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60 Diagnosing Corruption in Ethiopia
Recommendation 7: Learn from other countries when introducing new
financing schemes.
The Ethiopian government is in the planning stages for new health
financing schemes, including national health insurance and community
health insurance. Before implementing newly proposed health financing
schemes, however, Ethiopia should learn from other countries so it can
have systems in place at the outset for addressing tax evasion, fraudulent
claims, and embezzlement.
The goals of these programs are to provide households with protection
against impoverishment due to health care expenses. Because these programs
are still in the planning stages, there is no way to know how vulnerable
they may be to abuse and fraud. However, Ethiopia should design
policies that forestall common problems that afflict other countries with
such systems, including payroll tax evasion, underreporting of income,
sale or misuse of insurance cards, manipulation of claims, false claims, and
embezzlement.
If the government creates such insurance schemes, 10 it should seek
technical support from developing-country institutions with relevant
experience. Some Caribbean countries recently adopted national health
insurance schemes and might provide lessons in what did and did not
work (in Jamaica, for example). Vietnam and Zimbabwe have also sought
to address these problems in implementing national health insurance and
could offer useful lessons (Ron 2001). Although their political and institutional
contexts are very different from Ethiopia’s, countries such as
Chile and Estonia have some of the most advanced institutional frameworks
and administrative systems for managing the vulnerabilities of
national health insurance to corruption.
Recommendation 8: Undertake systematic studies and audits.
Instead of recommending new studies to assess health sector corruption,
we recommend that ongoing sector work be strengthened to collect
information useful for assessing and limiting corruption. To that end, we
favor two kinds of follow-ups to this study: a strengthened system of
random performance audits and facility surveys.
Performance audits. To establish which areas are most vulnerable to
corruption and to provide a check on its own internal audit procedures,
the FMOH could establish an internal investigative unit to conduct a
systematic program of random performance audits. The government