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Health Sector Corruption in Ethiopia 35
countries where NGOs have tried to distance themselves as much as
possible from the government. Fewer Ethiopians report being charged
illegal fees at public facilities than is common in other countries. For
example, only 3.6 percent of Ethiopians in a 2008 survey reported illegal
charges at public facilities compared with rates exceeding 20 percent in
Ghana and more than 50 percent in Cambodia (Ethiopian data from
FDRE 2008; others from Lewis 2006).
Sector comparison. In Ethiopia, health sector corruption also seems to be
less problematic than in other sectors. In our interviews, people who were
not employed in the health sector volunteered specific examples of corruption
in land and resettlement programs, transporting food relief, construction,
and industry. Though they also expressed concerns about
public health care provision and criticized the government for not being
more effective, they provided relatively few specific allegations of wrongdoing
in the sector.
This finding is also reflected in a recent study of local accountability in
eight woredas that identified 8 case studies of problems in public administration,
8 in education, 5 in water, 10 in agriculture, 6 in justice, and 3
related to gender and youth, but only 1 in health—involving a health post
that was allegedly not built to standards (Pankhurst 2008). Similarly, a
recent survey of local public services found that people were least satisfied
with roads and city cleanliness and more satisfied with public health
services, even though they expressed greater interest in improving health
and water services (Urban Institute 2009). Thus, corruption is an issue for
the health sector but apparently not as much as in other sectors.
Ethiopia also seems to be taking corruption in the health sector seriously.
Most of the specific allegations in interviews had been formally
reported and were under investigation, either internally by a government
ministry, by the auditor general, or by the FEACC. The exceptions to this
rule were a number of discrepancies and allegations of improper use of
funds in audit reports for which we could not find follow-up actions. This
issue was also noted in MOFED’s Public Finance Management Assessments
(FDRE 2007a; World Bank 2007).
Budget Allocations and Financial Oversight
Ethiopia has adopted internationally recognized procedures for classifying
and reporting its budget as well as for documenting flows of funds
and conducting audits. These procedures can limit corruption by linking
funds to visible outputs and increasing the chances of detection and
punishment.