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26 Diagnosing Corruption in Ethiopia
• combating major infectious diseases (AIDS, tuberculosis, and malaria)
• promoting health with a new cadre of health extension workers.
The health sector program is moving forward within a national context
of modernization and reform that includes substantial efforts to
improve public sector capacity through training (implemented by the
Ministry of Capacity Building) and business process reengineering
(BPR), reform of procurement (administered by the Public Procurement
Agency [PPA]), and substantial decentralization of most public services
to local governments (FMOH 2005, 2008; Independent Review Team
2008).
Responsibilities for the planning and implementation of public sector
health activities are shared by FMOH, Regional Health Bureaus (RHBs),
Zonal Health Bureaus (ZHBs), and Woreda Health Offices (WoHOs), as
table 2.2 illustrates.
Under the decentralization strategy, the FMOH, RHBs, and ZHBs have
become increasingly focused on policy development, technical assistance,
and regulatory oversight, while the WoHOs are assuming greater responsibility
for managing and coordinating the implementation of health
activities, particularly the delivery of primary health services. Tertiary
health services are mainly the responsibility of the RHBs. Increasingly, the
Table 2.2
Public Health Sector Structure and Responsibilities in Ethiopia
Federal Ministry of Health
(FMOH)
National health policy and
planning
Regulation of suppliers,
drugs, and providers
Specialized hospitals
Issuance of block grants
Health Management
Information System
Special programs
Donor coordination
Regional Health Bureau
(RHB) a
Regional health policy
and planning
Supervision and support of
WoHOs
Regional hospitals
Administration of block
grants
Health worker training
Woreda Health Office
(WoHO)
Local budget planning and
financial controls
Health clinics
Health posts b
Health Services Extension
Program
Sources: FMOH 2005, 2008.
a. Some regions are further divided into administrative levels called “zones,” which have some planning and
oversight functions as well as responsibilities for service provision. Ethiopia has nine regions and two city
administrations (Addis Ababa and Dire Dawa).
b. Health posts are small-scale public facilities, staffed by health extension workers, that provide the most basic of
health services.