Minutes of Meetings: # 9
Meeting Date: April 25, 2014
Meeting Venue: RA MOH National Institute of Health
Meeting Chair:: A. Babloyan, Deputy Minister of Health
- CCM assessment introduction by consultants and presentation of main results / External consultants Katherine Owen, Martha Ayvazyan
- Presentation of CCM self-assessment results / CCM members Mery Khachikyan, Anahit Papikyan
- Presentation of corrective action plan (for the time period until 15.08.2014) to meet GF requirements / Vardan Grigoryan, CCM secretary
- CCM decision making: including extension of present membership, establishment of a working group to develop Oversight Plan and the TOR of oversight Body, approval of self-assessment results and corrective action plan
- Presentation of TB CN development time table according to the GF 1st and 2nd requirements / Hasmik Hartyunyan
- Discussion, approval of main action plan
- Other Issues: Increasing the incentive payment of the pharmacist in National Center of AIDS Prevention/ Hasmik Harutyunyan
Discussions and Resolutios
RA CCM ordinary meeting was opened by Deputy Minister of Health A. Babloyan. He introduced the meeting agenda and the issues to be discussed and gave the floor to the external consultants realizing CCM assessment.
1. Katherine Owen introduced herself and Marta Ayvazyan, then acknowledged all participants and CCM secretary for support. She mentioned that French government always provides investments to the GF and is currently quite interested in supporting Armenian CCM. 5% of investments is exclusively provided to the technical assistance.
Katherine Owen presented the key findings of the CCM assessment process which are described in details in the presentation. She also presented the completed activities, including the workshop, interviews and development of corrective action plan.
Afterwards the floor was given to the GF colleagues following the meeting through Skype connection. Portfolio manager George Sakvarelidze introduced their group of 6 members.
2. CCM member Meri Khachikyan presented CCM self-assessment results with regard to the eligibility requirements that were developed at the CCM workshop held on April 23 (attached). CCM member Anahit Papikyan presented CCM self-assessment results regarding GF minimum standards (attached). A. Babloyan noticed that from the information given we can conclude that currently Armenian CCM has a serious work to do to meet all eligibility requirements and minimum standards, especially in the fields of oversight function and organization of reelections of CCM membership.
R. Doudaklian asked about the requirement of balanced presentation of males and females in CCM and was interested if that requirement refers the CCM as a whole or to each constituency.
A. Papikyan answered that this requirement refers to entire CCM membership and the current CCM structure meets that requirement.
M. Hovsepyan mentioned that at the time of CCM election that criteria was not taken into account and our balanced presentation is accidental. So he asked if it is satisfactory to meet requirement.
Marta Ayvazyan clarified that the current CCM structure is assessed, which is satisfactory, but in next elections this requirement should be considered.
3. A. Babloyan introduced the new secretary Vardan Grigoryan, asked to organize the presence of interpreter if necessary and technical support to make online connections with our colleagues in GF for the further meetings. He also mentioned that the mandate of some CCM members has expired and thus new elections are necessary to organize. But taking into account that our country is currently in the process of developing new Concept Notes, and after consulting with GF portfolio manager, it is suggested to extend the expired mandate of the members for the period of 6-12 months. Reelections will be organized soon after the development of Concept Notes. A. Babloyan suggested to discuss that issue and to make decision about it after the presentation of CCM secretary.
Vardan Grigoryan presented the CCM corrective action plan and its time-table (attached), which aims to ensure the compliance of Armenian CCM to the GF eligibility requirements and Minimal Standards.
Meeting participant (not CCM member) Hovhannes Madoyan asked if review of COI management is necessarily to be done before CN application in August, as current CCM staff does not meet COI requirement according to which CCM member with COI should not exceed one person per constituency. V. Grigoryan answered that according to the corrective action plan presented we are going to meet that standard by October - November this year, but we believe it is the final deadline and the review of COI management will be finished before it.
4. A. Babloyan suggested making decision to extend the current CCM mandate for 6 months till the end of October 2014. That will make 10 months from 1st January 2014. He also mentioned that this issue does not have COI; it concerns all members equally so everyone is eligible to express his/her opinion.
Gayane Ghukasyan asked if the fact that current staff is not meeting COI requirement won’t interfere in submission of CN.
Marta Ayvazyan clarified that Minimum Standards are different from Eligibility Requirements and will become mandatory since January 2015, so it is not affecting the applications provided before that time.
A. Babloyan added that in any case actions to meet that standard will be performed this year. He also suggested voting for extending the mandate of the current CCM for 6 months. He detailed that this 6-months extension will start from the day of decision making, thus taking into account that the mandate of some CCM members had expired earlier, therefore the total period of extension will compose 10 months.
M. Hovsepyan asked if it will be possible to submit a CN for HIV during that time.
A. Babloyan answered that the deadline of CN for HIV grant is next year and by that time CCM will have renewed staff.
H. Harutyunyan confirmed that CN submission is planned for 15th January 2015.
CCM members voted for extending the mandate of the current CCM for 6 months until November, 2014. The decision was made unanimously.
George Sakvarelidze asked if it would be more expedient to extend the CCM mandate for one year and not 6 months.
A. Babloyan clarified that time given will be enough to renew the CCM membership and to apply for further grants with the new structure. Besides 10 months of CCM mandate extension a serious delay in timings and if the current membership is extended for 1 year the new CCM members will not participate in development of any CN.
George Sakvarelidze mentioned two circumstances to be considered:
1. CCM current membership has to carry out all the activities described in corrective action plan.
2. CCM current members will pass on their authorities to the new ones in October and at the same time they will have to maintain continuity of CN developing process, because they will perform CN discussion and planning activities.
A. Babloyan appreciated provided comments and suggestions and noticed that all CCM members may discuss given suggestions, because they are the ones to will make the final decision.
R. Dudaklyan mentioned that MS are becoming mandatory from 1st January 2015 and extension of memberships by 1 year will also violate this timing.
H. Madoyan mentioned that in this case TB grant Concept Note will be developed by the current CCM and the CN for HIV grant will be developed new CCM members thus the extensive experience of current membership will not be considered for HIV CN. So he offered two variants to deal with:
a. Extend renewal by 1 year so by the time of HIV CN submission the current CCM will not meet the GF Minimal Standard for only 15 days and it may be possible to apply for one more extension of memberships for those 15 days
b. To submit HIV CN before January 2015.
A. Babloyan said that the process of restructuring the CCM should be started as soon as possible, with a clear plan of changes required and to meet all ER and MS at set deadlines. Besides even with the extension of memberships it is necessary to clearly show that current CCM is initiating steps to improve its structure. He assured that even if they make new decision to extend memberships by 1 year, anyway there is necessity to meet other ER, which in their turn is assuming a review of CCM staff to meet certain requirements with COI management.
George Sakvarelidze also mentioned that CCM eligibility will be assessed not only at time of proposal application but also afterwards at TRP and GAC and will be finalized by grant agreement signing, which can take up to 3 months.
Mery Khachikyan asked how often CCM self-assessment will be performed and external consultants answered that once a year is a must.
A. Babloyan offered to clearly define the constituencies of each CCM member to be elected by.
H. Madoyan expressed his solicitude about possible exception of some organizations presented in current CCM in case of reelections. He emphasized that NGOs working in the sphere of HIV are not many in Armenia and their possible absence in the structure of renewed CCM will result in development and approval of the new CN by the members who are lacking the experience.
A. Babloyan said that decision made is arising from assessment mission results and from necessities of corrective actions but CCM reelection does not essentially imply significant changes and in any case CCM staff is not going to have radical changes.
A. Harutyunyan noticed that previous elections of local NGOs were quite time consuming and expressed an opinion that the suggestion of George Sakvarelidze to extend memberships by 1 year is expedient in current condition.
Astghik Grigoryan also expressed her solicitude in combining the processes of CN development and CCM staff renewal.
A. Babloyan answered to the expressed considerations and reminded that issue was discussed and decision is made already, besides it is the responsibility of each organization to maintain timings of CCM membership of their representatives. About the extensive period of elections he noticed that it depends on the efficiency of organization and designed procedures. He also stated that there are already designed procedures for elections of local NGO’s developed by a group consisting of several NGO’s
A. Babloyan mentioned the need of having a 2-3 member working group before next meeting to work on establishing an oversight committee by designing a structure, terms of reference and to present them at next meeting. He offered CCM members to present candidacies to be included in working group.
H. Harutyunyan clarified that the group designing the oversight body structure has to consider certain criteria, i.e. experience of financial management, procurement, disease field as well as program management abilities.
A. Babloyan added that the group may also include non-CCM members, but at least one of them must be a member.
George Sakvarelidze promised to share with Armenian CCM existing TOR-s to support working group and Armenian oversight body TOR development. Besides he offered to create oversight body (OB) based on current technical working group structures (TB, HIV, HSS), but OB staff should not have PR and SR representatives and members should unequivocally have the above mentioned experience and skills.
Concerning the OB developing working group formation there was decision made to receive candidacies through e-mails.
CCM members made some changes in Armenian translation of the term “corrective action plan”.
CCM corrective action plan was approved by unanimous voting of all present CCM members.
Samvel Grigoryan said that there is a need of clarifying HIV proposal deadlines to define further steps and to effectively organize its submission.
A. Babloyan informed that those deadlines will be presented at next meeting and will be defined through appropriate discussions, considering also the need of technical assistance in CN development. Besides, clear demonstration of investment amounts and directions of the government in the programs is necessary.
5. H. Harutyunyan presented the deadline for TB proposal application: 15 August 2014. She said that up to now preparatory work was done including review of TB national program incorporating the recommendations of WHO, which will be provided to stakeholders. Besides, application for technical assistance in the development of CN was submitted to the GIZ organization and Armenia will get support of external consultant.
In frames of GF NFM, CN development requires active engagement of all stakeholders, KAPs and PLWD in the process. The next important requirement is a participation of the state at least by 40% in the TB national program. Beside that 40%, in order to get all amount intended for Armenia, the Government has to make additional investment in TB national program. Otherwise 15% of the sum will not be provided. For some countries, including Armenia, additional investment of the Government makes up 15% of the allocated amount. First two essential requirements to the CCM in application of proposal are transparent and inclusive concept note development process and open and transparent PR selection process.
Working calendar is the following: All TB related documentation will be circulated among all stakeholders by CCM secretariat, then TB working group meeting is planned to take place on 6-10 May with participation of technical colleagues and other stakeholders. Then international expert Andrei Mosneaga will visit in 14-24th May and 2 more discussions will be organized at that time again with participation of technical colleagues and other stakeholders. By consent of WHO, those discussions may have the format of round table, with participation of GF representatives.
At the end of May CCM extraordinary meeting is planned, during which demonstration of first report of the works and discussion of potential PR issue is anticipated. Meetings are foreseen also in June and August, namely generally 3 CCM and 5 WG meetings in the process of CN development and confirmation are planned (plan in details is attached).
6. After presentation floor was given to the colleagues in GF, they introduced the countries co-financing and willingness to pay mechanism. Importance of national health accounts related activities to receive information about state investments in the field of TB and HIV was mentioned. In those aspect activities concerning a development of TB and HIV subaccounts may be supported by GF. GF is ready to provide financial support and WHO will provide technical assistance and appropriate training course. Besides, in order to confirm amount of state investment and willingness to pay there is a need to provide appropriate corroborating documents, which will be based on the documents concerning a national strategy for midterm expenditures program and other programs for 2015-2017. It was recommended that Armenian experienced team should continue developing national health accounts including TB and HIV subaccounts, with the support of WHO and GF.
To confirm willingness of investment the government of RA has to show that state expenses for these diseases are rising annually and needs to define directions of further investments and how the financing provided by GF will be spent.
V. Avakova asked about the source of additional 15% investment.
G. Sakvarelidze answered that at least 40% of general budget of national programs must be provided by the Government and 60% should compose GF investment. The calculation for the mentioned 15% is realized differently. 15% of all amount provided for TB and HIV in Armenia, about 3.3 million dollars, is conditionally reserved. In order to receive that sum the Government must provide evidence of its additional investment of the same amount in addition to the 40% co-financing. Definition of that amount was based on the general income level of the country.
H. Madoyan’s question was about the confirmation of willingness to pay: is it a document or budget?
G. Sakvarelidze suggested asking GF all these questions in meeting minute or in separate letter.
A. Babloyan clarified that amounts of Government participation are defined by its share in program budget. Currently there is a calendar for developing midterm expenditures and these activities are ending in the beginning of summer and the state must increase its percent of participation the programs for 2015-2017. Today programs performed by GF are accounted and the percentages of state participation are increased. For TB program state participation is quite high but for HIV is significantly low. For that reason periodic interagency meetings are organized to raise existing issues among other partners.
M. Hovsepyan suggested that CCM should write a letter to the Ministry of Finances and ask for necessary investments provision to receive GF financing.
A. Babloyan considered suggestion acceptable and the draft of that letter will be provided to the CCM members for opinions as soon as it is prepared.
G Sakvarelidze said that any official document stating planned or realized expenses or national health counts showing spent sums for different components of diseases will be considered. And he also expressed his positive attitude toward writing a letter to the Ministry of Finance.
Summarizing the presentation of H. Harutyunyan G. Sakvarelidze emphasized that clear definition of TB and HIV program CN submission deadlines is necessary. For TB it is 15th August this year and for HIV it is tentatively 15th January 2015 but CCM needs to give definite timing.
It is also necessary to finalize the calculations of Government share. GF is expecting Armenian CCM answers concerning the following questions:
- Candidacy of two persons who will get opportunity to use the software designed for online submission of CNs.
- Budget of CCM secretariat is signed and soon first fund allocation will be realized.
- Decision about the currency (dollar/euro) of the money to be provided.
- CCM consent about provision of some funds (about 100 000$) from grant program savings to the WHO European region for TB program assessment. Assessment will be performed by WHO regional office and funds will be transferred directly to them. That assessment will become a base for future strategy as well as for development of TB CN. At the time of TB and HIV CN submissions the compliance with first two ERs of GF must be considered, i.e. transparent and inclusive concept note development process and open and transparent PR selection process by taking into account the opinions of all stakeholders.
G. Sakvarelidze also mentioned the necessity to design HIV CN development program, as the time remaining is rather scarce.
7. At the end Hasmik Harutyunyan introduced the request of the NCAP to increase incentive payment of the pharmacist. She informed that the current amount was defined many years ago in the beginning of the program and was not reviewed, so it is currently significantly lower than the same incentive payment provided to the similar specialist of TB program composing 28,000 AMD as compared with 210,000 AMD for TB Program pharmacist. Taking into account increased volume of work due to growing number of patients and aimed at equalizing the payments of appropriate specialists in TB and HIV programs there is a suggestion to increase the amount of the top-up payment from 28,000 drams to 119,500. Source of that financing will be NCAP SR’s savings. The total payment will comprise about 1 million dram annually.
R. Doudaklian asked why there was such a significant difference in top-up payments of two similar specialists working on HIV and TB Programs.
H. Harutyunyan once again emphasized that the top-up payment for HIV/AIDS program pharmacist was defined several years ago, when the program was starting and the payment of TB pharmacist was approved a few years later under the TB grant program and equaled to the state salary of that specialist. However it should be taken into consideration that the top-up payment provided to HIV/AIDS program pharmacist has not been increased after its initial approval, however the work load and responsibilities have significantly increased during the last years. Therefore currently it is recommended to increase the top-up of HIV pharmacist, equalizing it to the state salary received by this specialist.
8. A. Babloyan summarized the meeting by following considerations:
- It is necessary to activate CCM deputy chair functions, which according to the invited expert are not realized currently.
- CCM minutes must contain all discussions and decisions based on them.
- It is necessary to review the COI procedures and accommodate them to the requirements given.
- Is suggested to form a working group with 5 CCM members, which will have meetings more often than regular CCM meetings and will carry out necessary work in the period between regular meetings.
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