An Independent Review of World Bank Support to ... - DAG Ethiopia

Table 4.4: Service Improvements in the Health SectorIndicator Baseline 1997 Target 2002 Achievement2002Health Status• Life Expectancy at Birth, years 52 58 52• Infant Mortality Rate per 1000 110-128 90-95 97• Maternal Mortality Rate per 100,000 1400 871 500-700Health Services• PHC Coverage 45% 55-60% 61%• DPT3 67% 70-80% 52%• CPR 8% 15-20% 17%• Ante Natal Care 25% 35-50% 35%• Population per trained nurse 14,000 NA 4,883Source: HSDP, Final Evaluation, March 3, 2003, volume 1.4.38 Measuring improvement in public financial management is problematic as it isnot a sector delivering a well-defined set of services to the public. Efforts are being madeamong international donor agencies 14 to agree on a set of relevant indicators, but this is arecent development 15 , and thus, there has been no coherent and continuous monitoring ofperformance in Ethiopia. This problem is also highlighted by the lack of quantification ofthe numerous outcome/impact and output indicators listed for PSCAP (no baselines ortargets). Nevertheless, a few indicators can illustrate development in Ethiopia since themid-1990s, such as:• The Government’s domestic borrowing has remained low (except for 2-3 yearsduring the Ethiopia-Eritrean War) and indicates fiscal balance after donor grants andconcessional international borrowing.• Recurrent budget execution has remained much in line with the approved budget,actual expenditure for most of the large sectors are in the 95-100 percent range.• Delays in closing government accounts has reduced from 4 years during the mid-1990s to 12 months now, thereby providing an instrument for holding theGovernment accountable for implementation of the budget. The Auditor General’sopinions on the government accounts have not improved during the period, but thiscould well be associated with strengthening the capacity of the audit office 16 .• Recurrent expenditure allocations to social sectors as a percentage of the budget haveimproved, but not as much as the donors would have wished (ref. PER reports).Quality of the expenditure in the social sectors show deteriorating trends with14 This is the aim of the Public Expenditure and Financial Accountability program funded by the Bank,European Commission, UK and Switzerland, based in World Bank HQ.15 The Bank’s monitoring of the HIPC Expenditure Tracking indicators is also a recent development havingbeen approved by the Board in 2002 and currently undergoing the second annual reporting exercise.16 Information from interviews with the government officials in November 2003.23