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34 Diagnosing Corruption in Ethiopia
coordination by having these products channeled through a newly created
agency, the PFSA, responsible for managing the procurement and
distribution of supplies to all public facilities.
This overview provides the context for the findings that follow, which
assess the levels of corruption relative to other countries and sectors before
analyzing vulnerabilities to corruption along the value chain—from budgeting
and planning through health care delivery—and concluding with an
assessment of corruption in relation to the rapid expansion of foreign aid.
Extent and Sources of Corruption: Findings
Based on our field research, corruption in Ethiopia’s health sector does
not seem to be as pervasive as in other countries or other sectors.
Nevertheless, the sector is vulnerable to corruption, which could get substantially
worse as the health sector expands. The main areas identified as
particularly vulnerable to corrupt practices include the budgetary and
financial oversight system; the procurement of drugs, equipment, and
other health commodities; the pharmaceutical distribution system; regulation
and inspections; the interaction between providers and patients;
and the scale-up of new global health funding mechanisms.
Comparison with Other Countries and Sectors
Although this chapter focuses on opportunities for corruption in
Ethiopia’s own health sector, it is important to keep the issue in perspective.
Ethiopia’s health sector faces many problems related to limited
resources, a high burden of disease, and weak institutions. Corruption is
one part of the overall picture that should be addressed, but not without
considering the effects on the larger system. Focusing exclusively on controlling
corruption can end up creating further obstacles to extending
health care provision and implementing system reform.
International comparison. This is particularly the case because corruption
does not appear to be as pervasive in Ethiopia as in other countries.
The interviewees who have international experience all told us that
Ethiopia had fewer problems with health sector corruption than elsewhere.
One staff person from an international NGO said, “We infrequently
get shaken down or asked for bribes in Ethiopia. In other African
countries that I’ve been in, it was a regular problem.”
Another NGO staff member noted that the NGO is working with the
government on health care delivery because it perceives that the public
sector is serious about providing care—in contrast to experiences in other