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50 Diagnosing Corruption in Ethiopia
The practice of holding dual jobs can compromise the care provided
in public health facilities in several ways:
• Staff may work hard in their private practices, where they are paid
in relation to the number of consultations or drugs dispensed, and
exert less effort in their public sector jobs, where their salaries are
fixed.
• Staff may use their public practices to identify patients who can pay
more for private services and then refer those patients to their private
practices, promising higher-quality services or access to more sophisticated
equipment.
• Providers may transfer resources, such as lab equipment, from the public
sector to their private practices.
Other studies have also cited such examples (Lindelow, Serneels, and
Lemma 2005), and several cases have been referred to the FEACC.
Managing the public-private relationship. Private practice can contribute
positively to the quality and quantity of health care services and increase
access to care, but the rapid expansion of private provision in Ethiopia
appears to be outpacing the government’s capacity to regulate its relationship
with the public sector.
Ethiopia’s strategy for dealing with these tensions is to formalize and
regulate public-private interactions. For example, the government is
experimenting with the construction of private wings within public
facilities, promoting the establishment of special for-profit pharmacies
beside public facilities, and allowing dual practice among medical practitioners.
Managing this relationship is not easy, and whether these arrangements
will be functional in terms of performance and transparency
remains to be seen.
Rapid Expansion of Foreign Aid
Foreign aid is just as vulnerable to corruption as domestic spending. In
some respects, foreign aid is an even more attractive target because it is
paid in highly valued foreign currency and involves large transactions. In
other respects, foreign aid may be less of a target because external control
mechanisms may be harder to evade. Regardless, the forms of corruption
to which foreign aid is susceptible are as varied as the ones affecting
domestic spending, ranging from theft of commodities and kickbacks to
embezzlement and fraud.