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Health Sector Corruption in Ethiopia 55
• Decentralization and improved planning. The FMOH is implementing a
new planning system that includes analysis of bottlenecks in service
provision at the woreda level.
• Protection of Basic Services. The PBS program is simplifying and streamlining
the flow of block grant funds from and through the federal
government to regional and woreda governments.
• Investigation and prosecution. The FEACC is actively investigating
allegations of corruption, and its public reporting is increasingly transparent
and open.
In fact, these reforms are so far-reaching, ambitious, and recent that
many of the cases and allegations uncovered in this study may no longer
be relevant for policy making. Still, this research has uncovered a number
of issues that should be addressed if Ethiopia wishes to maintain and
improve the integrity of its health care system. Ethiopia’s health sector is
less corrupt than in other countries and sectors. Nevertheless, irregularities
are still problematic, and factors such as rapidly rising expenditures,
growing private provision, concentrated procurement, and financial innovations
could increase the sector’s vulnerability to corruption in the
future. The recommendations below address the existing and future areas
of vulnerability.
Recommendation 1: Improve human resources involved in financial
management and procurement.
To the extent that improved human resource management and training
are improving public officials’ capacity to follow procurement guidelines,
keep records, and undertake proper accounting, opportunities for corruption
may already have been significantly reduced. However, the divergence
between the assurances we received from high-level officials
regarding the effectiveness of the “paper trail” and the evidence provided
in audit reports and other interviews suggests that more work must be
done in this area.
Continued efforts to train, supervise, and motivate personnel are necessary
until the government has regular evidence in its external audits
that appropriate financial management and procurement procedures are
being followed and that information can be reported out of the system
readily. These efforts need to be redoubled, with special attention given
to addressing the problem of high turnover among skilled financial and
administrative staff.