taking over more and more the global economic product.

In the USA, the idea that 17% of the economic product is now the "cost" of healthcare is an indication of how worrisome this matter has become.

Another issue is that modern health interventions require international subsidy at a multi-billion dollar level ... and it has now become the norm for the world to accept this. At some point, there is going to be a disruption in this norm, to the detriment of the health of beneficiaries.

India has shown some very good initiatives ... there are many areas of health where the costs of medical products and procedures have been reduced by an order of magnitude because medical professionals broke out of a mold that treated established high cost methods as sacrosanct.

Some experience I have in various parts of the world suggest that there can be major improvements in healthcare delivery cost by rethinking training and the way in which personnel are used to engage in healthcare activities.

As far as I can see the CSSF is a methodology that strengthens the health "silo" and the totally unsustainable status quo. If the CSSF initiative was a move to strengthening the multi-disease integrated community level interventions with a view to low costs and high performance healthcare, I would be happy ... but it does nothing of this. Bluntly put, it is another top-side overhead that will just divert attention from what really needs to get done.

If you look at the recent history of global health, there has been a huge increase in funding ... and some improvement in outcomes. Relative to what is needed the health improvement has a long way to go ... but the money funding is pretty much maxed out. Someone needs to start bringing together what is possible scientifically with some reality about what is going to be able to be funded ... this is not about profit but about humanity ... something sadly lacking in modern society and its metrics. There are enough people to do the work ... but most of the people don't have a chance to get the training they need, and therefore cannot do the work. When medical staff get trained ... they migrate to where money is maximum. Makes sense for the individual but not good for society. A worthwhile CSSF would address issues like this in a serious way ... but it does not.

Lots of issues ... CSSF needs a big rethink ... as does the work of the Global Fund for AIDS, Malaria and Tuberculosis (GFATM) which has extremely weak knowledge of how well the work it funds actually perform. Like so much of the official development assistance (ODA) world, GFATM does a lot of analysis before the fact and before fund disbursement, but very little after the disbursement to ensure that the funds achieve good outcomes. This is classic ODA methodology which allows money to be misused without anyone being much the wiser ... and this is no accident ... unless the leadership of the ODA community is less intelligent than I would give them credit!

This is not the first time I have raised these issues ... it has been an ongoing effort for many years ... and will not stop. But it gets more and more urgent. It is time to have serious accountability on the front burner.

Peter Burgess
Community Analytics (CA)
Nandini Kapoor Dhingra,
UNAIDS India Office,
New Delhi.

---------- Forwarded message ----------
From: MK Nabeel
Date: Fri, Mar 5, 2010 at 9:39 AM
Subject: [afro-nets] Draft Framework for Community Systems Strengthening - Call for Comments

cross-posted from: Solution Exchange AIDS Community with the Maternal and Child Health Community

Dear All,

Hope you would have come to know about the consultation on the draft framework for Community Systems Strengthening (CSS) developed by Global Fund. Alliance and International Council of AIDS Services Organisations (ICASO) are holding a worldwide consultation to get feedback on this draft CSS framework before finalising it. Solution Exchange (SE) is facilitating this consultative process through the AIDS Community and Maternal & Child Health (MCH) Community of SE.

The call for comments is appended below my signature. It is also available through the Facebook page ( and Twitter page ( of SE AIDS Community.

We request you to take part in this consultation and also to spread the word among your civil society partners and other networks. Your assistance is highly essential in getting inputs from across the civil society.

Thanking you,

PS: The Online Consultation available at closes on 5 March 2010. However, please do take part in the consultation process too by providing your comments. To go through the responses so far, please visit

[aids-se][se-mch] FOR COMMENTS: Draft Framework for Community Systems

Dear All,

Community Systems Strengthening (CSS) is an approach that promotes the development of informed, supportive communities and community-based structures so that they can contribute to long-term sustainability of health and other interventions at community level. It also promotes the development of an enabling and responsive environment in which these contributions can be effective.

The Global Fund to fight AIDS, Tuberculosis and Malaria (GFATM) has developed a CSS Framework in collaboration with other stakeholders including UNAIDS. The Technical Working Group (TWG) developed the framework in recognition that there are gaps in funding for many aspects of community action on HIV, TB, malaria, reproductive health, and other health-related issues. Even though the TWG developed it to support the CSS component of Global Fund grants, it is applicable to all community-based activities aimed at improving health through community-based action. Specifically, the objectives are to:
Help civil society actors articulate and scale up their activities, and access funding from GFATM,
Equip governments to better understand the vital roles of community actors particularly when building stronger health systems, and
Enable GFATM to make informed decisions about awarding grants to proposals strong in CSS.

The International HIV/AIDS Alliance (Alliance) and the International Council of AIDS Services Organisations (ICASO) are conducting an online consultation for civil society to input into this draft framework. The full version of the framework can be downloaded at (PDF, Size: 375 KB), and the summary at (PDF, Size: 62 KB).

Apart from introductory sections and a section elaborating how community systems are interlinked and complementary to health systems, the framework talks about six Building Blocks (BBs). Further, each of these BBs have Service Delivery Areas (SDAs) listed under each of them. Members of the AIDS and MCH communities would have noticed several areas that could be influenced by stronger community systems. It may range from direct provision of healthcare services delivered by communities to broader community activities indirectly influencing determinants of health. Based on such experiences in the field, we are soliciting your feedback on different sections of this document.

Your comments will be collated and fed into the consultation carried out by Alliance and ICASO. By feeding back on the draft framework through Solution Exchange, you will add synergy to this international consultation. Thus, your inputs will further improve this key document.

Thanking you in advance,

Nandini Kapoor Dhingra,
UNAIDS India Office,
New Delhi.
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Peter Burgess
Tr-Ac-Net Inc ... The Transparency and Accountability Network
Community Analytics (CA)
Integrated Malaria Management (IMM)
Microfinance Focus Magazine in New York
tel: 917 432 1191 or 212 772 6918 or 212 744 6469
skype: peterburgessnyc
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