Resource Mobilization for Health in Devolved Context: The Ethiopian Experience

The following sections are included:Implementation of fiscal decentralization has had limited success in terms of creating fiscal space with woreda (district) resources more “tied” than federal and regional governments’ as most of their resources go to recurrent budget, especially for salaries.Domestic resource mobilization through user fees, including retention and utilization of user fees, was effective, both in terms of the number of facilities in which it is implemented and in the magnitude of resources being generated and used for quality improvement at the facility level.Ethiopia developed a series of financing arrangements and modalities to effectively align external support with government priorities for health and used these resources to reach the very poor and deliver results — indicating the value for money. This encouraged other development partners to support Ethiopia’s health sector.The impact of OOP on utilization, especially by the poor remains a concern, but introduction and scale-up of CBHI should alleviate the burden of OOP at the point of use with evidence suggesting that this insurance scheme minimizes catastrophic spending and impoverishment.There is evidence of significant inefficiency in services delivery, but more evidence about its causes and remedies is needed