Ethiopia Aid effectiveness in the health sector - Action for Global ...

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Ethiopia – Aid Effectiveness in the health sector come at the expense of the Government engagement with Parliament and civil society. 20 The number of ‘dialogue spaces’ and donor representatives should be limited to reduce red tape. In fact, in 2007 the Government informed the DAG that it wanted to streamline the coordination structures and replace the TWGs with five Sectoral Working Groups (SWGs): Rural Development and Food Security, Private Sector, Transport, Gender, and Water. In response, the DAG has created some SWGs, while some of the TWGs are still engaged in discussions with their Government counterparts. DP partners should strive to conclude these discussions as soon as possible. However, the DAG has stated that it will continue to work internally on the basis of the 11 TWGs. Even though this process is still at an early stage, it is difficult to see how this reaction will help improve coordination and alignment and not hamper dialogue. Furthermore, it has been two years since the Government requested that the DAG streamline the dialogue spaces and this process is still underway. This suggests that DPs are either not very keen on the process or they have not yet managed to agree on distribution of tasks. After the 2005 elections, DPs made significant changes to aid modalities in Ethiopia. Many DPs moved away from budget support and decided to pool their funds instead. Some donors who were working in Ethiopia when budget support was on the rise mentioned that the results were far behind the experiences of Ghana, Mozambique and Tanzania. Ethiopia is a federal country and the Government is completely decentralised. There is only a central budget for defence and foreign affairs and the rest of funds are transferred to district authorities, according to rules based on population, etc. This made it difficult for donors to track their money, especially when they had a target sector for budget support. Even though DPs wanted to support the health sector, in practice district authorities received their entire budget and redistributed funds at will. Bearing in mind that there are 611 districts or woredas, monitoring funds would have been a titanic task. The Government is probably aware of these difficulties. In the IHP+ Compact it states that the preferred instrument for DPs’ support to the health sector is not budget support but a basket fund managed by the Ministry of Health (MoH), the MDG Fund. In theory, the MDG Fund should replace the existing Protection of Basic Services (PBS) scheme. But DPs are not very keen on this because of the political consequences of providing direct support to the Government after the last elections as well as the new controversial Charity Law (see below). A major obstacle to achieving a higher degree of harmonisation in Ethiopia is the lack of commitment from the country’s largest donors: USAID, PEPFAR and the Global Fund. The volume of aid of all other donors to the health sector 12
Ethiopia – Aid Effectiveness in the health sector dwindles in comparison to the amount they provide. The use of their own procurement systems and delivery channels has also originated parallel structures (for example, the DAG has one TWG for Health, Nutrition and Population and another devoted to HIV/AIDS exclusively). Moreover, internal regulations tend to hamper coordination efforts. It is no wonder that PEPFAR has been described by one interviewee as “the worst fragmenter”, on the basis of its difficulties coordinating with other donors or aligning their procurement and aid delivery mechanisms. 21 Vertical donors could bring real change to the health sector if they coordinated their efforts better. The MDG Fund is the Government’s preferred funding mechanism but without the participation of the bigger vertical donors, it amounts to little. Actually, it is being used to fill the procurement gaps left by vertical donors. Both the Global Fund and USAID/PEPFAR, have started to show signs of change (see section on Vertical donors below), but they still have a long way to go in terms of alignment and harmonisation. Key challenges Political disagreements resulting from the Government’s poor record on human rights are holding back advances on alignment and harmonisation. Despite good progress on poverty reduction and health indicators the situation is at stalemate and it is not likely to change in the short term. In addition, vertical donors remain outside alignment and harmonisation efforts, hence limiting the amount of progress which could be achieved. Vertical donors, a wind shift? Ethiopia’s HIV/AIDS prevalence rate is low compared with other African countries at2.1% in 2006-2007. 22 As has been described, the two biggest donors to Ethiopia are PEPFAR (US$355 million in 2008) 23 and the Global Fund (over US$1.3 billion approved since 2003 with US$590 million already disbursed) 24 – both of which focus on HIV/AIDS. Even if Ethiopia’s large population means over 1.5 million people are infected and HIV/AIDS is one of the main causes of death (12% in 2002, though prevalence was twice as high back then) 25 , it is not difficult to see that the distribution of resources in the health sector for different diseases is uneven. Other illnesses such as respiratory infections (excluding TB) kill just as many people, and diarrhoea and perinatal conditions are not far behind. However, only around US$70 million was allocated by OECD-DAC countries to support the entire health sector. 26 This amount does not include aid provided as budget 13
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