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46 Diagnosing Corruption in Ethiopia
number of inspections. The two areas that they are working on most are
postmarket surveillance and laboratory quality control. 5
Regulation, Licensing, and Inspection
The health sector involves goods and services whose quality is difficult for
patients and their families to assess. Furthermore, patients do not want to
bear the cost and discomfort of trying different providers and treatments
to see which ones work. Consequently, countries use a variety of mechanisms
to signal whether a medical provider or medication is genuine and
to meet some basic standards of quality.
In many countries, health practitioners must be certified with specific
training before they can legally practice or get employment.
Professional associations sometimes establish codes of conduct and
investigate complaints. Pharmaceutical companies are usually subjected
to inspections, and medications must meet quality standards before
they can be sold. Although such quality control mechanisms can be
conducted by private companies and professional associations, most
countries have chosen to establish governmental or quasi-governmental
agencies to supervise medical licensing and drug registration. This interface
between public regulators and those they supervise is an avenue
that can be corrupted.
Quality control actors. In Ethiopia, several agencies are empowered
to regulate, license, and inspect health care providers and associated
businesses:
• FMOH has primary responsibility for regulating the health sector and
is in charge of licensing physicians and monitoring the quality of health
care provision in all public and private facilities; however other agencies
and ministries also play a role.
• DACA is another significant actor, a decentralized agency that reports
to the FMOH and is empowered to review all applications for importing,
producing, and selling medications in Ethiopia.
• The Ethiopian Radiation Protection Authority (ERPA), a dependency of
the Ministry of Science and Technology, is responsible for licensing and
inspecting all equipment with radiation, such as x-ray machines.
Risks in inspection, licensing processes. In interviews, people holding
a range of different positions—both within and outside of health
care provision—expressed concerns that inspections were prone to