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Ethiopia’s Committed Expansion of Basic Services

 

Tihtna Belay  01-27-16

In the past two decades, Ethiopia has continued to make remarkable progress in basic service delivery as in education and health in a way that promotes equitable access to services. Investing in human development is key to long term growth and transformation. This rapid expansion of basic services has helped Ethiopia in achieving the MDGs as related to gender parity in primary education, reducing child mortality, fighting HIV/AIDS, malaria and access to primary education.

The primary education net enrolment rate (NER) increased from 82.9 percent in 2009/10 to 92 percent in 2014/15. Secondary education first cycle (grade 9-10) gross enrolment rate (GER) stood at 39.7 percent. The preparatory education (grad 11-12) GER increased from 7 percent (male 8.9 percent, female 5 percent) in 2009/10 to 10 percent (male 10.7 percent, female 9.1 percent) in 2013/14 and estimated to reach 19.8 percent in 2014/15. The achievement is higher than the targets set for the end of the GTP period.

Regarding maternal and children health care, under five child mortality rate (U5CMR) was reduced from 204/1000 in 1990 to 64/1000 in 2013/14. Improvements in nutrition, effective implementation of the disease prevention programs and first stage medical treatment and changes in economic and social development have resulted in improvements in child health and the reduction in U5CMR.

In thus, encouraging results have been registered towards achieving the millennium development goals such as reducing under 5 child mortality rate and maternal mortality rate, combat HIVAIDS, malaria and tuberculosis. The U5CMR was reduced from 204/1000 in 1989/90 to 64 in 2013/14.

One of the instruments in this progress is the Promoting Basic Services program which is an essential component of Ethiopia's war against poverty and the cooperation with foreign development partners. 

PBS is a program that operates nationwide and contributes to expanding access to, and improving the quality of, basic services such as education and health to support Ethiopia in reaching the Millennium Development Goals. This is achieved by supporting direct grants to local authorities that ensure adequate staffing and operations for such basic services, and by strengthening local capacity, transparency, accountability and financial management systems. It is a multi-billion program funded by the Ethiopian government and supported by a number of Development Partners (UK, EU, AfDB, Austria and Italy) including the World Bank.

The PBS program was launched in 2006, and as the third phase of the program, called PBS 3, benefits from six years of program implementation. With close collaboration, the Government, IDA and other DPs created the nationwide PBS program, which brings together the Government and multiple donors to support and improve basic service sectors through sub-national levels of government. PBS 3 was approved by the Board on 25 September 2012, with a total financing of USD 600 million of IDA financing. IDA also manages a multi donor trust fund for the program of more than USD 700 million.

PBS 3 contributes to the higher-level objective of expanding access and improving the quality of basic services by funding block grants that ensure adequate staffing and operations, and by strengthening the capacity, transparency, accountability and financial management of governments at the regional and local authorities levels. The program defines basic services as education, health, agriculture, water supply and sanitation and rural roads

A nationwide program, PBS supports through the block grants woreda-level recurrent expenditures for basic services across the country, excluding Addis Ababa, which does not receive a federal block grant. In addition, the capacity building efforts of the program benefit the quality of local government services for Addis Ababa as well. As such, its beneficiaries include the population of Ethiopia. Thus, the program beneficiaries number 84 million of which 42.6 million (50.4 percent) are males and 41.8 million are females (49.6 percent).

The PBS program involves six donors --- the African Development Bank, Austrian Development Agency, the European Union, the UK Department for International Development (DFID), Italian Development Cooperation and the World Bank. The program reflects a strong partnership across the PBS donors and between the donors and the Government of Ethiopia. The PBS Secretariat is central to making this partnership work and is hosted by the World Bank.

Since 2006, the PBS program has supported decentralized delivery of health, education, water and sanitation, agriculture and (since 2009) rural roads.

The most recent Joint Review of Implementation and Support (JRIS) mission of PBS III took place in April, 2015 found that the program has continued to achieve results on sectoral service delivery against the targets.

Net enrolment in upper primary education (Grades 5-8) slightly increased from 47.3 % in 2010/11 to 49.5% in 2013/14. Student-teacher ratio as well as proportion of qualified teachers in primary school has improved through the past years. The student-teacher ratio for primary school has reduced to 47:1 in 2013/14 from 50:1 in 2011/12. The proportion of qualified teachers in primary schools has reached 70% in 2013/14.

Penta-3 vaccination coverage has progressed during the years of PBS III implementation. It reached 91.1% in 2013/14 from 84.9% in 2011/12, surpassing the target of 90.5% set for the year.

With regard to Water Supply, Agriculture, and Rural Roads —water supply in rural areas reached 75.5% coverage in 2013/14, average productivity of main crops for 2013/14 reached to 20.3 Quintals including both Meher and Belg seasons, and average travel time taken to reach all-weather roads on foot was reported to be 1.8 hours. Overall, the reviewed observed that these outcomes were major contributors to the country’s continued progress towards the MDGs and its GTP goals.

Another recent donor document confirmed that PBS has resulted in impressive development achievements. It highlighted that:

PBS has played an essential role in achieving several of the MDGs for more than 80 million Ethiopians across the country. For example, the PBS program has supported hiring of 100,000 primary school teachers and 35,000 primary health workers.

Based  on this decentralized service delivery approach in Ethiopia, the under  age  5 mortality rate has fallen from 123 per thousand in 2005 to 88 in 2010;  and there have been dramatic increases in net and gross primary education enrolment rates, and in the share of the rural population with access to clean water. 

Indeed, the PBS has been shown to be a very effective strategy for Ethiopia to attain its MDGs. This fact has been quantifiably demonstrated in each sector.

One example is the spending on health and education, which accounts for almost 80 percent of PBS-financed spending by the woredas and used to partially cover salaries of health extension workers (HEWs) and teachers.

Owing to the intervention of health extension workers (HEWs), the use of health services has increased, especially among the poorest quintiles. Every additional US$1 of per capita  health  spending by woredas is associated with increases  in the  use of contraceptives ( 6.4 percent) and  deliveries by skilled birth attendants (11.3 percent),both of which  can reduce maternal mortality dramatically,  as well as an  increase in antenatal care (3.6 percent), which can reduce infant and child mortality significantly.

For education, an increase of US$ 1 per capita in spending by each   woreda is associated with a 3.6 percent increase in the net primary enrollment rate. Similar results are seen for the pupil-teacher ratio.

Similarly, increased woreda -level spending on agricultural extension workers is associated with higher yields for major crops, including cereals, vegetables, enset, coffee and fruit. Spending on agricultural extension workers increases the probability that farmers, regardless of the size of their plots, will use improved farming techniques. 

Despite all the achievements, self-proclaimed rights groups targeted PBS for years, bringing one allegation after another. The latest attempt was based on the claim that the PBS is used to support the Commune Development Program (CDP).

Indeed, the CDP is a legitimate program designed to meet five major objectives, which are: enabling the communities dispersed in various parts of the regions to join together to establish a central village for sustainable and stable way of life; facilitating access to basic development services and amenities to the people; raising the livelihoods of the communities that are totally dependent on cattle raising to a more productive semi-pastoralist stage; ensuring food security and enabling the people partake in the benefits of sustainable development and of good governance.

Moreover, the Development Assistance Group ETHIOPIA (DAG), which consists representatives of western governments and development agencies residing in Addis Ababa gave its testimony on 18th March 2014 in the following words:

We found that the implementation of the COP has improved over time, and that the  Ethiopia has increasingly provided information to communities about resettlement in terms of timing and objectives. In areas where the program has been in place for some time, the quality of basic services was, even if delayed in many places, found to be the same, as good as or better than it had been where they lived previously, with people often saying that they preferred the new village, even when they had not initially wanted to move. In terms of livelihoods, it was too early to tell if these would improve, but where irrigated land and or improved extension services were being made available, this potential was there, However, there is a need to ensure that people who are moving to areas with different livelihoods practices get the necessary extension and education services to enable them to take advantage of new livelihoods opportunities.

Nonetheless, there is no link between the PBS and CDP. The detractors of Ethiopia's developmental path raised CDP, so as to exploit the misinformation and apprehension that development partners have on villagization programs.

The detractors made more wide reaching allegations on the PBS itself. That is the on-going PBS phase 3 program, which is a multi- year program totaling US$6 billion and funded by the  Ethiopian government as well as by a number of Development Partners (UK, EU, AfDB, Austria and Italy) including the World Bank.

The World Bank’s share is US$600 million, which funds approximately 9 percent of salaries of civil servants in the health and education sector which includes components that develop local capacity for citizens’ engagement – through financial transparency and accountability, a social accountability program, and grievance redress mechanisms which are critical to success.  

However, the World Bank's review attested that:

One of the key principles underlying PBS that of equity, is whether PBS program resources channeled to the woredas are reaching Ethiopia’s historically disadvantaged regions and ethnic groups.  Management can confirm that in terms of basic service expenditure per capita, the current system broadly favors Ethiopia’s historically disadvantaged regions compared to the historically dominant ones. 

More than 50 percent of the woredas in   Gambella and 30 percent in Benishangul  Gumuz—the two most disadvantaged regions of the country —spend more than 110 percent of the national   average per capita on the basic service sectors. Spending also appears to favor some historically disadvantaged ethnic groups, in accordance with constitutional mandates. Indeed, five majority-Anuak  woredas are noteworthy for receiving the most public resources per person of all woredas in the nation.

Moreover, the PBS itself is strengthening those mechanism. The PBS citizens’ engagement component – including social accountability and financial transparency – has increased opportunities for constructive collaboration between citizens and the state to improve basic public services.

The review highlighted that:

Even though woredas must operate under federal guidelines, they still exercise a significant amount of discretion that can affect the quality of life and services. In a survey on financial transparency, covering a sample of thousands of local people in pilot areas, more than 84 percent responded positively   to social accountability initiatives, which had increased citizens’ awareness of their rights, responsibilities, and entitlements to basic services.

After service providers and users drew up joint service improvement plans, basic services improved, and so did the quality of the engagement between citizens and service providers. Through the financial transparency and accountability component of the PBS program, citizens have become more aware of the government budgeting process. As a result, they are advocating more effectively for their rights. The PBS program has also improved the efficiency of resource use by improving financial management and procurement capacity at the woreda level.  

Furthermore the review confirmed that the grievance redress mechanisms in place are working and enabling citizens’ voices are heard with respect to government services.

Supporting this conclusion with the data, the review stated:

A grievance redress mechanism provides the opportunity for an impartial third party to review a transaction that has taken place between the government and a citizen or a group of citizens. As evidence of its value, a recent visit to Amhara and Tigray Regions found that in those regions, some 400-500 people per woreda, per year, are submitting complaints through this mechanism.  Through dialogue and technical and financial support, PBS 3 is strengthening the Ethiopian Institution of the Ombudsman and the regional Grievance Hearing Offices, which offer these services. 

Indeed, the PBS is one of the few examples of a development program that has clearly quantifiable achievements. Indeed, not only does PBS meets its objectives, it has helped to make government spending more effective. 

As the financial breakdown of the PBS demonstrated, education (62 percent), health (17 percent), and agriculture (18 percent) account for 97 percent of woreda spending, which in turn constitutes 97 percent of PBS-financed Woreda spending. This is complemented by support for greater engagement among citizens, improvements in local capacity to manage resources, and better access to information on national and local budgeting and development objectives. While it is difficult to provide precise estimates of the impact of the latter activities, the direction of their effect is clear: spending efficiency is improved through better capacity, more transparency, and greater accountability to citizens.

In particular, the Bank's review confirmed that:

The benefits of PBS-financed spending at the woreda level on health, education, and agriculture accrued to all income levels.   Woreda-level spending on health and education is particularly pro -poor: 58 percent Ethiopias to the two bottom wealth quintiles; this compares very favorably to 33 percent of total spending (including woreda spending) in these sectors going to the bottom 40 percent.  In agriculture, woreda-level spending (primarily for agricultural extension workers) drives increases in output and the adoption of new, improved methods across all asset quintiles.

However, as compared to the distributional impacts of education and health spending, the magnitude of the effect in agriculture was smaller for the bottom quintile, perhaps because of a lack of availability of financing to purchase productivity -enhancing inputs that development agents recommend.

Before concluding this piece, it would be vital to bring into readers' attention some of the main points from the overall assessment and remark of the World Bank leadership regarding Ethiopia.

Economic growth has helped reduce poverty in both urban and rural areas. Since 2005, 2.5 million people have been lifted out of poverty, and the share of the population below the poverty line has fallen from 38.7 percent in 2004/05 to 29.6 percent in 2010/11 (using a poverty line of close to US$1.25/day).

Ethiopia is currently implementing its ambitious Growth and Transformation Plan, which sets a long -term goal of becoming a middle -income country by 2025, with growth rates of at least 11.2 percent per year   during the plan period. Ethiopia has followed a “developmental state” model with a strong role for the government in many aspects of the economy.

 


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