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

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Ethiopia – Aid Effectiveness in the health sector mean that it will also be able to apply pressure and eventually close any organisation it dislikes. As a consequence, the accountability line running between the Government and CSOs would be threatened. This is in clear contrast to the idea of “democratic ownership” and many of the principles put forward in the AAA. The role of CSOs in the health sector It has been mentioned before that Ethiopia does not offer an enabling environment for CSOs. However, organisations working in the health sector seem to be in a much better situation. On the one hand, health is one of the priority sectors for the Ethiopian Government and it is making significant efforts to improve it. On the other hand, organisations working in the health sector tend to focus on service delivery and, though they also engage in awareness- raising activities, their work is of a practical nature and far from the right-based advocacy and political activism the Government is afraid of. In the words of one interviewee: “The attitude of the Government towards CSOs operating in the health sector is extraordinary. The Government encourages participation of CSOs in the development and review of the health sector development programmes and other national frameworks.” 49 This statement is encouraging, especially coming from a civil society representative. But it needs to be understood in the context of the overall situation of CSOs in Ethiopia Development partners have supported and contributed to empowering CSOs in the health sector. The Global Fund arrived in Ethiopia on the condition that two networks of NGOs were created to manage a significant share of its funds: the Ethiopian Inter-Faith Forum for Development, Dialogue and Action (EIFDDA), which represents 11 national and international faith based organisations; 50 and the Network of Networks of HIV Positives in Ethiopia (NEP+), which is made up of nine regional networks, one women's network and two national associations, representing 380 organisations. Moreover, members of the Development Assistance Group (DAG) and Protection of Basic Services (PBS) also made their grants conditional on increased CSO participation. The Government conceded and these measures have contributed to opening up space for CSOs’ participation and expanding and strengthening the role of CSOs in the health sector. There are about 400 CSOs, NGOs and INGOs currently implementing health or health-related projects. 51 In general, these organisations are involved in all areas of healthcare and service delivery, including capacity-building. Approximately 330 health facilities are being managed by CSOs in the Ethiopia. In addition to managing DPs’ and Government programmes, it has been estimated that CSOs contribute about US$24 million annually to the health 22
Ethiopia – Aid Effectiveness in the health sector sector, which represents 9.8% of the annual health budget (these figures only reflect money in the budget and exclude DP-funded health projects). 52 Key challenges Despite being in an arguably better situation than other CSOs, the organisations working in the health sector still face many challenges. Access to financial resources and lack of capacity and trained workers feature high on the list of complaints. Moreover, the fact that some DPs, such as USAID, prefer to work with INGOs, does not help the situation. In addition, the new law still grants significant powers to the Government. Members of the Consortium of Reproductive Health Associations (CORHA) met with representatives of the Ministry of Justice, who stated that the law will not affect organisations in the health sector. 53 Still, the Government holds broad powers over CSOs, which contradicts the AAA and potentially limits implementation of the AE agenda. 4. Conclusions and recommendations AE in Ethiopia faces significant challenges. Rapid progress in the health sector has not healed the wounds caused by the 2005 elections and donors are reluctant to make further concessions. Furthermore, the Government’s poor record on human rights and the new Charity Law has not helped rebuild trust among DPs and CSOs. The arrival of vertical donors to the health sector has multiplied the resources available, but it has also created further harmonisation and alignment problems. The determination of the Government and DPs to make Ethiopia a success story will probably help to iron out differences and we will probably see good progress in the near future. However, it looks like building an enabling environment for CSOs and recognising their role as political actors will stay a pending issue for the foreseeable future. The Charity Law is not a good start but there are still opportunities for change. Progress will need to be made one step at a time. Recommendations: • The Government should respect human rights and freedom of speech. Differences between the Government and Development Partners (DPs) in this regard are seriously hindering advancement in aid effectiveness. • Even if Vertical donors are starting to change their attitude and make progress in the principles of alignment and coordination,, much more efforts are needed to improve greater aid effectiveness • Continue making progress on the implementation of the aid effectiveness (AE) agenda in the health sector. IHP+ signatory countries should fulfil their commitments by backing the Government’s preferred aid delivery mechanism.. 23
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