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

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Ethiopia – Aid Effectiveness in the health sector HSDP III will end in financial year 2010-2011. By then, the HEP will probably be fully functional across the country. Some of the key targets being discussed for HSDP IV are to ensure that HEWs and the health posts are well-resourced so that all other basic health aspects in the HSDP can be adequately addressed; to continue working towards further harmonisation and alignment, and to start addressing broader health issues such as nutrition, population and emergency preparedness. DPs have focused their support to the HSDP on the HEP. Main contributors to the HEP during HSDP III are: the Government (for salaries for HEWs, construction, supervision); the GAVI Alliance (for health systems strengthening and HEW capacity-building); the Global Fund (equipment); Protection of Basic Services (PBS) (logistics master plan, equipment); USAID (HEWs and Volunteer Community Health Workers (VCHWs) training); and UNICEF (health post kits support, HEP website development). Other DPs also provide indirect support to the HEP through HSDP III programmatic areas. In addition, part of the DPs’ funding is channelled through a number of NGOs and special programmes. This picture of DPs and the health sector is relatively new. There were major changes in the DPs’ approach resulting from the 2005 elections. One hundred and ninety-three civilians were killed following the release of a report by the European Union Election Observer Mission which showed irregularities during the elections. 11,12 Before this, DPs provided a significant amount of budget support. After the election turmoil, DPs withdrew direct support for political reasons, ii but recognised that it was necessary to continue giving aid, especially to health and education sectors, while keeping better track of the money and how it was spent. 13,14 DPs came up with the Protection of Basic Services programme (PBS), a basket fund for health and education, managed and monitored by the World Bank. PBS is currently entering Phase II and more than US$1.2 billion has been committed by 12 DPs for the period 2009-2011. This is a significant increase on previous figures. 15 Nonetheless, since 2005, the work of “traditional donors” in the health sector has been pushed into the background by the arrival of vertical donors such as PEPFAR and the Global Fund. The latter are currently not only the biggest donors to the health sector, but also the biggest contributors overall of aid to Ethiopia. Their arrival has posed new challenges in terms of harmonisation and coordination, as well as creating new opportunities for the health sector. ii The OECD CRS online database, does not show a major drop, but this could be due to the arrival of new Vertical Funds (VFs) and the fact that donors continued providing programmatic aid, even if it was not direct budget support. 10
Ethiopia – Aid Effectiveness in the health sector 2. Aid Effectiveness in Ethiopia Alignment, harmonisation and budget support Ethiopia is the fourth largest recipient of Official Development Assistance (ODA). 16 This means it is also one of the countries with the largest donor community. DPs coordinate their work via the Development Assistance Group (DAG), which is the highest level coordination group. At a secondary level, work is divided among 11 technical working groups (relating to gender equality, health, governance, etc.). 17 About the DAG The DAG comprises 25 donor agencies providing development assistance to Ethiopia within the Paris Declaration (PD) principles of aid effectiveness and harmonisation. DAG members are: the African Development Bank (AfDB); Austrian Development Cooperation; Belgian Development Cooperation Agency; Canadian International Development Agency (CIDA); Danish Embassy; DFID; European Commission; Finland Embassy; French Embassy; German Embassy; GTZ-Ethiopia; Indian Embassy; International Monetary Fund (IMF); Irish Aid; Italian Development Cooperation; Japanese Embassy; Japan International Cooperation Agency (JICA); KfW, Dutch Embassy; Norwegian Embassy; Swedish International Development Agency (SIDA); Spanish Agency for International Development Cooperation (AECID); UNDP: USAID and the World Bank. The work plan of the DAG is set by the Executive Committee. Members of the Committee include UNDP and the World Bank as DAG co-chairs, and three representative DAG members on a rolling one-year basis. DAG Ethiopia 18 While these structures are necessary for DPs to coordinate and harmonise their work, they can also strain already stretched administrations. At the highest level, DAG and Government representatives engage every year in the High-Level Forum to discuss policy issues. At a secondary level, and focusing on specific sectors, DPs and the Government conduct Joint Annual Reviews, for instance in the education sector. 19 Moreover, each of the Technical Working Groups (TWGs) meets regularly with their Government counterparts. In addition to the DAG structures, each DP’s project has a steering committee, chaired by a project manager and where the Government is also represented. The complexity and frequency of dialogue structures has increased in line with the number of donors and the amount of aid reaching the country. However, more dialogue does not necessarily mean better aid. Too much interaction can also stretch the Government’s capacity and workforce. There is a risk that these constant and detailed interactions between DPs and the Government might 11
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