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Health Sector Corruption in Ethiopia 29
external agencies, the expansion of private health care provision is creating
challenges for controlling corruption in Ethiopia.
Until the mid-1990s, following the Derg’s collapse, private health care
provision was illegal. Today, it is legal and expanding. Currently, about 30
percent of households that seek health care services do so at a private
facility (authors’ calculation from FDRE 2008). The overall share of
people seeking care is higher in urban areas than in rural areas, as is the
private share. Although private health care is formally most extensive in
the major cities (such as Addis Ababa and Dire Dawa), it appears to be
expanding informally throughout the country. Average household spending
on health care is about US$2.20 per person per year, accounting for
20 percent of total health expenditures in the country. Although this
amount includes user fees in public facilities, most of it (at least twothirds)
pays for medications and consultations in the private sector.
Ethiopia’s regulations and oversight system does not appear to have
kept pace with the expansion of private practice. In 2003, individuals
and public health workers described how common it was for public sector
health workers to redirect patients from public facilities to private
consultations or particular pharmacies (Lindelow, Serneels, and Lemma
2005). Our interviews show that this phenomenon continues today:
individuals commonly attribute absenteeism and theft of supplies to
health sector workers who shirk their public duties and see patients in
private, using the justification that they are too poorly paid in their
public sector jobs.
Although private providers play a positive role in the provision of
health care services in many countries, the relationship between private
and public provision needs to be carefully delineated if corruption is to
be limited.
Framework for Analysis
Accurately measuring the extent and forms of corruption in such a large
health sector would require extensive resources. This study aimed to
establish the most common forms of corruption in Ethiopia’s health sector,
the most vulnerable aspects of the system, and potential remedial
actions to limit future opportunities for corruption.
Methods and Approach
The research was primarily qualitative, interviewing 66 people at the
woreda, regional, and national levels between May and June 2009 and