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

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Ethiopia – Aid Effectiveness in the health sector Moreover, DPs will need some success stories in 2015 – the target for the MDGs – and Ethiopia has made significant progress on many of the MDGs, especially looking at where it started. The Government is well aware of and takes advantage of this situation in order to strengthen its position. 32 The Government is in fact proving to be an artful political actor. There are people who argue that “the Government has learnt how to play donors one against each other.” 33 Though this statement may not be 100% realistic, the truth is that it knows how to reassert and push its own agenda. In addition to being instrumental in guaranteeing long term continuity, it has also occasionally approached DPs individually to negotiate financial support for projects which are without secured funding from other sources. By doing so, the Government has managed to get a higher total amount of funding than was previously on the table. 34 Accounts of ownership may vary depending on which indicator one looks at. In the case of Ethiopia, it seems that the Government has learned how to negotiate the ‘aid jungle’ and affirm its position. This can help to explain why despite the dramatic events following the 2005 elections, aid levels (excluding debt cancellation) have never stopped increasing. It is also remarkable that Ethiopia is one of the first countries where the Global Fund has started to support general infrastructure investment in the health sector and coordinate its work with the Government and other DPs. Strong government ownership has not translated into greater “democratic ownership” in Ethiopia. The Government has opened up some space for CSOs in the country’s priority development areas such as health, but it is also making the work of rights-based advocacy organisations very difficult (see section on CSOs). Similarly, Parliament is not sufficiently involved in aid processes. Key challenges Political disagreements with the Government and different views on how to respond have further hampered coordination among donors. In principle, this situation does not seem conducive to achieving greater ownership but the truth is the Government is showing strong leadership in aid processes. Unfortunately, the same is not true of “democratic ownership”: both CSOs and Parliament play an insignificant role. Reinforcing the role of these actors in the aid process is one of the main AE challenges currently in Ethiopia. IHP+ Ethiopia and DPs signed the IHP+ Compact in August 2008. 35 Although its implementation is being obstructed by political disagreements, mainly about the new Charity Law (please refer to the next section), the result is a very good document, which is being implemented through a complicated political deal. 16
Ethiopia – Aid Effectiveness in the health sector The Compact is, broadly speaking, a sound and progressive piece of work in terms of the AE agenda. The process leading to it has involved strong ownership by the Government. 36 In fact, ownership has been so great that Parliament is never mentioned in the document and CSOs and NGOs only twice – and only once with any relevance. This shows that the IHP+ Compact is not in line with the concept of “democratic ownership” and the Accra Agenda for Action (AAA) commitments. In this regard, the Compact reflects the intransigent position of the Government towards CSOs and civil society (please refer to the CSOs section). One of the main objectives of the IHP+ is to improve alignment and coordination in the health sector. In the text of the IHP+ Compact, the Government makes very clear that the main tool to achieve this is implementing aid modalities managed through government systems. More specifically, the document puts forward the MDG Fund as the most desirable option, and asks DPs to progressively move from Protection of Basic Services (PBS) to this new instrument (PBS is a pooled fund managed by the World Bank and not the Government). At the time of signature, only the GAVI Alliance was contributing to the MDG Fund, through the Health Systems Strengthening component (HSS). More recently, some of the other IHP+ signatories (the World Bank, DFID and the World Health Organisation (WHO)) have also started to contribute to this fund. Unfortunately, the shift in aid modalities sought by the Government is not happening as not all DPs are willing to engage in the MDG Fund. The fund is managed by the MoH and some donors (i.e. the Netherlands and Sweden) refuse to provide funds directly to the Government for political reasons. Many DPs are still concerned about the Government’s response to the last elections. Moreover, the new Charity Law has also stirred up some controversy. This situation has led to a less than ideal scenario in which the World Bank has created an intermediate instrument, which provides “sceptical donors” with fiduciary checks and accountability on their contributions to the MDG Fund. However, it is not yet clear which DPs will use this instrument. Due to its small size, the MDG Fund is currently being used to cover procurement gaps. This is only one of the many other components of the PBS. Aid to the health sector is now more complex than it was before the IHP+. On paper, this should be a transition phase while donors phase out other mechanisms and start contributing to the MDG Fund. But it is in practice unlikely that most DPs will change their position in the short term. Furthermore, the potential of the MDG Fund to achieve greater alignment and coordination is not very clear. Contributors to the MDG Fund and the PBS are “traditional donors” and not Vertical Funds (VFs). It has already been mentioned that Ethiopia’s biggest DPs both in absolute terms and in the health sector are the 17
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Ethiopia Aid effectiveness in the health sector - Action for Global ...

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