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28 Diagnosing Corruption in Ethiopia
Ethiopia has a particularly large number of international donors:
10 multilateral institutions, 22 bilateral agencies, and 50 international
NGOs. However, it has been reasonably successful in fostering coordination
among most of its donors. For example, Ethiopia was the first
country to sign an International Health Partnership for donor coordination,
and donors are pooling their contributions into a Multi-Donor
Trust Fund (MDTF) and the PBS program (managed by the World
Bank) as well as an MDG Fund managed by the FMOH. As a result of
this coordination, a substantial amount of international aid flows
directly through the Federal Ministry of Finance and Economic
Development (MOFED) (Channel 1) and FMOH (Channel 2), with
the rest remaining outside of the government’s oversight and information
systems (Channel 3).
Using a variety of information sources, as shown in figure 2.1, we
estimate the share of total health expenditures supported by taxpayers
has fallen to about 17 percent, out-of-pocket expenses for private
care and user fees is approximately 20 percent, and donors account
for 63 percent. 3
The public-private conundrum. In addition to the highly dispersed nature
of the public health system and the overlapping flows of funds from
Figure 2.1
Share of Total Health Expenditures by Source
households (OOP)
20%
Channel 3
28%
taxpayers
17%
Channel 2
31%
Channel 1
4%
subject to Ethiopian
public financial
management
52%
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: Channel 1 = donor funding directed through MOFED. Channel 2 = donor funding directed through
FMOH. Channel 3 = donor funding through nongovernmental channels. OOP = out-of-pocket.