US slashes HIV/aids funding to Ethiopia by 79%: Could corruption be the reason?

13 Jan
    Editor’s Note

    This story about US reduction of its aid to the Ethiopian health sector comes at the heel of the controversy over the $22 million lost to corruption in Uganda’s health sector. This stolen money problem in Uganda came to light, after the country’s auditor general exposed it in his report last October, according to news reports.

    When that story was made public, donors (Denmark, Norway, Ireland and UK) made a demarche to the government in Entebbe, announcing their decision to suspend aid to Uganda.

    This immediately elicited the response of the Uganda government, the treasury declaring willingness to refund the money. Thus Ireland reclaims €4 million on January 7th. In addition, on January 11, 2013 Uganda also made it public that it would return another $15 million to other donors by the end of next week.

    Similarly, in Ethiopia it must have been corruption that forced the US government to slash $200 million from its programmed funds for 2013 for Ethiopia’s health sector.

    Ethiopian officials, who are aware of what happened in Uganda speeded to spin their version of the story, which through the new Minister of Health Kesetebirhan Admassu, implied the cuts were due to “the current global financial crisis and the budget deficit in the US.”

    However, concerns about corruption in Ethiopia’s health sector have been a subject of numerous articles and studies. Nevertheless, it has been so far indicated that the corruption in Ethiopia was not givens sufficient attention. Because of that, it has seen any findings have not gone much beyond problem of perception.

    From a different perspective, nonetheless, research by Center for Global Development found out in 2006 “health officials complained about unfair hiring practices, nepotism and preferential treatment to well connected individuals.”

    Aslo beyond these ‘other’ allegations included were problems of actual lower level corruption that occur in connection with:

    (a) construction and rehabilitation of health institutions;

    (b) purchase of equipement, supplies and drugs resulting in bribes, kickbacks;

    (c) and political considerations influence specifications and winners of bids, bid rigging during procurement, lack of incentives to choose low cost and high-quality suppliers; and

    (d) education of health professionals: bribes to gain place in medical school or other pre-service training, bribes to obtain passing grades, and political influence, nepotism in selection of candidates for training opportunities

    More concerning, however, is that, beyond problems of perception, a new study by the World Bank – Diagnosing Corruption in Ethiopia is more serious. In what it referred to as the “new sector” (telecommunication, HIV/aids and pharmaceuticals subsectors), it points out that corruption in Ethiopia, especially in the HIV/aids and pharmaceuticals subsectors is found to be “on a trajectory similar to highly corrupt countries.”

    In recalling that, we are aware of the denial by Dr Tedros Adhanom, former health minister and now foreign minister, of even the perception of corruption in Ethiopia, much less its existence in reality, when he recently tapped in the WHO Bulletin to get his views across. Unfortunately, even there the good minister’s reading of the World Bank’s study of corruption slightly differs from what appears in black and while in the above excerpt taken from the report.

    He is of the opinion there is “significant discrepancy which often exists between the perceptions and reality of corruption.” That certainly is too obvious and that is not what the study says about the corruption in the “new sector.”

    To date, to my understanding, there is no statement by the US government linking its decision on slashing funds to Ethiopia’s health sector to corruption. Sadly for Ethiopians, we cannot also learn from the Ethiopian end, since no auditor general ever dares again under this regime to to hold government accountable, as happened in Uganda. If the international donor cannot see this difference between Ethiopia and Uganda, I cannot blame them since they do not also seem to have sense of the dangerous direction Ethiopia is headed.

    After all, Meles Zenawi humiliated a very seasoned auditor general of Ethiopia Lemma Argaw in 2006 in a full session of parliament for presenting his report that accused the government and regional administrations for their misuse of the budget allocated for them. Days later, he was dismissed from his job.

    That was one more dark day for efforts to hold government accountability in Ethiopia. Since then, many instances of corruptions have occurred. Instead of official institutional report to censure government and correct the mistakes, they have only been a subject of leaks and secret revelations by concerned individuals, the sources of which often pointed to concerted networks operating within the government.

    At the time, one of his Meles’s un-statesmanly behavior in parliament elicited the following reaction from Addis Fortune:

    “Alas, the Prime Minister did not mince his words when he told a dumbfounded, although subdued House, that regional administrations had the authority that could go as far as burning the money they received as subsidies from the federal government, if there was to be an article in their constitution allowing for that to happen. Although speaking metaphorically, his utterance was a shocker to many who followed the proceeding on a live TV.

    The Prime Minister accused the Auditor General of two cardinal sins: being a breach of constitutional rules and unethical. He argued that the Auditor General has no business auditing the expenditure of regional governments that have the constitutional right to spend their money the way they want to. He said that when it comes to auditing they have their own regional auditing offices to take care of the job. He wants the Office to register to subsidies as a federal expense but stop its power short of meddling in their internal affairs.”

    His supporters took it as kind of ‘give it as it is’ kind of action. However, it has left a huge scar on the country’s personalized governance, whose typical manifestation of Louis XIV-esque, whose end was not history’s favorite read. In the case of Ethiopia’, this for the time being has killed any concern by government of the possibility of being questioned on grounds of accountability, within or without the country.

    It is therefore important that the US make public what it based its decision on to suddenly slash 79 percent of its earmarked aid to Ethiopia’s health system. There are whiffs of in Ethiopia’s power corridors that this was unanticipated, a terrifying decision, until the US made it known to the government.

    In the circumstances, can one assume that the US is giving more weight to the importance of not exposing further a beleaguered ally in the fight against terrorism in the Horn of Africa? Of course, the money is theirs and they have sovereign rights on their monies. But also ignoring the excesses of the regime is something that could at some point turn around and hound the US administration, when the situation goes out of hand in Ethiopia.

    It is also essential to reiterate that, since Ethiopians cannot expect their auditor general to be serving to ensure integrity in government, the US should help Ethiopians to make them what the truth is. This would serve two objectives. Firstly, the TPLF regime would derive a lesson that it cannot always get away with mischiefs, heists and misappropriating a poor nation’s resources.

    Secondly, such pressure is important in sensitizing the TPLF that government accountability is important in democracy building. To ward off such things, it is common knowledge all along that the TPLF has managed to deny foothold to civil society groups in the country and the media has been muzzled by imprisoning journalists and closing newspapers.

    In addition, the case of rejection by the Extractive Industries Transparency Initiative’s (EITI) Ethiopia’s application for membership first in 2010, in 2011 and later in March 2012 is evidence of what is wrong with the governance of Ethiopia in that regard.

    Nevertheless, as a democratic country which believes in the rule of law and transparent governance, the US would do much better informing both Ethiopians – as recipients of its generous aid – and out of respect for US citizens as taxpayers, why the US aid is slashed. It would be one tool to put down the systematic corruption not only in the health sector, which affects the most deprived population, but also in the many other sectors, subsectors, contracts and subcontracts, where the sole criteria have been ethnicity – once again corrupted ethnicity as power base of the regime.

    After all, this is not the first time we have heard of corruption in the Ethiopian health sector. At some point, although it could be considered petty theft at government level, it was alleged that public and private funding to the health sector have been siphoned off to strengthen TPLF’s propaganda networks, such as Fana broadcasting and Walta Inc, etc.

Hereunder is the news report by IRIN/PlusNews:

 

ETHIOPIA: Concerns over HIV/AIDS funding cuts

ADDIS ABABA, 9 January 2013 (PlusNews) – Major projected cuts in US government funding for Ethiopia’s health sector could greatly undermine the progress the country has made in the fight against HIV, authorities and experts say.

“There’s an AIDS spending cliff in Ethiopia, and the government is already in free fall. Next year, Ethiopia will experience a 79 percent reduction in US HIV financing from PEPFAR [the US President’s Emergency Plan For AIDS Relief],” wrote Amanda Glassman, a director at Global Health Policy and a senior fellow at the Center for Global Development.

Ethiopian government officials, however, told IRIN/PlusNews that, while they were concerned about the funding cuts, they had been expecting them.

“We are a bit concerned, but considering the current global financial crisis and the budget deficit in the US, we had anticipated this,” said Kesetebirhan Admassu, the new minister of health.

“Most of the cuts are going to be around softer programmatic activities that can be taken care of by mobilizing internal resources as well as using some innovative approaches like the health development army and so on,” Admassu added.

Steep declines

Aid to Ethiopia’s health sector would, according to the US government-run web portal ForeignAssistance.gov, fall to US$171 million in 2013 from $390.6 million in 2012. A major cut would be felt in HIV/AIDS programmes, which would receive only $54.1 million, a dramatic cut from the $254.1 million allocated in 2012.

However, a US government official in Ethiopia downplayed the likelihood of such steep funding cuts in an interview with Capital, a local weekly newspaper.

There’s an AIDS spending cliff in Ethiopia, and the government is already in free fall…“We don’t have a budget for 2013 right now… We are not seeing those major reductions. Even though the prevalence rate of HIV/AIDS is coming down, there are still over 800,000 [people] on ART [antiretroviral therapy]; those still require investments and being cared for,” Dennis Weller, the director of the US Agency for International Development (USAID) in Ethiopia, told Capital, a local weekly paper.

But he did call for a transition from direct donor support to greater in-country funding for health programmes.

“Because we have been directly supporting health for so many years, the real focus now is transition to much more country ownership and looking at the sustainability of these investments. So things like health financing and community health insurance will be important,” he explained.

Growing government contribution

The government says it has done just that.

“If you look at the trend of government contribution, it is growing year by year. Our government has also passed a law and regulation to establish a social health insurance. So starting from the next budget year [July 2013] all employees will be covered with a social health insurance scheme,” Admassu said.

A recent report, however, warned that careful management of such a transition would be necessary to avoid creating gaps in areas such as “mentoring health centre staff now charged with ART delivery; prevention programmes to reach commercial sex workers and men who have sex with men; and programmes to benefit orphans and other vulnerable children on mass scale.”

According to UNAIDS, while Ethiopia has made significant strides in reducing new adult HIV infections, it has is yet to do so for new paediatric infections. Just 24 percent of pregnant women living with HIV receive ART to prevent mother-to-child transmission of the virus.

Between 2006 and 2011, Ethiopia received an estimated $1.4 billion from PEPFAR. Since 2004, Ethiopia has also received $1.23 billion from the Global Fund, making it one of the Fund’s biggest recipients globally.

*Edited and updated.

TE – Transforming Ethiopia

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