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Health Sector Corruption in Ethiopia 27
WoHOs are also assuming responsibilities for local budget planning by
means of the Marginal Budgeting for Bottlenecks planning software. 2
One of the FMOH’s major strategic priorities is to improve physical
access to health services and health care providers across the country. It
has expanded access to basic health care services by training and deploying
additional health care workers; investing in construction of new facilities;
and increasing spending on supplies, drugs, and commodities. The Health
Services Extension Program is a key part of this strategy and involves training
and deploying two health extension workers to each village in the
country. In the past three years, the government has trained and deployed
more than 24,000 of these workers, with a target of 30,000.
Role of international donors. International donor contributions to the
health sector have increased dramatically over the past decade from both
bilateral and multilateral sources. When the last National Health
Accounts were reported in 2005, households and government each
accounted for about 30 percent of total health spending while donors
accounted for almost 40 percent. Today, the donor share is likely to be
substantially larger because of the disbursements of major initiatives
such as the Global Fund to Fight AIDS, Tuberculosis and Malaria
(GFATM); the U.S. President’s Emergency Plan for AIDS Relief
(PEPFAR); and the GAVI Alliance (formerly the Global Alliance for
Vaccinations and Immunisations). GFATM increased its disbursements
from US$118 million in 2006 to US$630 million in 2007; PEPFAR,
from US$123 million in 2006 to US$242 million in 2007; and the GAVI
Alliance, from US$4.6 million in 2006 to US$110 million in 2007.
These amounts far surpass domestic government spending and represent
an enormous influx of resources over a short time. Substantial shares
of these funds procure pharmaceuticals (for example, antiretrovirals, antimalarials,
and vaccines) and commodities (such as contraceptives and
bednets) through international competitive bidding managed by (a) firms
contracted by bilateral agencies (for example, Management Sciences for
Health procures for the U.S. Agency for International Development) or
(b) United Nations (UN) agencies (such as the UN Children’s Fund
[UNICEF] and UN Population Fund [UNFPA]). Still, much of the foreign
aid money goes to the Ethiopian government to cover recurrent
costs through block grants (for example, the Protection of Basic Services
[PBS] program) or to pay for specific programs; other funds go directly
to nongovernmental organizations (NGOs) and service providers outside
of governmental channels.