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Health Sector Corruption in Ethiopia 61
has a system for internal and external auditing, including provisions for
performance audits. However, all the public finance management
assessments note that Ethiopia is weak when it comes to reporting and
following up on federal and regional external audits. The studies we
reviewed included performance audits that could not show that funds
were used as intended, and we could not identify follow-up actions in
these cases.
The advantage of a systematic but random program of performance
audits is that it provides intelligence on problematic aspects of spending—
not just evidence on preselected areas based on guesses or ad hoc
interviews. 11 Such a program would be even stronger if the investigative
unit reported directly to the minister and were required to simultaneously
disclose its reports to the Office of the Federal Auditor
General (OFAG), the FEACC, or both. Given the amount of funding
from GAVI Alliance and the GFATM through the FMOH, it would be
appropriate for these organizations to provide some of the resources to
support such a unit.
Facility-level surveys. We do not recommend that a full Public
Expenditure Tracking Survey or new facility survey be conducted just to
determine the amount of leakage or corruption in Ethiopia’s public
health care services. However, it would be useful to address the corruption
issues raised in this report in any ongoing health sector work that
involves facility-level surveys.
To improve human resource management, drug distribution, maintenance
of supplies, and quality of care, the government needs regular and
systematic information on the performance of health facilities. Any surveys
used for this purpose should capture information about the amount
of resources reaching facilities, the amount of time that staff members are
absent, and diversion of resources to private practices.
Recommendation 9: Support the FEACC, OFAG, and other auditors.
Finally, the government has established a number of institutions—the
FEACC, OFAG, regional auditors general, the PPA, the PFSA, and so
on—to limit corruption in Ethiopia. These entities need continuing
political and economic support to fulfill their responsibilities and to collaborate
more closely with the health sector.
When anticorruption agencies and auditors begin to find and prosecute
problems, they almost always find themselves accused of overzealousness