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Health Sector Corruption in Ethiopia 59
major donor agencies is simplifying financial and administrative control
functions and focusing technical support on improving one public system.
However, some agencies continue to use their own financial control
systems, which may be stronger or weaker than Ethiopia’s own public
system.
In general, donors should provide Ethiopia and the public with a full
accounting of the amounts disbursed (whether financial or in-kind), the
channels used, and subrecipients’ use of these funds. More specifically,
our research identified three major ways in which foreign aid affects
Ethiopia’s health sector and increases the risk of corruption—and we
recommend the following steps to address each:
• Increased funding through government channels increases the stress on
the country’s financial management, procurement, and logistical distribution
systems. More money and more supplies mean more attractive
targets for abuse. The first recommendation, then, is to reemphasize the
importance of strengthening the government’s financial management
systems, as discussed above.
• Expansion of staff opportunities for alternative private employment or
for special travel and training increase the demands on public health
care providers. The government must address these challenging publicprivate
interactions in its human resource planning and management.
Donors should collaborate closely with the government to ensure that
their engagement with public health care providers truly supports,
rather than undermines, the fulfillment of their public service commitments.
• Funds distributed outside government channels for major disease-targeted
programs may be less susceptible to corruption if the donors or NGOs
involved properly control them. However, in several instances, this does
not appear to be the case. The scale of funding entering Ethiopia
through the GFATM, GAVI Alliance, and PEPFAR is so large that it
deserves special attention. Each organization should provide the government,
and the public, with a clear annual report stating how much
funding was actually disbursed in a given year, in what form (funds or
commodities), and through which channels. 9 Funds flowing into HIV/
AIDS support work, in particular, should be the subject of a special
investigation to determine whether funds are being appropriately
spent.