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Health Sector Corruption in Ethiopia 45
their private practices when certain products are unavailable. Although
this is not necessarily a form of corruption, it is difficult to monitor this
process, and it is unclear whether patients are referred only when a product
is truly unavailable.
In Ethiopia, certain medicines, such as antiretrovirals for HIV/AIDS,
are available only in the public sector. Therefore patients who need
medicines, even those who would not normally access health services in
the public sector, must get them from public facilities. At least one pharmacist
reported that because many patients with means want to avoid
visiting a public facility, some pharmacists have offered to deliver medicines
to the patients’ homes in exchange for delivery fees.
Interviews have also suggested that pharmacists may use their access
to public and private stores to improve their incomes. For example, a
pharmacist with medicines that are close to expiration might transfer the
product to a public pharmacy for faster sale. Although this represents an
abuse of the individual’s public office, the pharmacist justifies the action
by arguing that it reduces waste of useful medicines.
By law, most pharmaceuticals can be dispensed from pharmacies only
with a doctor’s prescription, opening another avenue for abuse. We were
told of one case in Addis Ababa in which an audit of a hospital pharmacy
found many prescriptions written to a particular group of patients.
Allegedly, the drugs were purchased at subsidized cost in the public pharmacy
for later resale, at a higher price, in a private pharmacy.
A black market is growing for pharmaceutical products, many
imported from Kenya, Somalia, and other countries (Jubat and Ongeri
2009). Many of the drugs available on the black market are either
lower-cost versions of drugs available in public pharmacies or products
that are not registered and available within Ethiopia. Some pharmacists
reportedly sell such drugs by storing them in the trunk of a car
parked outside the pharmacy and selling them in a way that is easily
hidden and formally off-premise. Because these products are outside
of the regular market, DACA and other authorities cannot monitor
their quality.
Progress continues. In sum, DACA officials listed a number of measures
they are taking to ensure the integrity of their regulatory functions.
Some involve improving pay and educational opportunities for inspectors
to improve morale and make them less vulnerable to corruption.
They also have organized their teams of inspectors separately from those
responsible for laboratory supervision and are trying to increase the