MINUTES OF CCM MEMBERS MEETING

9TH JULY 2013

The meeting started with recitation of Holy Quran, which was followed by a brief round of introduction. Mr. ImranZali, Vice Chair CCM/Acting Chair CCM, welcomed the participants and informed them about the most important agenda item – election of Chair CCM.

Agenda Item 1

Election of Chair CCM

CCM Coordinator gave reference of different clauses of CCM By-Laws for conducting the election for the position of Chair CCM. Chair and Vice Chair have to be from two different sectors and currently the Vice Chair is from non-government sector. Moreover, only CCM Member can propose a name and it has to be seconded by another member. Method of voting is by open ballot with the option of secret ballot. Vice Chair/Acting Chair CCM told the house that he had already proposed the name of Mr. ImtiazInayatElahi, Federal Secretary, Ministry of National Health Services, Regulations and Coordination (NHS,R&C) which was seconded by another CCM Member Dr. Shahzad of Health Services Academy. The name was circulated electronically and the government sector was invited to propose any other name (s). No names were received either before or on the day of election.

Vice Chair then requested the members to vote by “show of hands”. All the members unanimously elected Mr. ImtiazInayatElahi, Federal Secretary, NHS,R&C, as Chair CCM. The newly elected Chair CCM then thanked the house for reposing confidence in him and electing him as Chair CCM. He assured the participants of his full support, wherever and whenever it is needed. He said that the most fascinating aspect of this forum is the participation of civil society especially CSOs. He is aware of the working of the GF and CCM as he remained Additional Secretary Health in Federal Ministry of Health. He said that bureaucracy takes decisions while sitting in the office and seldom takes civil society along. Infact it is the civil society which ensures the success of a project. In this regard he gave an example of his early service days. He also highlighted the importance of Transparency and said that it should be ensured at every step and during every activity. He also highlighted the importance of Conflict of Interest and reminded the members to ensure that no such issue exists. He congratulated the newly elected CSOs, especially from Sindh and Balochistan, both the provinces are being represented for the first time in CCM and welcomed them in CCM.

Agenda Item 2

Endorsement of newly elected CSOs

CCM Coordinator briefed the house about the process of CCM elections, the dates on which the elections were held in each provincial headquarter and the names of elected CSOs.

CCM Coordinator shared with the house a suggestion from PTP Punjab – “To have one TB CSO from Punjab”. CCM Coordinator informed the house that it was decided in the CCM Members Meeting that only ONE CSO will be elected from each province and it will represent the province in the CCM. The elected CSO will have to come out of disease specific approach and be a representative of all the three diseases. This aspect was conveyed to all the CSOs before and after the elections. It is also pertinent to mention that a balance has to be maintained between different sectors – government, non- government and multi/bilateral agencies. Dr.Saleem pointed out that if we allow Punjab to have one TB CSO then this decision is to be for all the provinces and we will end up with may be 15-20 CSOs resulting in imbalance at this forum.He also said that the organizations elected such as Bridge Consultants from Sindh, although working in HIV, but basically its working in TB. Similarly Legends from Balochistan is not HIV specific CSO. Dr. Ayesha DFID supported Dr.Saleem’s viewpoint. Dr.IqbalKhalil, HDRS said that the elected CSI should collaborate with all the CSOs in the province working in all the three diseases and represent all of them in CCM.Marc Saba, UNAIDS said that we should promote partnerships and see how different actors perform. We should also concentrate on establishing a method of dialogue between different stakeholders and have better communication channels in order to achieve our goals. CCM Coordinator informed the house that despite best efforts, the Secretariat was unable to obtain the names of CSOs working in Gilgit-Baltistan, from the Health Department. However, the efforts are still on and as soon as names are received the schedule for the elections will be communicated. Dr.Altaf Tariq appreciated the efforts of CCM Secretariat and UNAIDS for conducting elections in transparent manner.

Decision: CCM endorsed the newly elected CSOs.

Agenda Item 3

Endorsement of Multi/Bilateral agencies

UNAIDS was assigned the responsibility of sharing the names of multilateral agencies for a period of next two years and DFID to share the names of bilateral agencies. Marc Saba, UNAIDS informed the house that he has proposed to continue with WHO and UNAIDS and would give final names in the next meeting. Dr. Ayesha, DFID said that she circulated to all the bilateral agencies. GIZ showed interest which was conveyed to CCM Secretariat. Invitation was extended to GIZ, which was accepted by GIZ. Dr.Steinmann, is attending the meeting representing GIZ.He thanked CCM Secretariat for extending the invitation. CCM Coordinator welcomed GIZ in CCM. Dr. Steinmann said that basically it’s the representation of the German government.

Decision: CCM endorsed the selection of Multi/Bi-lateral agencies as CCM Members.

Agenda Item 4

Declaration of Conflict of Interest

CCM Coordinator appraised the members about Conflict of Interest. He informed the house about actual, potential and perceived conflict of interest. He told that all the members are supposed to make the declaration at the beginning of every year ant then periodically and also before commencement of every CCM Members meeting. He also requested the members to make declaration of conflict of interest or otherwise by signing declaration of conflict of interest form which is being circulated.

At this point, Chair had to leave for some important meeting in the Federal Secretariat. He excused from the house and asked the Vice Chair to continue with the proceedings.

Agenda Item 5

Update on Oversight Committee Visit – TB Component

MrImranZali, Vice Chair CCM updated the house on the oversight committee visit. He was accompanied by Dr G.N. Kazi of WHO and facilitated by CCM Coordinator. He informed the house that they were given comprehensive briefing by the provincial TB program. The committee visited four public private partnership sites – two labs and two clinics, all the four private providers are of Greenstar. According to the Vice Chair, the clinics and labs were overcrowded but showed satisfaction over the knowledge of the staff including medical officers and lab technicians. He also showed satisfaction over the referral system, the follow up of patients and the medicines record maintenance. The Vice Chair proposed that the compensation paid for testing is too less and should be increased. Dr Ayesha, DFID said that though it is correct that the compensation is less but we should keep the resource implication in mind as it will be for all the labs and applicable across the country. Moreover, we have to think beyond the GF grant period, once it is over, will the government be able to continue/sustain it? It should be given a long term thought. She also said that the program should make efforts to include the cost of this in their budgets.Dr. HussainHadi, Senior Program Manager Mercy Corps , which is the PR for the PPM part of the grant explained the measures taken by PR to address this demand for incentives from the private labs, despite of the limited funds available. He also informed that there is an increasing demand of incentives from the private practitioners also, but the approved resources do not allow monetary incentives for the GPs. Dr. EjazQadeer, NPM, NTP said that efforts will be made to include the cost in the budget of the program. NTP shall prepare the cost implication of incentives for private GPs and private labs and share with CCM members.

CCM showed satisfaction on the update given by the Vice Chair CCM/Member Oversight Committee.

Decision: CCM endorsed the point to work out the financial implications and integrating/costing the expenditure in the program’s budget.

Agenda Item 6

Update on Oversight Committee meeting

Marc Saba, UNAIDS, Chair Oversight committee updated the house on the oversight committee’s meeting.

  1. OC in principal agreed to the activities in the proposal for Phase II of Round 10 of Regional HIV Grant. However, it was highlighted that the budgetary component was missing. National Coordinator of APLHIV was asked to obtain it from the PR (APN+) and attach it with the proposal or give an estimated budget based on the assumption of Phase I budgetary allocations for Pakistan, as its share of Regional Grant. Due to severe time constraint, Endorsement/Approval of CCM Members will be obtained electronically.
  2. OC observed very low utilization of budget for TA by DoMC. On clarification of DoMC , OC recommended that WHO may be requested to issue the disbursement request on priority.
  3. DoMC has requested reprogramming of Indoor Residual Spray (IRS) – from P-5 (Oct-Dec2012) to P-13 (Oct-Dec 2014). OC recommended that a request should be forwarded to CCM Secretariat, which will be circulated to CCM Members electronically for endorsement.
  4. OC recommended that Save the Children should do reprogramming to utilize the unspent funds of Phase I in Phase II.
  5. OC recommended that NACP has to review its systems/baselines before making ARV forecasting and should use one source – either estimates or data.
  6. OC recommended that CRS to continue as SR in Balochistan, till the time BACP assumes the role of SR. However, fresh EOIs should be published for selection of SSRs.
  7. OC recommended that the presentations made by the PRs should include

Current Update - (last completed quarter)

Cumulative Update – (from P-1 to the last completed quarter)

  1. A concise report on security issues in various areas of the country and how it is affecting the achievement of targets/implementation of activities. Any innovative/specific measures taken.
  2. OC recommended that the PRs should be allocated a disease specific “Time Block” in which PRs (both public and private sector) for each disease will make presentations. Each disease component will be invited at a separate/specific time. This time efficient approach will benefit all the PRs.

Mr. Alamgeer , Save the Children, informed that since they have got extension of Phase I and they will be utilizing the unspent funds in Phase I.

Agenda Item 7

Update on decisions of last CCM Members meeting

  1. Declaration of Conflict
  2. Chair Oversight Committee - UNAIDS
  3. CCM Membership - Reviewed
  4. CSOs Elections – Completed in all the four provinces (GB – Pending)
  5. Gender – HRCP invited, invitation accepted by HRCP
  6. Elections of Multi/Bilateral Agencies – Completed
  7. Tax Exemption – Respective programs to ensure
  8. Claims of Ex ES – Case finalized and sent to NACP PR Unit for payment
  9. Reference Labs – WHO and NTP to identify the labs requiring TA
  10. SR – PLYC Issue – Decision reviewed. PLYC to continue for Phase I. PRs to reassess the SR before start of Phase II and decide whether to continue or otherwise
  11. CCM Budget, Oversight Plan and Workplan – Reviewed and shared with GF and approved by GF.

Dr. Kazi, WHO,while commenting on agenda item, pertaining to review of decision about SR-PLYC, said that, since the decision was taken by CCM, the review should have been brought before the CCM. Dr. Saleemsupported what Dr. Kazi said and added that the decision to review could have been withheld till the next CCM Members meeting. He also said that it should not be sole discretion of one person as the chair is an equivalent member and has one vote as the other members.Although the information was shared electronically with all the members, but still, it would have been better had the secretariat waited for CCM meeting. CCM Coordinator assured compliance in future.

Decision: Reviewing any previous decision to be brought before CCM meeting as an agenda item and discussed, before initiating the proceedings.

Agenda Item 8

Endorsement of minutes of CCM Oversight Committee meeting

CCM endorsed the minutes

Agenda Item 9

Endorsement of minutes of last CCM Members meeting

CCM endorsed the minutes

Agenda Item 10

Approval of Travel Policy

New Travel Policy was circulated beforehand so that the members could go through it and they were requested to give inputs during themeeting. MrImranZali, Vice Chair CCM had recommended that the new policy is too complicated and difficult to follow. He suggested continuing with the old policy but with revision of DSA and Petrol prices. Dr.Ayesha, highlighted the fact that the slide shown is against the ethics, equity and is discriminatory. Why a driver gets Rs. 2100 as DSA whereas a CEO of CSO gets 6000. She was told that this is the policy in practice and basically it is the UN policy which is being followed. She insisted that this discrimination should be addressed. Dr.Saleem said that basically CCM Secretariat pays only for one person representing the CSO and anyone else accompanying is not paid anything. It was decided that since the other columns are not relevant so they should be removed and in this manner the problem of discrimination will also be addressed.

Regarding the issue of increase in DSA and petrol price reimbursement in case a member uses his/her own vehicle, Dr Ayesha said that instead of increasing the amount without any homework, is not justified, and there should be some logic behind this. CCM Coordinator told her that he checked the rates of various hotels which provide a reasonably comfortable and secure accommodation, they charge about Rs.7500-8500 per night and if we include meals in that the total amount will come to about Rs 9000/-. She was satisfied with the justification.

DrTahira of HRCP raised the point that the participants coming from Balochistan face a unique problem because of flight schedule since there are no daily flights to Quetta. She proposed that the members coming fromBalochistan be given special consideration of staying for two nights in Islamabad.

Decision: CCM Secretariat to continue with old policy, which is basically the UN Policy, with special permission for Balochistan members and addressing the issue highlighted by Dr. Ayesha. Following rates have been approved by CCM for future travel:

Rs. 9000/- per day will be paid as DSA.

In case a member travels by his/her own vehicle, he/she will be paid at a rate of Rs. 15 per kilometer.

Members coming from Balochistan are permitted to claim two nights’ stay in Islamabad, subject to availability of flight. CCM Secretariat will pay TWO DSAs to members coming from Balochistan.

Special Agenda Items

NACP – Performance/HR Issues

Vice Chair CCM highlighted the issue of NACP – PR Unit as he was advised By DR Werner, FPM. He said that the PR unit is in shambles and he considers it imperative to brief the house about the precarious condition, where we might lose the grant. He further added that the GF is watching and if we let the situation continue, GF may change the PR and hand over the implementation of grant to UNDP. There Is severe infighting between the members of PR team which is adversely affecting the implementation of the grant. This will be an embarrassment for the country at international level. Dr.Saleem said that a couple of months back it was decided to give a last chance to NACP, but no improvement has been seen. Phase II is almost like a new grant. Now, restructuring and reprofiling of PR Unit is being done. Positions have been reduced. We need to reform PR Unit in order to save the grant. Dr.Kazi said that it would have been better had the PR unit given a chance to make presentation highlighting the core problems, issues and the bottlenecks. Prof.Dr.Rumina of Aga Khan University supported the idea. Dr. IqbalKhalil of HDRS said that NACP should be supported as it is going down the drain. On this Dr.SulemanOtho, SPO for R-9, said that the unit has been able to get the endorsement of the phase II of the grant. Commenting on the issues pertaining to the PR Unit, he said that it is the mindset that is playing the role. There should be clear cut demarcation of roles and responsibilities. The team is not cooperating. Dr.AmerRaza from LFA asked about the restructuring plan which NACP was supposed to submit. He asked about what exactly is the deadline of submission of the plan. Dr. Saleem said that the GF is not satisfied and has asked NACP to do the restructuring. Vice Chair CCM said that the CCM will support the NPM NACP’s decisions in carrying out the required reforms in the PR Unit.

Decision: CCM endorsed the restructuring/reforming of the PR Unit in order to save the grant.