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24 Diagnosing Corruption in Ethiopia
private health care provision; and welcoming increasing flows of foreign
aid.
Health financing in Ethiopia can be broken into four major funding
categories: federal and regional governments, bilateral and multilateral
funders, nongovernmental organizations, and households’ out-of-pocket
expenditures. Government policies have increased the share of government
expenditures for social programs, including health, during the past
decade. Health as a share of government expenditures rose from approximately
4 percent in 2004 to about 9 percent in 2007, but a large share
of this was financed by donors. The government spent an estimated
US$230 million on health in 2007, about two-thirds of which came from
international aid, as shown in table 2.1.
The increased government health expenditures have been accompanied
by fiscal decentralization and broad reforms in the administration and
management of public finance. Despite the increased expenditures, total
annual expenditures on health in Ethiopia amount to only about US$8 per
person, among the lowest in the world. By contrast, average spending on
health in Sub-Saharan Africa (excluding South Africa) is about US$58 per
person, according to the World Health Organization (WHOSIS 2009).
Although Ethiopia has made significant progress in the past two
decades, health indicators in Ethiopia remain some of the poorest in the
world. World Health Organization (WHO) statistics show that life
expectancy at birth was 56 years of age and the under-5 child mortality
rate was 123 per 1,000 live births in 2006 (WHOSIS 2009). Only about
half of pregnant woman receive any form of prenatal care, and trained
medical personnel supervise only 16 percent of births. Coverage rates of
standard Expanded Programme on Immunization vaccines are low—
anywhere from 53 percent to 73 percent, depending on the data source.
The country’s ratios of health human resources to population also are
among the lowest in the world.
The Federal Ministry of Health’s (FMOH) sector policy has been
structured around a series of Health Sector Development Programs
(HSDPs), the first of which ran from 1997 to 2005, followed by HSDP-II
(2002–05) and HSDP-III (2005–10). These programs address the government’s
commitment to achieving numerous international health objectives,
including the Millennium Development Goals (MDGs), and
domestic health objectives such as
• expanding physical access to health care services
• raising immunization coverage