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September 16, 2010

Ethiopia’s Tedros: No ownership, no scale

   Dr. Tedros Adhanom Ghebreyesus


Part three of the 8-part series In the Driver’s Seat: A Series on Country Ownership of Health Programs. Ethiopian Health Minister Tedros Adhanom Ghebreyesus has worked in his country’s Health Ministry since 1986 and has led it since 2005.

Q: What has frustrated you about the lack of country ownership in the past?

A: The frustration comes from this: If there is no ownership, some partners will come up with activities that are not a priority for a country. And to be engaged in something that is not your priority is not something you like to do. A second problem is duplication of efforts. A third problem is that transaction costs could be high. When you deal with many partners, they have their own planning system, own budgeting system, and own reporting mechanism. Due to lack of ownership, some things that could be done by the country itself are done by a non-governmental organization and you don’t even have a say in selecting the NGO. What happens in this case is you have high, high overhead costs. We always say to our partners, we can give you value for the money. So yes, I have been frustrated, but we are on our way to resolving this.

Q: How are you resolving it?

A: We started in 2005 when we signed the first code of conduct, based on the Paris Declaration. It took us more than three years to develop the first harmonization plan. Now we have designed a pool fund, based on one budget, one plan, one report. Aid partners have joined this mechanism and they have already started channeling funding into it. That means minimizing planning for several partners, sticking to one reporting mechanism, addressing the major problems of duplication, and minimizing overhead cost. We are seeing more encouraging results. By doing this, we own the whole process.

Q: Would you say Ethiopia now owns its health programs?

A: It’s not perfect, it’s not 100 percent. We have only like eight partners who have joined our pool fund. We have just started it, but we are encouraged.

Q: What about the fears that there will be more corruption under country ownership plans?

A: I don’t think so. When there is ownership, ownership leads to commitment. I cannot commit to something I do not own. It really helps in putting in checks and balances, because if it’s owned by one process, you can see how things are going. You develop a commitment to results. Then you are committed to preventing anything that can hinder you from achieving results. And when we say ownership in Ethiopia, it goes all the way to the grassroots. The best ownership is when it’s owned by the community. So people are informed, they know what is going on, they know what we are doing where. We involve them in planning, we involve them in monitoring and evaluation. They check us. That can prevent any corruption from happening. When I say ownership, it should be owned by the people.

Q: USAID Administrator Rajiv Shah said in this series that ownership is important, but what’s more important in achieving the MDG goals is to "seriously innovate" and bring things to scale. Is he correct?

A: Ownership and innovation go together. If the country owns it, then it’s easier to scale it. We are asking for ownership so we can bring things to scale. We are bringing things to scale now! In the last five years, we have distributed 36 million nets (for malaria prevention). This is really big. In the last five years, we have built 14,000 health posts. Is that not scale? It’s scale. Every village is covered now. We have trained and deployed more 34,000 health extension workers – two per village, working to transfer ownership to communities, showing them how to prevent malaria, HIV and TB and other diseases. If there is ownership, there is scale. If there is no ownership, you will see fragments of things.

In the Driver’s Seat: A Series on Country Ownership of Health Programs

Part 1: WHO's Chan: 'Some countries are angry'

Part 2: Shah: 'We want real outcomes in health'

Part 4: Wisman: Donors need to `take a little risk’

Part 5: Omaswa from Uganda: `Donors want a controlling say’

Part 6: From Nepal: `We build step by step’

Part 7: From Mali: `We have a lot of control now’

Part 8: Sturchio: 'The focus should be on outcomes'