Diagnosing Corruption in Ethiopia - Ethiomedia

Health Sector Corruption in Ethiopia 23
In addition to stealing from limited resources, corruption in the health
care sector directly affects people’s health, causing situations in which
health facilities lack supplies and staff, substandard and dangerous substances
are peddled as life-saving medications, or people go without care
because they cannot pay a bribe.
Corruption also erodes trust in the public sector concerning not only
provision of care but also drug regulation, practitioner licensure, and
equity. In Ethiopia, where foreign aid accounts for more than half of all
health spending, corruption could seriously undermine the country’s ability
to continue attracting these resources from wealthier countries.
Finally, corruption encompasses more actors and practices in the
health sector than in other sectors. Although corruption is often associated
exclusively with public officials, it occurs whenever someone
entrusted by the public abuses his or her position of power. The health
sector includes many private actors who hold such positions of trust.
Societies generally invest medical practitioners with status and privileges
in the expectation that they will put their clients’ health and
needs above their pecuniary interests. Health is considered so important
that even pharmaceutical companies and medical equipment suppliers
suffer particular disapproval when they breach social norms regarding
the appropriate balance between self-interest and clients’ well-being.
Therefore, an assessment of health sector corruption often requires
consideration of not only public sector employees but also a range of
private actors.
The Ethiopian Health System
Ethiopia’s health sector has a number of features that make it susceptible
to corruption:
A highly dispersed and weakly supervised system of service delivery
Accounting systems that overlap between governmental levels and
external aid agencies
A weakly regulated relationship between public and private provision.
Decentralization, programs address lagging health indicators. After
the Derg (the ruling military junta, formally known as the Provisional
Military Government of Socialist Ethiopia) was overthrown in 1991,
the new government replaced the highly centralized health delivery
system with one that is highly decentralized: sharing responsibility
among federal, regional, and woreda (district) governments; allowing