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

Ethiopia – Aid Effectiveness in the health sector
support. But it still does not withstand comparison with the money going into
HIV/AIDS, TB and malaria.
It has been mentioned before that this uneven distribution of resources has
created problems with harmonisation and duplication of structures. In addition,
both PEPFAR and the Global Fund have been criticised for focusing too much
on urban areas and not supporting health efforts in rural Ethiopia. 27 It is true that
HIV/AIDS has a much higher incidence in big population centres (incidence in
urban areas is 5.5%, versus 0.7% in rural areas). 28 However, with 83% of the
population living in rural areas, the total amount of infected people living in
rural and urban areas is approximately the same.
Furthermore, it has been argued that PEPFAR has very high transaction costs,
makes heavy use of technical assistance and delivers very little value for
money. As one of the interviewees put it, “It spends a lot, but reaches a few”. 29
The Global Fund has traditionally been seen as a more versatile player. The
Fund, for instance, has contributed to developing a stronger civil society. When
it started working in Ethiopia one of its conditions was that CSOs should be
involved, and two networks of service delivery NGOs and CSOs were created.
The approach of both PEPFAR and the Global Fund has recently started to
change in Ethiopia. The Government has been putting a lot of pressure on both
DPs, even though it is difficult to tell who has been responsible for this change,
given other contributing factors such as the views of other DPs and mounting
criticism at international level. The Fund is now supporting the Health Extension
Programme (HEP) by helping with the construction of the basic health posts in
villages and it is also investing in laboratories and other infrastructures, which will
have spillover effects in the health sector.
Similarly, PEPFAR has shown signs of making a similar turn. It has started to
implement its first Partnership Framework in Malawi, which should increase
alignment and coordination. Other countries will soon follow. Internal
regulations still mean that PEPFAR will remain independent to a certain extent,
but the framework could help reduce the number of management bodies set
up by PEPFAR as well as improve alignment with instruments such as the IHP+
(even though they are not signing on to it). Though only a first, it is an important
step forward. Many more will need to follow if PEPFAR wants to contribute to
the advancement of the AE agenda in developing countries.
14