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20 Diagnosing Corruption in Ethiopia
harming individuals. Ethiopia’s health sector has many problems—including
limited resources, a high burden of disease, and weak institutions—but
corruption also plays a role.
Corruption in Ethiopia’s health sector has been relatively minor
compared to that in other countries and sectors. Low public health
spending and limited job options for public health staff workers may
explain why the health sector has been less prone to fraud and abuse.
However, rapidly rising expenditures, a growing private health sector,
concentrated procurement, and new financing arrangements could
increase the sector’s vulnerability to corruption in the future.
This study assesses the nature and extent of corruption within
Ethiopia’s health sector. It relies primarily on interviews to map the flow
of resources in Ethiopia’s health sector and to assess whether resources
are being diverted from their intended uses. The interviews were supplemented
by analysis of documentation, including internal and external
audits and previously collected survey data.
Overview of Findings
In summary, the study identified the following key areas of concern:
• Financial management. Although the Ethiopian health sector has implemented
and improved its financial management system, compliance is
still weak in critical areas such as record keeping, performance audits,
and follow-up on audits.
• Procurement. Although the public procurement system has been greatly
strengthened in recent years, significant challenges remain such as
poorly functioning reporting systems and weak oversight.
• Pharmaceutical management. Concerns involve the licensing, selection,
and sale of medicines; pharmacists’ opportunities to exploit patients;
and a growing black market for pharmaceuticals.
• Regulation. Several agencies regulate, license, and inspect health care
providers, facilities, and associated institutions. The inspectors who
enforce these regulations, however, are poorly paid and vulnerable to
requesting and accepting bribes.
• Unequal patient treatment. Although illegal payments do not appear to
be a major issue in Ethiopia’s front-line service delivery, many interviewees
reported complaints that providers give preferential services to
friends and colleagues. In addition, the practice of dual job holding in
both the public and private sector has opened up opportunities for
providers to take advantage of patients.