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

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<strong>Ethiopia</strong> – <strong>Aid</strong> Effectiveness <strong>in</strong> <strong>the</strong> <strong>health</strong> <strong>sector</strong><br />

HSDP III will end <strong>in</strong> f<strong>in</strong>ancial year 2010-2011. By <strong>the</strong>n, <strong>the</strong> HEP will probably be<br />

fully functional across <strong>the</strong> country. Some of <strong>the</strong> key targets be<strong>in</strong>g discussed <strong>for</strong><br />

HSDP IV are to ensure that HEWs and <strong>the</strong> <strong>health</strong> posts are well-resourced so that<br />

all o<strong>the</strong>r basic <strong>health</strong> aspects <strong>in</strong> <strong>the</strong> HSDP can be adequately addressed; to<br />

cont<strong>in</strong>ue work<strong>in</strong>g towards fur<strong>the</strong>r harmonisation and alignment, and to start<br />

address<strong>in</strong>g broader <strong>health</strong> issues such as nutrition, population and emergency<br />

preparedness.<br />

DPs have focused <strong>the</strong>ir support to <strong>the</strong> HSDP on <strong>the</strong> HEP. Ma<strong>in</strong> contributors to <strong>the</strong><br />

HEP dur<strong>in</strong>g HSDP III are: <strong>the</strong> Government (<strong>for</strong> salaries <strong>for</strong> HEWs, construction,<br />

supervision); <strong>the</strong> GAVI Alliance (<strong>for</strong> <strong>health</strong> systems streng<strong>the</strong>n<strong>in</strong>g and HEW<br />

capacity-build<strong>in</strong>g); <strong>the</strong> <strong>Global</strong> Fund (equipment); Protection of Basic Services<br />

(PBS) (logistics master plan, equipment); USAID (HEWs and Volunteer<br />

Community Health Workers (VCHWs) tra<strong>in</strong><strong>in</strong>g); and UNICEF (<strong>health</strong> post kits<br />

support, HEP website development). O<strong>the</strong>r DPs also provide <strong>in</strong>direct support to<br />

<strong>the</strong> HEP through HSDP III programmatic areas. In addition, part of <strong>the</strong> DPs’<br />

fund<strong>in</strong>g is channelled through a number of NGOs and special programmes.<br />

This picture of DPs and <strong>the</strong> <strong>health</strong> <strong>sector</strong> is relatively new. There were major<br />

changes <strong>in</strong> <strong>the</strong> DPs’ approach result<strong>in</strong>g from <strong>the</strong> 2005 elections. One hundred<br />

and n<strong>in</strong>ety-three civilians were killed follow<strong>in</strong>g <strong>the</strong> release of a report by <strong>the</strong><br />

European Union Election Observer Mission which showed irregularities dur<strong>in</strong>g <strong>the</strong><br />

elections. 11,12 Be<strong>for</strong>e this, DPs provided a significant amount of budget support.<br />

After <strong>the</strong> election turmoil, DPs withdrew direct support <strong>for</strong> political reasons, ii but<br />

recognised that it was necessary to cont<strong>in</strong>ue giv<strong>in</strong>g aid, especially to <strong>health</strong><br />

and education <strong>sector</strong>s, while keep<strong>in</strong>g better track of <strong>the</strong> money and how it<br />

was spent. 13,14<br />

DPs came up with <strong>the</strong> Protection of Basic Services programme (PBS), a basket<br />

fund <strong>for</strong> <strong>health</strong> and education, managed and monitored by <strong>the</strong> World Bank.<br />

PBS is currently enter<strong>in</strong>g Phase II and more than US$1.2 billion has been<br />

committed by 12 DPs <strong>for</strong> <strong>the</strong> period 2009-2011. This is a significant <strong>in</strong>crease on<br />

previous figures. 15<br />

None<strong>the</strong>less, s<strong>in</strong>ce 2005, <strong>the</strong> work of “traditional donors” <strong>in</strong> <strong>the</strong> <strong>health</strong> <strong>sector</strong><br />

has been pushed <strong>in</strong>to <strong>the</strong> background by <strong>the</strong> arrival of vertical donors such as<br />

PEPFAR and <strong>the</strong> <strong>Global</strong> Fund. The latter are currently not only <strong>the</strong> biggest<br />

donors to <strong>the</strong> <strong>health</strong> <strong>sector</strong>, but also <strong>the</strong> biggest contributors overall of aid to<br />

<strong>Ethiopia</strong>. Their arrival has posed new challenges <strong>in</strong> terms of harmonisation and<br />

coord<strong>in</strong>ation, as well as creat<strong>in</strong>g new opportunities <strong>for</strong> <strong>the</strong> <strong>health</strong> <strong>sector</strong>.<br />

ii The OECD CRS onl<strong>in</strong>e database, does not show a major drop, but this could be due to<br />

<strong>the</strong> arrival of new Vertical Funds (VFs) and <strong>the</strong> fact that donors cont<strong>in</strong>ued provid<strong>in</strong>g<br />

programmatic aid, even if it was not direct budget support.<br />

10

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