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

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Ethiopia – Aid Effectiveness in the health sector Global Fund and USAID/PEPFAR. Neither has signed the IHP+ or has the intention to do so (though USAID/PEPFAR sent a strong letter of support for the IHP+). Therefore, even a full transition from the PBS to the MDG Fund would only affect a small share of funds going into the health sector. It is too early to say where the IHP+ is heading in Ethiopia. So far, DPs are not putting the IHP+ Compact into practice and big players are missing from the picture. People make different analyses of this situation. Some argue that the IHP+ “does not look like a very promising initiative”. 37 However, a perhaps more interesting analysis views the IHP+ Compact as a really good outcome given existing political obstacles. DPs can refuse to implement the IHP+ on the grounds of the Government’s attitude towards human rights and CSOs, but “if the situation improves in the future then DPs will have to fulfil their commitments”. 38 Key challenges Implementing the IHP+ will not be easy in Ethiopia. Signing the document was an achievement, but donors are reluctant to start delivering on their commitments under the IHP+. A new and restrictive charity law and the Government’s poor record in human rights are the main obstacles. Unless the Government changes its attitude, full implementation of the IHP+ seems unlikely. In addition, the IHP+ does not include Ethiopia’s largest donors, the Global Fund and PEPFAR, which constrains the outcomes of the initiative. Politics are part of the aid game ODA is not only about charity. For many years it has also been an instrument at the service of foreign policy. In fact, it continues to be part of a much broader political trade-off. Aid distribution patterns (see aid figures for Afghanistan and Iraq, for instance) and the significant amount of tied aid provision, clearly show that aid can sometimes be politically motivated. “Helping them” and “helping us” are not always two different motivations. When aid relationships are examined in this light, some of the problems in the implementation of the AE agenda can be more easily explained. At a lower level, small incidents or individual views in one country can have a huge impact on the other side of the world. An example from the Netherlands illustrates this point. The Dutch Government has always been supportive of a progressive aid agenda and the work of its diplomats has been instrumental in the IHP+ process in Ethiopia. However, despite all efforts, when it came to join the MDG Fund, the Ministry in Amsterdam did not give the green light. Apparently, the problem was that CSOs in the Netherlands concerned about the Ethiopian Government not being open to civil society and the new Charity Law put pressure on the Dutch Development Minister. 39 18
Ethiopia – Aid Effectiveness in the health sector National regulations interfering with the AE agenda are another example of this. The problem with USAID is the most common example, but many other countries also have their own procurement rules and accountability mechanisms. Italy, for instance, requested some recipient countries to reform their procurement and reporting systems so that these would fit with their own standards. 40 These examples show that AE is not only about a willingness to make things happen in a given country but also about the donor country’s own national political decisions and systems. 3. Democratic ownership Overview of CSOs in Ethiopia Compared with other African countries, Ethiopian CSOs are weak and they have to work in a difficult environment. During the Derg or Communist regime (1974-1992), CSOs were not allowed to operate. In 1994, a new constitution was adopted and in 1995 democratic elections were held. The Ethiopian People's Revolutionary Democratic Front (EPRDF), headed by Meles Zenawi, has been in power ever since. The number of CSOs working in Ethiopia has grown significantly over the last few years. According to the registry of the Ethiopian Ministry of Justice, the number of national NGOs increased from 540 to 1981 between 2004 and March 2008. Similarly, the number of registered religious organisations grew from 192 to 690 in the same period. 41 However, the increase in the number CSOs can be better by higher aid flows, rather than the existence of an enabling environment. CSOs in Ethiopia face problems of a different nature. Some are social constraints such as a lack of skilled workers, which fuels competition between donors and CSOs for the limited available human resources; and a low level of public awareness, which makes it difficult to mobilise the social masses in a country which anyway has a highly dispersed population. Other problems arise from internal and organisational factors. CSOs and NGOs in Ethiopia are not subject to a voluntary Code of Conduct, as in many other countries, even though there was an attempt to create one back in the 1990s. Moreover, the mission of some organisations is not always clear and there are CSOs which were created along political lines based on family ties. 42 Coordination among CSOs working on the same issues needs to be improved and transparency remains an issue. The accounts and audits of certain CSOs are not publicly available. In addition, competition for funding has driven some CSOs to work in areas beyond their mandate or mission statement. Furthermore, the institutional link between the 19
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