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.
mailto:NabeelM@unaids.org

---------- 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
To: afro-nets@healthnet.org


cross-posted from: Solution Exchange AIDS Community with the Maternal and Child Health Community
http://www.solutionexchange-un.net.in/

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 (http://bit.ly/aids-se-facebook) and Twitter page (http://bit.ly/aids-se-twitter) 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,
Nabeel


PS: The Online Consultation available at http://bit.ly/CSS-Survey 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 http://bit.ly/CSS-Framework

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

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
http://www.aidsalliance.org/includes/document/CSS_framework.pdf (PDF, Size: 375 KB), and the summary at
http://www.aidsalliance.org/includes/document/wrifu-eng.pdf (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.
mailto:NabeelM@unaids.org
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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
website: www.tr-ac-net.org
tel: 917 432 1191 or 212 772 6918 or 212 744 6469
email: peterbnyc@gmail.com
skype: peterburgessnyc
Books: Search Peter Burgess at www.lulu.com

Using CA to plan ongoing relief and a continuum to rebuilding

Dear Colleagues

There is a huge amount of energy in the Haitian diaspora ... and there are 9 million Haitians that should be a central part of the relief and rebuilding process. But is this the plan that will emerge from the planning process of the Government of Haiti together with the UN, World Bank, bilateral donors, NGOs and all the other entities that operate in the relief and development industry?

If history is any indicator, probably not. But success and sustainable progress requires that the people of Haiti are engaged in the process, and while there are legitimate needs for the government to mobilize resources to repair and rebuild a lot of infrastructure, it needs to be done in ways that serve to build the local economy.

A process of rebuilding that engages the population of Haiti at the community level all over the country could be transformative ... and should be transformative. Accordingly the CA methodology is being used to develop a supplement to the official plan so that there is a framework to guide development resources to the community level so that there may be progress at this level. Furthermore, the CA methodology calls for the plan to be based on critical data about the state of the community, and for the progress of the community to be measured as times goes by. The CA metrics are, of course, not only about money, they are also about all the various aspects of community value.

The CA supplementary plan takes every community in Haiti and asks the simple questions: (1) What is? (2) What can it be in the future? (3) What is missing? (4) How to overcome the obstacles?

This supplementary plan will be dynamic and change as more information becomes available. The framework of the plan merely guides resources to assist in areas where there is a need.

Data acquisition is from many sources ... data already in some electronic form ... data sent in by email to peterbnyc@gmail.com with "Haiti CA Plan" in the subject line ... and stay tuned for a text message input process along the lines of the Ushahidi method.

The immediate goal is to have the Haiti Supplementary Plan available for use prior to the March 31st launching at the UN of the official GoH plan so that donors and others may be able to consider its merits in the context of the official plan.

Further information about this initiative will be posted as the work progresses.

Peter Burgess
Community Analytics (CA)

The problem of education ... US society cannot afford it!

Dear Colleagues

I was pointed to this article about student protests in California
http://sdsublog.wordpress.com/2010/03/05/a-students-perspective-of-the-day-of-action The issues they are facing are serious ... but the problem has been a very long time in the making. I wrote the following comment:

Dear Colleagues

While I agree with the students that the situation stinks ... why did the situation get this way?

For all my adult life (50 years or so) the decision makers have done "easy" things and "profitable" things but rarely the difficult. The underlying "value" dimension of decisions has not been in the conversation. It is a disgrace ... and the academic and intellectual community must take some considerable part of the blame.

Accountancy is a failed profession. The world's numbers are not making much sense because so much of the reporting is now governed by rules that report what the law makers wanted and not what is reality. The great corporate and banking failures is a failure that starts with greed, but ends up with a failed professional community and a failed intellectual community.

The idea that a State the size of California is working on a cash based accounting system is ridiculous ... not to mention all the government on the planet except one or two ... and major public entities like transport systems. This is another example of professional and intellectual failure. Without a balance sheet it is difficult to relate the operating numbers to the underlying assets that are being (or should be) maintained!

And the foolishness of the GDP growth metric ... what has the cost of health care got to do with "product"? Product is good health ... but that is never valued in a quantitative way though I would argue that good health is pretty valuable.

Until we get metrics right ... we will get decisions wrong.

My generation of leaders first consumed all the value of prior generations ... and then they started to consume the future that ought to be the legacy of any generation, not a liability. Shame on the decision makes of the present and the past 40 years.

Lets get a serious conversation going ... and then get some serious upgrading of the process that determines what the future is going to be like!

Peter Burgess
Community Analytics (CA)
http://communityanalyticsca.blogspot.com

Until there is a widespread recognition that profit reporting without value reporting ... that is impact on society ... there will be bad decisions for society, we will continue to head down a road to economic disaster. We have gone a long way down this road, but it is not too late.

One critical thing that people have got to take into consideration is that most systems do not work with straight line relationships ... everything is exponential. When things get really out of control, it is very difficult to sort them out. The bail out at the end of 2008 early 2009 was big ... but maybe not yet the "big one".

Let's make some progress to change the metrics

Peter Burgess
Community Analytics (CA)

Accountability after the Haiti earthquake

Dear Colleagues

The issue of accountability in the aftermath of the Haiti earthquake is going the way of accountability after all the other major disasters where ordinary people have parted with their money and nobody is able to inform them later on what happened with all the money.

I have tried to contact almost one hundred (100) major NGOs that have raised money for Haiti with a request that they give some accountability for the resources mobilized for work in Haiti ... with hardly any response beyond simply getting additional requests for donations.

Some weeks after sending my emails the news media is starting to ask the same questions ... and soon there will be the all too predictable embarrassment. This is an unacceptable state of affairs.

Today Relief Web posted one of these articles:
http://www.reliefweb.int/rw/rwb.nsf/db900SID/MYAI-8382KY?OpenDocument

I have sent the following comment to Relief Web. I am not holding my breath that they will be responsive, but I am trying:

I read a lot of the material posted via the Relief Web and think it is a wonderful resource ... but the issue of accountability is NOT being adequately addressed by those with authority and responsibility. Based on my expertise in this area, the Haiti program is grading at F and for no good reason.
Peter Burgess
Community Analytics (CA)

The Community Analytics (CA) methodology is an ideal approach to the accountability issue. The public is not interested in the paperwork to prove that every dime is used correctly, but they are intensely interested in whether or not the big fund flows are used to produce big results, and that the relationship between the two is reasonably good ... or even very good.

CA recognizes that mistakes are made ... but there is no need for CA to address this incident by incident, but if, in the aggregate the organization is all mistake and no success, then there is a cause for concern. The key word in all of this is "materiality".

CA does not take the view that relief and development do not need accounting, cost accounting and performance analysis because "it is not a profit making business". CA argues that it is all the more important to have performance analysis because the funds are usually other people's money and it is irresponsible not to use the resources in the best possible manner, and be able to show this. Donors certainly are asking for it ... but they are not getting particularly clear answers.

This is a big problem ... and it has to be solved.

Stay tuned

Peter Burgess

Microfinance ... investing amid the downturn?

Dear Colleagues

I just received this ... it is a good example of money metrics taking over from the essential value constructs that are critical for a successful society. The report referred to is at http://www.cgap.org/gm/document-1.9.42531/OP16.pdf

Dear Colleague,

CGAP and JP Morgan recently published a joint paper titled "All Eyes on Asset Quality: Microfinance Global Valuation Survey 2010," of which I am one of the authors. It looks at the growth of private equity investments in MFIs amid one of the most turbulent periods for microfinance in at least a decade.

The findings are surprising -- both the pace and depth of the near-simultaneous decline in portfolio performance of MFIs around the world and consequent impact on their profitability have no precedent on a global level. Yet the equity market appears to have continued along the same growth trend as before, with no sign of having been in any way affected by any of this. The paper also devotes a short section to a particularly active microfinance equity market in India, suggesting that many of the transactions there show significant overvaluation, despite the fact that Indian MFIs have largely continue to show excellent portfolio performance. Finally, it looks at a sample of publicly-traded low-income finance institutions (LIFIs) operating in developing countries, which appear to have weathered the economic downturn significantly better than MFIs.

I believe you'll find this an interesting read.

Best,

My response was fairly blunt ... although I know the writer fairly well:

How you, CGAP, JP Morgan et al can write about microfinance performance for some 40 pages of text and a whole lot of graphs, and in so doing totally ignore the social impact of microfinance is mind-boggling ... and deeply disturbing.

It was certainly an interesting read, but symptomatic of the dysfunctional financial focus of the capital markets on money metrics that cause real economy disaster over and over again.

I am not sure how I want to "handle" this report and what it has to say ... or more important what it fails to say. What I do know is that the prevailing metrics and the analysis done around them is a formula for a continuum of catastrophe!

Peter
Community Analytics (CA)

I really do not know the best way to "raise hell" ... but I do know that bankers are about as dangerous a human sub-specie as any part of the human race. When I was involved with corporate management, making sure the bankers would not make us do "stupid" things was a full-time job ... and as my work moved to international socio-economic development the obscenely bad allocation of resources has me angry and very determined that things have to change.

Community Analytics (CA) is a powerful way of starting to get the analysis better and then the decisions. Bankers who make valueless but profitable decisions need to be held to account ... and punished!

Peter Burgess

About Ethics

I grew up thinking that ethics were central to the way the world worked. It has taken me a long time to realize that this is not very much the way it is at all. I am a slow learner … but I am still an optimist that it will be an ethical society that emerges in the end.

Clearly there are very powerful forces that try to make ethics go away … but in my view they are no match for the good that is latent in most human beings. Over the years I have done work assignments in more than fifty countries. In every country my local colleagues have been delightful people … good people … ethical people. I have had to deal with people who I would not describe in this way, but they are few in number, get to have too much press and attention and quite often run things!

I was shocked years ago when I was living in Canada in British Columbia when the Provincial Government banned the teaching of religion in the school system. I had difficulty with the idea that right and wrong could be effectively taught without a religious foundation for these ideas. Religion was a very convenient way of putting right and wrong into context for children … and indeed adults. Ethics without religion was not an adequate substitute … but it was absent anyway!

Not much later, I was associated with some of the faculty at the Harvard Business School … and while I admired the case system for teaching business and was a disciple of management information for decision making in the corporate world, I was shocked and appalled at the absence of any ethical limits on what the decisions might be. If the numbers worked, then that was good enough. Ethics was absent from the HBS teaching in the 1960s as far as I could tell.

As I progressed through different management responsibilities I was shocked over and over again at the way ethics was pushed aside in the interest of corporate performance or for personal gain. While my job was to facilitate corporate performance, my underlying assumption was that the staff would behave in essentially ethical ways while striving for good results. How wrong this proved to be. The reality turned out to be that people would do whatever it took no matter how unethical it was if it produced results and they thought they could get away with it ... so much more profitable to dump toxins into a river than to process them safely!

Eventually I worked on the assumption that everyone was a crook and had little or no ethical compass. When I designed accounting systems using this idea, they were very strong accounting systems and the management information was very reliable. The good news that most people including crooks are quite lazy so they could not be bothered to “break” our accounting systems, and everything went along very smoothly. But … how awful that I had to assume the worst in order to make something work.

If I fast forward to my present interest in global development in all its aspects … and specifically the microfinance sector, ethics is a critical matter. If you merge the idea that most people are good people, and the idea that most people will do what they can get away with, and the idea that meaningful metrics matter, then there can be a good outcome for society … but it does take measurement and it does required transparency and accountability.

Peter Burgess

The cost and impact of global malaria initiatives

Dear Colleagues

I was unable to attend the recent Malaria Roundtable hosted by the Global Health Council in Washington DC. I was wanting to attend because the key questions of the Community Analytics (CA) initiative are not getting answered. The purpose of the gathering is set out below

Monday, March 1
RSVP: ksutton@globalhealth.org
The Malaria Roundtable is a community space where individuals and organizations dedicated to policies and programs that reduce the global burden of malaria can meet, exchange information and share resources. Convened by the Global Health Council, the Malaria Roundtable is a working section of the broader Infectious Disease Network which brings together groups working on malaria, tuberculosis (TB), the neglected tropical diseases and other infectious disease issues including avian influenza.

The amount of money that has now been disbursed through a variety of programs, including the US funded President's Malaria Initiative (PMI), the Global Fund for AIDS, Tuberculosis and Malaria (GFATM), the Gates Foundation and others is substantial ... maybe in excess of $2 billion a year ... and yet the amount of accessible data about progress and performance is minimal.

What seems to be going on is that well connected organizations are in control of the process ... with all the dataflows well controlled within this control group. Public access to any of the data is virtually impossible. Were this an audit, this would constitute a good reason for further inquiry. Bottom line, the public is funding a lot of expenditure ... and so far the public only is being given public relations press releases that praise the activities but studiously avoid any verifiable data about costs and impact.

The problem is that this is not just about money ... it is also about lives. If the resources are not used well, people die ... and in fact very large numbers of people die. How many is difficult to estimate ... but think in terms of several Boeing 747s crashing every day gives an idea of what is at stake! Yet nobody seems to know anything very much about much things cost, and what impact the different interventions are having. Scandalous ... this is 2010, not 1910.

Peter Burgess