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Health Sector Corruption in Ethiopia 57
oversight procedures seem adequate for an organization that already has
a good track record, but to establish the PFSA’s credibility, the government
might find it advisable, initially, to establish stronger external
supervision.
For example, it could create a group of rotating officials from other
agencies to be included as observers on key PFSA committees who would
report directly to the FMOH and the FEACC. Alternatively, an external
commission—chaired by an FEACC representative—could be appointed
to review quarterly reports on procurement during the PFSA’s first few
years of operation.
Whatever the specific mechanism chosen, some process for increasing
the PFSA’s transparency to the public or external authorities is necessary
if this new agency is to develop the credibility and reputation for integrity
that it needs as one of Ethiopia’s largest and most prominent procurement
entities.
Recommendation 3: Improve inspections.
Regulations, licensing, and inspections are not often viewed as high corruption
risks because the amounts of money involved may be relatively
small. However, in the health sector, these governance mechanisms are
critical to ensuring the quality and integrity of health care provision, and
progress on three fronts could significantly curb corruption among
inspectors:
• Reforming incentives by addressing inspectors’ pay, per diems, training,
motivation, work programs, and supervision. Pay and per diems should
be structured and monitored to meet inspectors’ real needs while also
creating significant chances of detection and punishment for failing to
abide by the laws.
• Improving information by establishing random revisits by a core team of
trusted inspectors.
• Addressing social norms by rotating inspectors to prevent development
of personal relationships with the people at facilities they are inspecting.
Training should emphasize the importance of the inspector’s mission
of protecting the public by upholding the law—one counterbalance
to pressures to accept bribes or overlook noncompliance. Role-playing
exercises could suggest tactful ways to resist unlawful approaches and
subtle forms of influence. The government could implement these
changes for inspectors at DACA and ERPA as well as for internal and
external auditors in different ministries. 8