Gender-focused ODA to health and agriculture in Ethiopia

Official development assistance (ODA) is facing unparalleled pressures from growing, competing demands including humanitarian and crisis response, national development priorities, and investment in global public goods (such as tackling climate change), among others. Development Initiatives (DI) seeks to highlight the value of ODA in programmes that are national priorities to recipient countries. In addition, DI aims to enhance the understanding of enabling factors that contribute to improving the impact of aid.

Led by national demand for international finance data and evidence on its most appropriate use, DI embarked on producing a series of country case study reports to consider how aid has been more effective in specific development sectors in Ethiopia, Kenya and Uganda (forthcoming), including trends, the factors that unlock the value of aid, and the challenges that lie ahead.

This country report for Ethiopia presents evidence regarding factors that are attributable to national ownership of ODA, and the alignment of these resources to national priorities, fostering an enabling environment for significant development outcomes. The report focused on programmes in the health and agriculture sectors, characterised by a high proportion of ODA and a gender focus.

Among other key findings on volumes and development outcomes, we find that in the programmes studied, vital factors establishing ownerships are:

• government coordination and implementation
• political leadership and commitment
• enabling policies

Vital factors establishing alignment to national plans are:

• streamlined management of resources and implementation
• streamlined planning and reporting
• flexible funding in the form of pooled funds
• ‘fit for purpose’ (scalable and adaptable) approaches.

You can read more about the approach we took and other key findings in the executive summary.

Download the full report.

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Our approach

A focus on aid effectiveness

In 2005, government ministers and heads of multilateral and bilateral institutions made a resolution to deliver and manage aid better. From Paris to Accra to Busan, attempts have been made to define and promote ways to boost aid effectiveness and establish development effectiveness frameworks at the global level. There are measures of aid effectiveness with globally agreed-upon principles and indicators. The two guiding principles of aid effectiveness this paper considers are: ownership (developing countries setting their own strategies for poverty reduction, improving their institutions and tackling corruption) and alignment (donor countries align behind these objectives and use local systems).^[1]

Effectiveness requires an enabling environment

The effectiveness agenda argues that while the quantity of funding is a necessary condition for achieving positive development outcomes, it is not a sufficient condition in itself unless accompanied by an appropriate enabling environment created through the policy and operational practice of donors and partners. This paper considers how the principles of ownership and alignment to national agendas manifest and impact development outcomes at the country level through the consideration of national development programmes in two sectors in Ethiopia.

This paper identifies specific enabling elements that result in tangible development outcomes from official development assistance (ODA). It attempts to make attribution to the aid sector for progress made in programmes whose capital budgets^[2] are heavily donor dependent and establish the enabling factors on the ground. It is important to note that the intention of the paper is not to establish causality between aid and development outcomes nor conduct impact evaluation.

Consultation to ensure relevant case studies

To ensure analysis of this paper generated directly applicable evidence, DI consulted with relevant development actors in Ethiopia to co-identify the programmes and their associated sectors for assessment. After establishing sectoral ODA trends in Ethiopia, we approached development partners, two consortia of implementing agencies and ministries and state departments to further understand the aid landscape of Ethiopia, success stories within sectoral programmes, evidence of functional donor–government coordination together with state development priorities. Appendix 3 contains a complete list of the KIIs we undertook. This exercise led to the selection of programmes from two national priority sectors that have also received the largest volumes of ODA support over the last 15 years: health and agriculture.

The consultation exercise also identified gender as a priority for analysis. Using the OECD gender marker, we identified health and agriculture ODA projects with explicit gender objectives and reviewed them with stakeholders. Through consultation with stakeholder priorities, informed by quantitative analysis on ODA, the programmes in two sectors were identified as the focus of analysis:

• Under health, the two suites of programmes are sexual and reproductive health (SRH) and maternal, newborn and child health (MNCH).
• Under agriculture, the second level rural land certification programme.

The programmes have a heavy gender focus. While SRH and MNCH have an obvious direct gender link, the rural land registration has been identified as catalytic for women’s social economic empowerment in the country’s National Development Plans. These affirmed actions to ensure the benefits of women in economic growth and social development. In both cases, while donor support in meeting capital costs has been particularly significant, they were also suggested by development actors as priority programmes to analyse.

Quantitative and qualitative analysis

Analysis of these programmes assessed both national and international support, alongside programme outcomes. We reviewed national socioeconomic data, programme assessments and undertook key informant interviews to identify critical enabling conditions to maximise the impact of foreign aid in nationally owned, gender-focused programmes.

Validation of the findings

Eight peer reviewers in Ethiopia reviewed this report. Two actors (a development partner and the Consortium of Reproductive Health Associations (CORHA)) reviewed the health component. Five actors (the MoA and development partners) reviewed the agriculture sector. The paper was also reviewed overall by an Advisor at the Ministry of Finance. We presented the health component of the paper at a validation workshop where we received rich insights from the MoH and members of CORHA, among others. We have shared the outcomes of the workshop and our presentation with the Minister of Health and her state department ministers.

Key findings

The finance landscape (FY2015/16−2020/21)

• Health sector interventions have benefitted heavily from ODA, which comprised 94.3% of funding to sexual and reproductive health (SRH) and maternal, newborn and child health (MNCH) while the capital budget from the national government funded the rest.
• Under agriculture, the Sustainable Land Management Program (which includes rural land certification) has been over 99% funded by foreign aid, and the capital budget of the national government covered the remaining 1%. This is possibly because of the costly nature of some of the activities including the certification exercise with technological requirements.^[3]

Development outcome indicators

Ethiopia has been making impressive progress on development outcome indicators for both heavily donor-dependent programmes:

• Across health (SRH/MNCH): Since 2005, both maternal and child mortality have halved, and fertility rates have reduced due in part to a 193% increase in the use of contraceptives among married women. New HIV infections are down 68%, and there have been reductions in unsafe abortions. National health data also indicates significant increases: the number of children delivered in a health facility has increased by 860%, and there has been an 83% increase in the vaccination of infants.
• Across agriculture, the flagship second-level land certification has made the economic empowerment of rural Ethiopian women possible. For example, it enables access to credit, with a disproportionally positive effect on the capacity of female-headed households to invest in productive activities – including by giving them access to credit and enabling them to participate in the land rental market. It has especially benefited married women, as it is conditional on joint titling as well as entitlement of female headed households. This has enhanced tenure security and reduced land related disputes.

Factors reinforcing the principle of national ownership

• Government as the overall lead: In the programmes, the Ministry of Health (MoH) and Ministry of Agriculture (MoA) take the lead role in coordination and implementation of donor-funded programmes. This has allowed the country to implement ambitious sector plans and align interventions with other ongoing programmes and strengthen institutional frameworks.
• Political leadership and commitment: The rural certification programme and health extension programmes are flagship programmes, which garnered the support of political leadership at both federal and regional levels down to Woredas/districts and Kebele/ward levels. Particularly in the health sector, the personal commitment, vision and open advocacy by ministers at various times in the last two decades, were mentioned by key respondents as a critical factor of success in the sector.
• Enabling policies: Progressive global and continental commitments, particularly in the health sector, have served as impetus for ambitious domestic health strategic plans. It is noteworthy that sector specific policies implemented within the two sectors are not the sole contributors to the success in the programmes. A case in point is the 2019 policy change implemented by the National Bank of Ethiopia that permitted farmers to use their land use rights certificates as collateral to access loans from banks and microfinance institutions. This policy has revolutionised land use in Ethiopia, transforming it from being dead capital into an actively market-integrated asset.

Factors reinforcing the principle of aid alignment

• Management of resources and implementation: The Ministry of Finance at the Federal level is the only institution that has the mandate to enter into agreements with donors for any on-budget support to ensure agreements are based on national priorities. This streamlined approach for monitoring purposes signifies that other ministries, and even regional governments, lack the authority to directly receive external funding donors.
• Pooled fund mechanism: In the health sector, the Sustainable Development Goals (SDG) Performance Fund (SDG pooled fund) gives flexibility to the MoH to manage and align external funding to the sector’s priorities.
• One Plan, One Budget, One Report (the Three Ones): In the health sector, the ‘Three Ones’ approach has helped the country to have zero tolerance towards parallel reporting systems and fragmented and disjointed activities. It has helped the country to streamline interventions and align and mobilise partners in the effort to strengthen the health system.
• Fit-for-purpose approaches: Nationally, an enabler in the health or agriculture sector is termed a ‘fit-for-purpose’ approach. Such approaches minimise time and cost but are also easily adaptable to context and understood by locals.
  • In the health sector, since early 2000s, the country has mobilised 40,000 professional health extension workers at the lowest level of administration to reach communities directly, aided by deeper grass-roots support from millions of part-time volunteer Women’s Development Army. This has helped in facilitating access to healthcare for households in remote areas of the country, particularly for women and adolescents. Closely linked to this is the task-shifting service delivery strategy.
  • In the agriculture sector, to address the shortage of trained surveyors during the Ethiopian land certification process, young people with a minimum of a 10th-grade education were enlisted as para-surveyors. This approach allowed for a more efficient and effective land certification process, shortening the time of surveying.

Practical challenges impacting the future effectiveness

We identified challenges that are either programme specific or applicable to the overall respective sectors.

• For programmes whose capital budgets depend on donor money (for example, the country spends only 5.7% on average on SRH and MNCH, and the rest comes from aid), the issue of sustainability is a huge concern.
• Particularly for the health sector, challenges include significant regional disparities in health outcomes, external shocks leaving the health sector in a constant state of emergency, and potential challenges in sustaining gains in the Women’s Development Army achievements.
• Lastly, the pace of the rural certification programme could potentially drive inequalities among Ethiopian farmers, if not managed carefully.