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Health Sector Corruption in Ethiopia 47
corruption. One person reported that four inspectors were under investigation
by the Ministry of Science and Technology for allegedly pressuring
people for bribes to certify that radiation equipment in their facilities
complied with safety standards. Several individuals expressed concern
over inspections of private and public pharmacies, stating that they
knew of cases where noncompliant or expired medications remained
on shelves for sale and use after inspectors agreed to overlook the
violations.
The FEACC has also investigated allegations that licensing and
inspections were not being conducted properly. It reported that some
FMOH licenses had been issued to private health institutions even
though these facilities were not in full compliance with regulations. It
also reported inconsistencies in the licensing of health practitioners
and private health institutions by the Addis Ababa Health Bureau
(FEACC 2008).
Our informants argued that low pay and low per diems made it difficult
for inspectors to make a living, and this is used as a justification
for accepting or requesting bribes. They also noted that abuses were
more common in rural areas, where visibility and the likelihood of
detection were lower. Several individuals emphasized the nature of
familial networks and social pressures that make it difficult for inspectors
to sanction providers: if an inspector has family connections to the
provider, this attachment can be used to pressure the inspector to
overlook noncompliance because a negative report would either harm
the provider’s ability to conduct business or look bad on his or her
employment report. Because of the low per diems, inspectors are also
susceptible to being given meals or a place to stay. However, issuing a
sanction to an individual who has just hosted an inspector breaks social
norms.
Notably, most of those who mentioned corruption of the inspection
process also cited examples where those who had allegedly broken the
law were facing investigation. Ethiopia does have mechanisms in place for
responding to complaints and investigating and punishing corruption in
inspection processes.
Inspections, as an area of vulnerability to corruption, may not be of
primary importance in terms of lost funds, but it is nevertheless important
for its effects on the health of individuals who are treated and on the
staff who are exposed unnecessarily to harmful working conditions.
When the public is aware that government inspection is not effectively
ensuring the quality of health facilities, it also erodes confidence in the