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

Ethiopia – Aid Effectiveness in the health sector
Executive summary
Ethiopia is the second largest country in Africa by population; 84% of people
live in rural areas. The starting point in terms of development in Ethiopia was
poor and guaranteeing access to basic health services depends on heavy and
long term investments. Difficulties are further increased by the country’s difficult
topography.
Strong economic growth and innovative health programmes in the health
sector are leading to important improvements in health services. Still, progress is
far from optimal. Both maternal and under-five mortality rates will have to
decrease by half in order to meet Millennium Development Goals (MDGs) 4
and 5 by 2015.
More effective aid should help to speed up progress in the health sector, but
political disagreements resulting from the Government’s poor record on human
rights are holding back advances on alignment and harmonisation. Despite
good progress on poverty reduction and health indicators, the situation is at
stalemate and it is not likely to change in the short term. In addition, vertical
donors remain outside alignment and harmonisation efforts, hence limiting the
amount of progress which could be achieved.
Ethiopia was one of the first countries where the Government and donors
signed an International Health Partnership and Related Initiatives (IHP+)
Compact. However, full implementation seems unlikely in the short term. Donors
are reluctant to start delivering on their commitments because of their political
differences. In addition, the IHP+ does not include Ethiopia’s largest donors, the
Global Fund and the US President’s Emergency Plan for AIDS Relief (PEPFAR),
which constrains the initiative and its outcomes.
Major vertical donors in Ethiopia are showing positive signs of change. The
Global Fund is making efforts to increase the impact of its activities on the
health sector overall. PEPFAR has announced a move towards better alignment
and harmonisation as principles of Aid Effectiveness (AE), but it still has to put
this into practice. However, one should not expect to see a radical
transformation of these donors. Internal regulations limit their movements and
changing them will take time.
“Democratic ownership” is still missing in Ethiopia. The Government is showing
leadership in aid processes but it is not contributing to creating an enabling
environment for Civil Society Organisations CSOs. The role of CSOs and
Parliament is therefore weak. The situation of CSOs working in the health sector
is better but poor access to financial resources and lack of capacity are still
problems. Moreover, some donors such as the US Agency on International
Development (USAID) prefer to work with International Non-Governmental
6