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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$58 per person, according to the World Health Organization (WHOSIS 2009). Although Ethiopia has made significant progress in the past two decades, health indicators in Ethiopia remain some of the poorest in the world. World Health Organization (WHO) statistics show that life expectancy at birth was 56 years of age and the under-5 child mortality rate was 123 per 1,000 live births in 2006 (WHOSIS 2009). Only about half of pregnant woman receive any form of prenatal care, and trained medical personnel supervise only 16 percent of births. Coverage rates of standard Expanded Programme on Immunization vaccines are low— anywhere from 53 percent to 73 percent, depending on the data source. The country’s ratios of health human resources to population also are among the lowest in the world. The Federal Ministry of Health’s (FMOH) sector policy has been structured around a series of Health Sector Development Programs (HSDPs), the first of which ran from 1997 to 2005, followed by HSDP-II (2002–05) and HSDP-III (2005–10). These programs address the government’s commitment to achieving numerous international health objectives, including the Millennium Development Goals (MDGs), and domestic health objectives such as • expanding physical access to health care services • raising immunization coverage
25 Table 2.1 Estimated Health Expenditures in Ethiopia, by Source and Control Mechanism, 2006 a Funding sources Primary financial agents Procurement agents Control mechanisms Main uses of funds Amount (US$, millions) Share (%) Taxpayers MOFED, block grants Regions, zones, FDRE, PPA Salaries, local purchases 100 13 woredas Patients Health facilities Woreda FDRE, PPA Drugs, supplies 25 3 Taxpayers MOE MOE FDRE, PPA Educational services 30 4 GAVI FMOH, MDG fund PFSA FDRE, PPA Commodities, training, infrastructure 110 15 Donors, WB Regions, PBS II Component A Woreda FDRE, WB agreement Salaries, local purchases 30 4 Donors, WB (Multi-Donor FMOH, PBSII Component B PFSA FDRE, WB agreement Imported commodities 60 8 Trust Fund) GFATM HAPCO Various FDRE, local financing agent Commodities, special activities 54 7 GFATM FMOH UNICEF, UNFPA UN system Commodities 64 9 U.S. PEPFAR Various Various United States Commodities, special activities 123 16 “Channel 3” donors b Donor (largest is USAID) Donor Donor Commodities, special activities 25 3 Patients Private facilities, pharmacies Private facility n.a. Salaries, drugs, supplies, facilities 130 17 Total n.a. n.a. n.a. n.a. 751 100 c Sources: Authors’ calculations based on Alemu 2009; HCFT 2006; FMOH 2008; GAVI 2005, 2006, 2007; GFATM website (http://www.theglobalfund.org); PEPFAR website (http://www.pepfar.gov); and interviews (for a list of individuals interviewed, see the annex). Note: MOFED = Ministry of Finance and Economic Development. FDRE = Federal Democratic Republic of Ethiopia. PPA = Public Procurement Agency. MOE = Ministry of Education. GAVI = GAVI Alliance (formerly the Global Alliance for Vaccines and Immunisation). FMOH = Federal Ministry of Health. MDG = Millennium Development Goal. PFSA = Pharmaceutical Fund and Supply Agency. WB = World Bank. PBS = Protection of Basic Services (program). GFATM = Global Fund to Fight AIDS, Tuberculosis and Malaria. HAPCO = HIV/AIDS Prevention and Control Office. UNICEF = United Nations Children’s Fund. UNFPA = United Nations Population Fund. U.S. PEPFAR = U.S. President’s Emergency Plan for AIDS Relief. USAID = U.S. Agency for International Development. n.a. = not applicable. a. At the time this study was completed, the only National Health Accounts data available were from 2005. National Health Accounts for 2007–08 were subsequently published in 2010 (FDRE 2010). b. International aid flows directly through MOFED (Channel 1), FMOH (Channel 2), or outside of the government’s oversight and information systems (Channel 3). c. Column total is rounded to 100.
Page 1: DIRECTIONS IN DEVELOPMENT Public Se
Page 5 and 6: Diagnosing Corruption in Ethiopia P
Page 7 and 8: Contents Foreword Preface About the
Page 9 and 10: Contents vii Chapter 6 Construction
Page 11 and 12: Contents ix Map 3.1 Ethiopian Regio
Page 13 and 14: Contents xi 3.6 Summary of Corrupti
Page 15 and 16: Foreword The government of the Fede
Page 17 and 18: Preface Although many would argue t
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Page 26 and 27: xxiv Abbreviations GAC Governance a
Page 29 and 30: CHAPTER 1 Overview Janelle Plummer
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Annex 4.1 Ethiopian RWS Borehole St
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CHAPTER 5 Justice Sector Corruption
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Justice Sector Corruption in Ethiop
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Table 5.2 Disposition of Civil and
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CHAPTER 6 Construction Sector Corru
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Construction Sector Corruption in E
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Figure 6.5 Drivers of Corruption Ri
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292 Table 7.1 Upstream Value Chain
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CHAPTER 9 Corruption in the Mining
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Corruption in the Mining Sector: Pr
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