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Health Sector Corruption in Ethiopia 53
relatively high marks for foreign aid in public financial management
assessments, we were surprised that foreign aid program audits we
reviewed found that supporting records were frequently unavailable,
compliance with procurement guidelines was weak, and accounting
discrepancies were common.
For example, the GFATM awarded a grant to the government for
preventing and controlling malaria. The audit, covering 2004 through
2007(Audit Services Corporation 2008), found
• duplicate entries (expenses entered once as an advance and again as a
settlement);
• charges for medicines and supplies that were part of other programs
(such as medicines for obstetric care that were charged to GFATM);
and
• overstated charges (for example, US$3,000 of per diems paid out but
recorded as US$2,000).
The audit also could not find cash receipts or goods receiving vouchers
for transporting of bednets, purchasing of spare parts, medical supplies, and
rental agreements, among other expenses. In one UNFPA program, the
disbursements were validated, but the final balance of funds available was
off by 30 percent or about US$1 million (Alia Abdulahi & Co. 2005).
Misuse of direct aid to NGOs and community organizations. Since
2000, the international sense of urgency to rapidly expand and scale up
programs to fight major diseases has required the involvement of many
new actors, in particular community-based NGOs that were not particularly
active or well resourced in the past. Many of these organizations
were created specifically to implement these programs. As a result, their
capacity to monitor their own performance and to report back on their
financial expenditure was initially weak.
Our informants reported that substantial resources are being channeled
into regions and woredas for awareness creation, advocacy, and
capacity building. However, the outcomes of such activities are difficult
to monitor, making it easy to divert funds. The extent to which
these resources are having any effect is unclear, and the limited
amount of reporting and record keeping makes it difficult to know
whether funds are being used as intended. Hence these funds are vulnerable
to abuse of per diems and workshops through favoritism and
embezzlement.