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Health Sector Corruption in Ethiopia 31
• a new budget planning system
• a new procurement and distribution process
• extensive capacity building and training.
For example, responsibilities and procedures for drug procurement
have changed completely since the creation of the Pharmaceutical Fund
and Supply Agency (PFSA) in 2007, so earlier evidence of corruption
may not be relevant for judging future prospects.
Mapping of Resources and Activities
As noted above, health sectors are vulnerable to numerous corrupt practices.
Using a value chain framework, we can see the full range of potential
abuses, from distortions in policy and budget decisions to illegal
charges at public health facilities, as listed in figure 2.2.
Some of these practices cannot occur in the Ethiopian health sector
today because of its structure. For example, fraudulent billing is a regular
problem in countries where public insurance agencies reimburse providers,
but Ethiopia does not yet have such an insurer. Similarly, federal officials’
ability to distort budget allocations is limited because most federal
health funds are distributed in block grants to regions, and these allocations
are calculated based on population and other measures of need.
An alternative way of mapping health sector corruption is to focus on
the different actors. As figure 2.3 illustrates, the public health sector is
vulnerable to the following types of corruption:
A. Manipulating bureaucratic procedures for personal gain or political
goals; favoritism in employment
B. Fraud, kickbacks, and bribing inspectors
C. Absenteeism, theft of supplies, and misuse of funds
D. Diverting patients to private practice
E. Charging illicit fees
F. Embezzlement, fraud, kickbacks, and theft
Finally, the opportunities for health sector corruption can be mapped
in terms of the applicable control mechanisms, as table 2.1 previously laid
out. In this regard, Ethiopia has made some important advances relative
to other countries that rely so heavily on foreign aid. In particular, the
efforts of government and external agencies to bring significant amounts
of funding into a single or few channels of financial management has been
quite successful.