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

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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
Ethiopia – Aid Effectiveness in the health sector Organisations (INGOs), something which does not contribute to strengthening national CSOs. 7
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