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48 Diagnosing Corruption in Ethiopia
public sector overall and casts a negative shadow over those facilities and
inspectors who remain honest. 6
Provider-patient interactions
Thus far, we have discussed aspects of health care that are largely invisible
to most people. Now we turn to opportunities for corruption in direct
patient-provider interactions. Corruption can affect patients at this level
through the extraction of bribes or informal payments, favoritism in the
allocation of services, staff absenteeism, or pilfering of supplies essential
to the delivery of care. All of these corrupt practices can directly reduce
the quality of care patients receive, increase the overall cost of care, lead
patients to seek care from alternative providers who may be unskilled or
more costly, or deter patients from seeking care altogether.
Overall, however, corruption does not appear to be a major issue in
Ethiopia’s front-line health service delivery. Recent surveys have not substantiated
allegations of bribery and absenteeism. When asked about their
satisfaction with public health care services, as figure 2.5 shows, a large
share of people cite problems with the distances they have to travel
Figure 2.5
percentage
Reasons for Dissatisfaction with Public Health Services in Ethiopia
distance
drug & supply
availability
medical attention
building conditions
staff availability
waiting time
staff demeanor
0 10 20 30 40 50 60
percentage of population expressing dissatisfaction
rural
urban
Source: Urban Institute 2009, table 4.1, 37.