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For decades, corruption in Ethiopia has been discussed only at the margins. Perhaps because many have not experienced corruption as a significant constraint to their lives and businesses, or perhaps because a culture of circumspection has dampened open dialogue, Ethiopia has seen neither the information flows nor the debate on corruption that most other countries have seen in recent years. To address this information gap, the World Bank agreed with the government of Ethiopia and its Federal Ethics and Anti-Corruption Commission (FEACC) to undertake research and produce an independent overview of corruption, identify follow-up actions to these diagnostics, and articulate the proposed approach in an anti-corruption strategy and action plan for Ethiopia. This publication fulfills the first stage of the process through a set of preliminary studies that map the nature of corruption in eight Ethiopian sectors, focusing on three key objectives: 1) develop sector frameworks that enable mapping of the potential areas of corruption on a sector-by-sector basis; 2) map the different forms and types of corrupt practices in the selected sectors; and 3) consider the higher-risk areas and identify appropriate sector or crosscutting responses for government and other stakeholders.

Ethiopia has made major strides in improving its human development indicators in the past 15 years, achieving significant increases in the coverage of basic education and health services in a short period of time. Imrovements took place during a period of massive decentralization of fiscal resources, to the regions in 1994 and to woredas in 2002-03. The devolutionof power and resources from the federal and regional governments to woredas appears to have improved the delivery of basic services. Surveys of beneficiaries reveal that they perceive that service coverage and quality have improved. Beneficiary satisfaction has increased markedly in education, and less conspicuously in water and health services. In the south, the decentralization to woredas 2002-03 tended to narrow differences in per capita expenditures on education and health across woredas. Decentralization disproportionately favored woredas that are remote (more than 50 kilometers from a zonal capital), food-insecure, and pastoral, suggesting that decentralization has been ppro-poor. Decentralization also narrowed the gap in educational outcomes between disadvantaged and better-off woredas, especially in the south. Pastoral, food-insecure, and remote woredas gained in terms of the educational outcomes examined (gross enrollment rates, grade 8 examination pass rates, repetition rates, pupil-teacher ratios, and teacher-section ratios).

Ethiopia, like most developing countries, has opted to deliver services such as basic education, primary health care, agricultural extension advice, water, and rural roads through a highly decentralized system (Manor 1999; Treisman 2007). That choice is based on several decades of theoretical analysis examining how a decentralized government might respond better to diverse local needs and provide public goods more efficiently than a highly centralized government. Ethiopia primarily manages the delivery of basic services at the woreda (district) level. Those services are financed predominantly through intergovernmental fiscal transfers (IGFTs) from the federal to the regional and then the woreda administrations, although some woredas raise a small amount of revenue to support local services. Since 2006, development partners and the government have cofinanced block grants for decentralized services through the Promoting Basic Services (PBS) Program. Aside from funding the delivery of services, the program supports measures to improve the quality of services and local governments capacity to deliver them by strengthening accountability and citizen voice.

As a low-income country, Ethiopia has made impressive progress in improving health outcomes. This report examines how Ethiopia's Health Extension Program (HEP) has contributed to the country's move toward Univeral Health Coverage (UHC), and to shed light on how other countries may learn from Ethiopia's experiences of HEP when designing their own path to UHC. HEP is one of the government's UHC strategies introduced in a context of limited resources and low coverage of essential health services. The key aspects of the program include the capacity building and mobilization of more than 30, 000 Health Extension Workers (HEWs) targeting more than 12 million model families, and the mobilization of \"health development army\" to support the community-based health system. Using the HEP-UHC conceptual model and data from Demographic and Health Surveys, the study examines how the HEP has contributed to the country's move toward UHC. During the period that the HEP has been implemented, the country has experienced significant improvements in many dimensions: in terms of socioeconomic, psychological, behavioral, and biological dimensions of the beneficiaries and in terms of the coverage of health care services. The study finds an accelerated rate of improvements among the rural, less-educated, and the poor population, which is leading to an overall reduction in equity gaps and improvements in the equity indicators including the concentration indices - that suggest a more equitable distribution of resources and health outcomes. The HEP in Ethiopia has demonstrated that an institutionalized community approach is effective in helping a country make progress toward UHC. The elements of success in the HEP include the emphasis on community mobilization which identifies community priorities, engages and empowers community members, and supports their ability to solve local problems. The other aspect of HEP is the emphasis on institutionalization of the activities, which addresses the sustainability of community programs through high level of political commitment, and effective coordination of national policies and leveraging of support from partners. These findings may offer useful lessons for other low income countries facing similar challenges in developing and implementing a sustainable UHC strategy.

For decades, corruption in Ethiopia has only been discussed at the margins. Perhaps because many have not experienced corruption as a significant constraint to their lives and businesses, or perhaps because a culture of circumspection has dampened open dialogue, Ethiopia has neither seen the information flows nor the debate on corruption that most other countries have seen in recent years. This study attempts to fill this information gap. Conducted by the World Bank (with financial support from the UK, the Netherlands and Canada) in conjunction with the Federal Ethics and Anti-Corruption Commission of Ethiopia (FEACC), the study is an independent overview of corruption. It attempts to map the nature of corruption in eight sectors in the country. The studies focuses on three key objectives: (i) to develop sector frameworks that enable mapping of the potential areas of corruption on a sector-by-sector basis; (ii) to map the different forms, and types of corrupt practices in the selected sectors; and (iii) to consider the higher risk areas and identify appropriate sector or cross cutting responses for Government and other stakeholders. The sectors covered are health, education, water, justice, construction, land, telecommunications and mining. In designing the methodologies for undertaking the diagnostics, the sector experts developed approaches that most suited the sector and stakeholder context. However, a number of universal principles have guided the approach. One commonality in the methodology has been the effort to tap into the perceptions and knowledge of all stakeholders, be they politicians, senior government officials, private sector businessmen, civil society advocates or consumers of services.The diagnostics strongly suggest that, in Ethiopia, corrupt practice in the delivery of basic services is comparatively limited and is potentially

Malnutrition can be transient like an acute disease. More often, it is chronic, a lifelong, intergenerational condition beginning early in life and continuing into old age. Most under-nutrition starts during pregnancy and the first two years of life. After a child reaches 24 months of age, damage from early malnutrition is irreversible. Various indicators are commonly used to measure and monitor malnutrition, including rates of stunting, wasting, and underweight among children under five years of age (see the glossary for definitions and explanations). Stunting is a measure of long-term, chronic malnutrition. Wasting is a measure of more transient, acute, but reversible malnutrition. These two measures are often not highly correlated. Underweight is a composite index of stunting and wasting; an underweight child can be stunted, wasted, or both. The government of Ethiopia formulated and approved the first National Nutrition Strategy in February 2008 to concentrate efforts on reducing malnutrition. The National Nutrition Program was approved in December 2008 to implement the strategy following a programmatic approach. The Ministry of Health is the lead agency overseeing the program and implementing its key aspects; other ministries and sectors are also involved in the multisectoral effort to reduce malnutrition.

Background To address the multifaceted challenges associated with tuberculosis (TB) in-person directly observed therapy (DOT), the World Health Organization recently recommended that countries maximize the use of digital adherence technologies. Sub-Saharan Africa needs to investigate the effectiveness of such technologies in local contexts and proactively contribute to global decisions around patient-centered TB care. This study aims to evaluate the effectiveness of pillbox-enabled self-administered therapy (SAT) compared to standard DOT on adherence to TB medication and treatment outcomes in Ethiopia. It also aims to assess the usability, acceptability, and cost-effectiveness of the intervention from the patient and provider perspectives. Methods This is a multicenter, randomized, controlled, open-label, superiority, effectiveness-implementation hybrid, mixed-methods, two-arm trial. The study is designed to enroll 144 outpatients with new or previously treated, bacteriologically confirmed, drug-sensitive pulmonary TB who are eligible to start the standard 6-month first-line anti-TB regimen. Participants in the intervention arm (n = 72) will receive 15 days of HRZE—isoniazid, rifampicin, pyrazinamide, and ethambutol—fixed-dose combination therapy in the evriMED500 medication event reminder monitor device for self-administration. When returned, providers will count any remaining tablets in the device, download the pill-taking data, and refill based on preset criteria. Participants can consult the provider in cases of illness or adverse events outside of scheduled visits. Providers will handle participants in the control arm (n = 72) according to the standard in-person DOT. Both arms will be followed up throughout the 2-month intensive phase. The primary outcomes will be medication adherence and sputum conversion. Adherence to medication will be calculated as the proportion of patients who missed doses in the intervention (pill count) versus DOT (direct observation) arms, confirmed further by IsoScreen urine isoniazid test and a self-report of adherence on eight-item Morisky Medication Adherence Scale. Sputum conversion is defined as the proportion of patients with smear conversion following the intensive phase in intervention versus DOT arms, confirmed further by pre-post intensive phase BACTEC MGIT TB liquid culture. Pre-post treatment MGIT drug susceptibility testing will determine whether resistance to anti-TB drugs could have impacted culture conversion. Secondary outcomes will include other clinical outcomes (treatment not completed, death, or loss to follow-up), cost-effectiveness—individual and societal costs with quality-adjusted life years—and acceptability and usability of the intervention by patients and providers. Discussion This study will be the first in Ethiopia, and of the first three in sub-Saharan Africa, to determine whether electronic pillbox-enabled SAT improves adherence to TB medication and treatment outcomes, all without affecting the inherent dignity and economic wellbeing of patients with TB. Trial registration ClinicalTrials.gov, NCT04216420 . Registered on 2 January 2020.

The primary purpose of this study was to examine the role of good governance practices on public trust in local government. In this study, a conceptual model was developed and tested empirically in Ethiopia by selecting Bahir Dar City Administration. The data analyses yielded the following results. All independent variables were highly influential in describing the public’s level of trust in their local government. In this case, participants who perceived the existence of transparency, accountability, and responsiveness had greater trust in the City Administration than their counterparts.

A systematic review was conducted to evaluate the status and intake of iron, vitamin A, iodine, folate and zinc in women of reproductive age (WRA) (≥15–49 years) and pregnant women (PW) in Ethiopia, Kenya, Nigeria and South Africa. National and subnational data published between 2005 and 2015 were searched via Medline, Scopus and national public health websites. Per micronutrient, relevant data were pooled into an average prevalence of deficiency, weighted by sample size (WAVG). Inadequate intakes were estimated from mean (SD) intakes. This review included 65 surveys and studies from Ethiopia (21), Kenya (11), Nigeria (21) and South Africa (12). In WRA, WAVG prevalence of anaemia ranged from 18–51%, iron deficiency 9–18%, and iron deficiency anaemia at 10%. In PW, the prevalence was higher, and ranged from 32–62%, 19–61%, and 9–47%, respectively. In WRA, prevalence of vitamin A, iodine, zinc and folate deficiencies ranged from 4–22%, 22–55%, 34% and 46%, while in PW these ranged from 21–48%, 87%, 46–76% and 3–12% respectively. Inadequate intakes of these micronutrients are high and corresponded with the prevalence figures. Our findings indicate that nationally representative data are needed to guide the development of nutrition interventions and public health programs, such as dietary diversification, micronutrient fortification and supplementation.