Minutes of Meetings: # 10
Meeting Date: June 20, 2014
Meeting Venue: RA MOH National Institute of Health
Meeting Chair:: V. Poghosyan, Deputy Minister of Health
- Opening and introduction/approval of Meeting agenda
- Management of Conflict of Interest
- Election of CCM Vice-Chair
- Presentation and approval of the CCM Oversight Plan
- Oversight Body establishment
- Presentation of TB Concept Note development progress
- Discussion and approval of extending the mandate of the current Principal Recipient for new TB Grant Program
- Presentation on the results of assessment of social support program for TB patients
- Other issues
- Meeting wrap-up
Discussions and Resolutios
1. RA CCM ordinary meeting was opened by Deputy Minister of Health V. Poghosyan. He greeted participants and informed that regional representatives of Global Fund Valeria Grishechkina and Vira Zemlyanska are attending the meeting. He also informed that Valeria Grishechkina has recently been nominated as a portfolio manager for what he congratulated her and wished productive cooperation.
Afterwards V. Poghosyan introduced the meeting agenda, which was confirmed by all CCM members present.
V. Poghosyan asked participants to attend the meetings, because CCM has to make important decisions regarding Concept Note submission. He also instructed CCM secretariat to be aware about possible absences in advance: Also was mentioned that CCM is going to work simple and transparent and active participation will be appreciated. Afterwards floor was given to Valeria Grishechkina
V.Grishechkina greeted attendants, informed that this was her first visit to Armenia, mentioned that all CCM members, PR representatives and other stakeholders can always address her for any questions and that they are always ready to support CCM.
V.Poghosyan informed that according to bylaws hereafter all CCM members must fill in COI declaration forms provided and pass them to CCM secretariat.
2. V.Poghosyan informed attendants that election of CCM Vice chair in agenda is conditioned with the resignation of former vice chair and Armenian Red Cross representative Naira Matevosyan. Participants were proposed to offer candidacies.
Mamikon Hovsepyan offered Meri Khachikyan’s candidacy.
Varduhi Petrosyan offered Lusine Kocharyan’s candidacy.
Candidates introduced themselves and their organizations.
Was decided to make open vote:
- Meri Khachikyan: For -14, withhold - 3, voters - 22
- Lusine Kocharyan: For -5, withhold - 3, voters - 22
By voting results Meri Khachikyan was elected as a CCM vice chair and the meeting chair V.Poghosyan congratulated her for that.
3. Floor was given to the CCM secretary Vardan Grigoryan, who presented CCM Oversight Plan (attached to the minute) and answered the questions of attendants.
Anahit Harutyunyan asked a question on how PR and SR serve as “Oversight key institutions” while they may not be involved in OB membership.
V.Grigoryan answered that PR and SR-s are not OB members and their participation is limited by the provision of necessary information.
Anahit Harutyunyan requested a clarification about the difference of oversight from monitoring and evaluation.
V.Grigoryan explained that in difference from monitoring and evaluation the oversight is carried out through an interview, is not focused on detailed activities of program implementation and it is like a scan across grants to identify cross-cutting issues threatening successful grant performance.
Raffi Dudaklyan asked about OB membership consisting of 4 and not 5 members, which would be more convenient in view of majority at votes.
V.Grigoryan clarified that number of OB members is not principal and other suggestions can be discussed.
Gayane Ghukasyan asked why the terms of office for OB members is 3 years
H.Harutyunyan answered that international expert Katherine Owen recommended us to match CCM and OB membership durations with the standard grant program duration, which is usually 3 years.
Viktoria Avakova asked about the workload of OB members
V.Grigoryan answered that certain working hours are not defined and general impression about workload can be gained through orientation from annual work plan.
Anahit Papikyan asked if oversight plan is already prepared or it will be prepared by OB.
V.Grigoryan answered that oversight plan is already prepared and electronic version of it was posted to all CCM members.
Meri Khachikyan noticed that soon will take place the elections of CCM members and it can affect OB membership.
H.Harutyunyan clarified that CCM current membership is renewed until the end of 2014, so OB will be able to start working and if CCM members are changed then OB membership also may be changed. Also each OB member anytime can resign and OB membership will be replenished by new members.
Greta Khachatryan asked about remuneration of OB members.
V.Grigoryan answered that oversight budget covers expenses of all oversight activities but OB members are not remunerated.
Greta Khachatryan asked if PR and SR representatives for HIV program can become OB members for TB program.
V.Poghosyan answered that OB is one for all programs and generally PR and SR representatives cannot become OB members.
Viktoria Avakova suggested to define 5 members of OB membership in order to be more convenient to involve 40% non CCM members and to have majority’s opinion in OB internal decision makings.
Astghik Grigoryan offered to have 3 additional alternate (reserve) members for OB along with the main stuff.
Arsen Aslanyan asked about 2 oversight visits mentioned in annual work plan and noticed that their quantity is not matching with the quarterly 4 reports of PR.
H.Harutyunyan clarified that there are two more meetings planned with PR except site visits and also those reports can be analyzed even without visits.
V.Poghosyan suggested noting in oversight plan that visits are 2 at least and there can be more meetings as necessary.
Anahit Harutyunyan asked if last item of annual work plan implies trainings of OB members.
H.Harutyunyan answered that training is foreseen also.
V.Poghosyan instructed to correct the formulation of that item in Oversight plan and make it clearer.
V.Poghosyan offered to give 1-2 day time to CCM members to make suggestions and comments, substantiating it by the fact that some of the members have not managed to get thoroughly familiar with the oversight plan.
Offer was accepted by participants.
V.Poghosyan offered to approve oversight plan by vote and incorporate suggestions or remarks in final version of it. Final version of oversight plan also will be posted to CCM members.
CCM Oversight plan was approved by unanimous voting of all present CCM members.
4. V.Poghosyan asked to suggest candidacies for establishment of Oversight Body.
V.Grigoryan informed that OB member must have technical experience in the areas of programmatic, procurement & financial management of programs.
V.Grishechkina informed that it is not compulsory for each member to have all above mentioned qualifications, but the body as a whole should have the above expertise. Besides OB may periodically involve other specialists such as financiers for technical support.
Lusine Kocharyan offered CCM members World Health Organization representative Gayane Ghukasyan’s and Director of the American University of Armenia’s Centre for Health Services Research Varduhi Petrosyan’s candidacies for OB membership.
V.Poghosyan informed that OB members can be selected from CCM working group members also and asked H.Harutyunyan to present them.
H.Harutyunyan introduced TB, HIV and HSS working group members and organizations they represent. She also reminded that at least 60% of OB membership must consist of CCM members.
Viktoria Avakova asked if another representative of her organization can be included in OB membership.
H.Harutyunyan answered that it is possible but in 40% of non CCM members.
Meri Khachikyan asked if CCM vice chair may become an OB member.
V.Grigoryan answered that according to bylaws it is not restricted.
Mamikon Hovsepyan offered to provide 1-2 day time for this issue also, to think and to suggest candidacies through e-mails.
Anahit Papikyan expressed concern that in this case some may offer candidacies that lack of required qualifications.
V.Poghosyan persuaded to suggest such candidates that will indeed have desire, time and skills to work in OB.
Gayane Ghukasyan asked if 2 people from one organization can be involved.
V.Poghosyan answered that for the OB with only 4-5 members that will not be reasonable for COI aspect and it is preferable to have members representing different organizations.
Pavel Ghazaryan asked if budget of oversight plan is covering invitation of external technical support.
V,Grigoryan answered that not and V.Poghosyan clarified that in order to maintain high quality of oversight function in Armenia Global Fund may provide external technical assistance.
Astghik Grigoryan asked if it is possible to select organizations instead of members and each organization to be responsible for some sphere of Oversight.
V.Grishechkina clarified that it is desirable to have OB members that are strongly familiar with the programs being implemented. She also added that the goal of oversight visits is to get acquainted with and to understand the process of program implementation right in place and to discover issues threatening successful grant performance.
Lusine Kocharyan offered to withhold from including representatives of state departments, because they have legislative oversight authority and thus they already carry out appropriate oversight activities. She also asked for clarification of electronic voting mechanism.
V.Poghosyan suggested to vote for candidates already presented and to organize nomination and election of the others through e-mail.
Two CCM members due to other appointments left meeting hall.
All present members agreed by unanimous voting.
Nominated candidacies and voting results are reflected in the following table:
Viktoria Avakova said that she will clarify with her organization whether she or another representative will be included in OB membership.
Astghik Grigoryan said that she will clarify with her organization whether she will be involved in main or alternate staff of OB.
Araqs Hovhannisyan informed that her organization soon will discontinue its CCM membership, so she may be involved in the list of 40% non CCM members.
V.Poghosyan thanked participants for voting and asked to provide other candidacies through e-mail as soon as possible and to mention for which group they are nominating (main or alternate).
H.Harutyunyan asked attendants to be more sensible and solve this issue quickly, because all these procedures required to be done by 15th August 2014 before submission of Concept Note.
5. The floor was given to Hasmik Harutyunyan, who presented TB Concept Note development progress (attached to the minute).
Anahit Papikyan asked if the new program foresees palliative care for TB patients.
H.Harutyunyan answered that for current year it is planned to build a department for failures and for next year capacity building activities are planned.
Greta Khachatryan asked if experience of NGO’s involved in HIV program will be considered in models of care with patient centered approach.
H.Harutyunyan answered that mechanisms of civil society involvement are not yet developed; but its importance is obvious and surely existing potential will be considered.
V.Poghosyan offered to take information presented into consideration and start with next item in agenda.
6. Floor was given to the Tsaghik Vardanyan, who presented the proposal on Re-election of the Ministry of Health as Principal Recipient in the next GF Grant Project in Support of the National TB Program of Armenia (attached to the minute).
V.Poghosyan stated that the issue of re-election will be put to the vote but some members may have COI. He gave floor to the CCM secretariat.
V.Grigoryan stated that according to the COI declaration forms that CCM members submitted there are 4 members that cannot participate in voting:
- Vahan Poghosyan, Ministry of Health
- Tsaghik Vardanyan, Ministry of Health
- Gohar Panajyan, RA MOH State Health Agency
- Hasmik Harutyunyan, RA MOH GF Program Coordination Team
Varduhi Petrosyan reminded that international expert Katherine Owen recommended recusal practice for those members that are not voting by waiting from the outside of meeting hall during the vote.
V.Poghosyan put the issue to the vote and went out from the hall with three other above mentioned members and representatives of Ministry of Health (MOH).
There were 16 CCM members present in meeting hall and quorum was provided.
Varduhi Petrosyan remarked that she is voting FOR if MOH will continue to work the way it did in last two years.
CCM members voted for Re-electing the Ministry of Health as Principal Recipient in the Next GF Grant Project in Support of the National TB Program of Armenia. The decision was made unanimously.
Members outside got back to the hall and got informed about voting results.
7. V.Poghosyan gave floor to Armen Hayrapetyan who presented the results of assessment of social support program for TB patients (attached to the minute).
Anahit Papikyan asked if coupon mechanism of social support of TB patients is currently being used.
A.Hayrapetyan answered that in Armenia yet not and it is just a proposal for discussing and establishing a more flexible system of social support. He also informed that other countries employ this mechanism.
Anahit Papikyan noticed that if this mechanism is going to be employed only for TB patients, then other patients may feel discriminated. Besides it will be difficult to maintain confidentiality from servicing personnel.
A.Hayrapetyan answered that coupon system may be introduced for other patients also and appropriate conditions will be developed to ensure confidentiality.
Lusine Kocharyan noticed that 75% of patients involved in investigation of assessing the social support program for TB patients were men, which could affect the results of investigation because preferred forms of social support may be different for men and women. For instance women are usually accompanied by relative who helps in carrying social support parcels. That relative subsequently becomes a person who tracks treatment uninterruptedness by ensuring social support continuity. That may help when introducing the patient centered treatment approach.
A.Hayrapetyan assured that introduction of coupon mechanism will involve both cities and villages, besides system will be developed only after multiple discussions with engagement of all stakeholders.
V.Poghosyan warned that population is quite sensible now and before introducing any program, detailed investigation is mandatory with consideration of experience of other countries, otherwise additional problems will arise. Discussion with CCM members are also necessary to assure that the system is in the frames of national strategy and ensures accessibility, affordability and quality.
Greta Khachatryan asked if social support is provided to the all TB patients or socially vulnerable only. She also noticed that MSF organization has experience of providing social support by coupons in Armenia.
A.Hayrapetyan answered that social packages are provided to all TB patients: for drug-sensitive patients once a month, for drug-resistant patients twice a month, daily compensation of transportation expenses, besides fresh fruits for drug-resistant patients and fresh food in in-patient phase of treatment and consulting services are also provided. Regarding the MSF experience he remarked that their experience is limited with one marz in Armenia but in any case it will surely be considered.
V.Avakova asked about the percentage of the patients from cities and villages in the investigation presented.
A. Hayrapetyan answered that detailed data of investigation is reflected in report which was posted to the CCM members in advance.
V.Avakova asked if stigma effect on the TB patients was investigated.
A. Hayrapetyan answered that patients satisfaction of social support was investigated but stigma effects were not. He also mentioned that they are working hard to eliminate stigma effect and trying to increase awareness of population to perceive TB as a regular disease.
V.Poghosyan offered to take information presented into consideration.
8. H.Harutyunyan stated that there are two possible dates for HIV Concept Note submission: 15.01.2015 and 15.04.2015. She informed attendants that initially there was intention to submit in January, but because Christmas holidays may hinder so probably it will be submitted in April. Concerning the current program she said that it will probably be extended by three months needed. She said that timetable of activities will be provided in forthcoming CCM meeting.
9. Vahan Poghosyan thanked attendants for participation and activeness and reminded that submission of TB Concept Note is to be done on 15th August and before that time CCM 1 or 2 extra meetings will be arranged. For confirmation of grant package signings of CCM permanent (not alternate) members will be required. In that aspect he asked the presence of CCM members in upcoming meetings.
Raffi Dudaklyan suggested that CCM members planning vacation inform CCM secretariat in advance.
Anahit Papikyan informed that she will be absent from country 23.07-05.08.2014.
Astghik Berezovskaya asked to provide information about vacations through e-mail.
Hasmik Harutyunyan informed that the Concept Note final discussion & approval meeting of CCM is tentatively planned on 13th August.
Vahan Poghosyan stated that Minister of Health will also be present at that meeting and that he is reporting the Minister about each decision of CCM.
Documents: Download ZIP