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Health Sector Corruption in Ethiopia 41
Infrastructure challenges. One procurement area that remains outside
the PFSA’s purview is construction. The FMOH is undertaking a large
effort to expand the infrastructure necessary to reach the entire population,
particularly in underserved rural areas. It has almost tripled the
number of government health centers (from 243 in 1997 to 600 in
2005) and constructed 13,625 health posts (small structures in rural
villages, staffed by health extension workers, that provide the most
basic level of health care services) over the course of the past four years.
This scale of construction, funded federally and regionally but executed
locally, is vulnerable to corruption. Although proper bidding procedures
are in place, informants told us of two ways in which the system
has been corrupted: (a) manipulation of the process for selecting contractors,
and (b) compromising the quality of construction by stealing
materials.
In the Amhara region, we saw documentation of a few cases in which
the selected contractors did not satisfy the contractually agreed specifications
for a project. In another example, again from the Amhara region,
construction materials were stolen. In both cases, those responsible had
been prosecuted and sentenced to prison time and large fines. Also in the
Amhara region, a contractor complained of favoritism in the awarding of
construction contract by regional authorities. In another case, in the Afar
region, community members alleged that a health post had not been
built to standard; however, no investigation was ever conducted
(Pankhurst 2008).
Strong, independent oversight essential. In sum, procurement is an
aspect of the health sector that is highly vulnerable to corruption. The
government is limiting opportunities for corruption by simplifying procedures,
training staff, consolidating procurement into relatively few standardized
systems, and investigating cases when they arise. However, it is
too early to determine whether these reforms will resolve past difficulties
with record keeping and compliance with procedures.
Regardless of progress in general procurement, two issues stand out for
special attention in the future:
• The continuing need for procurement of high-value and specialized
equipment and commodities will require the PFSA to ask the PPA for
special exceptions. Managing this process with appropriate oversight
and controls—but without hampering the efficiency of procurement
and use of these supplies—will require substantial effort.