Parliament Grills Health Officials Over Irregular Audit Findings, Weak Epidemic Preparedness

MPs express concern over regression in fight against malaria

Members of Parliament pressed officials from the Ministry of Health this week to provide  explanations for financial gaps revealed in audit reports, lagging service delivery, and weaknesses in epidemic preparedness.

The parliamentary Standing Committee on Health, Social Development, Culture and Sports Affairs gave audit-related lapses at the Ministry and other health institutions precedence as its members conducted a wide-ranging review of the health sector’s first-quarter performance.

MPs also interrogated Ministry officials on maternal health, nutrition, disease outbreaks, pharmaceutical supply, and the rollout of insurance reforms.

The Committee began its questioning by citing a report tabled to Parliament by the Office of the Federal Auditor General in June 2025, which detailed roughly 7.27 billion Birr in unresolved audit findings across the Ministry and its affiliated institutions.

Lawmakers said the size of the discrepancies points to persistent weaknesses in documentation, revenue collection, and compliance with federal financial rules.

The bulk of the financial irregularities were attributed to the Ministry itself, and include transactions that auditors argue do not meet legal or procedural requirements.

Among the findings was 170 million Birr in transactions at Amanuel Mental Specialized Hospital, the most sizable irregularity outside of the Ministry’s own balance. Yeka Kotebe General Specialized Hospital followed with slightly over 30 million Birr, while the Ethiopian Public Health Institute (EPHI) was cited for more than 21 million Birr in irregularities.

Several other institutions were also flagged. Both St. Paul’s Hospital Millennium Medical College and the Ethiopian Health Insurance Service carried around eight million Birr each in unresolved items, while Alert Comprehensive Specialized Hospital registered slightly more than four million Birr, and the Ethiopian Blood and Tissue Bank Service was cited for under one million Birr.

“These were presented as audit findings,” committee members stressed, demanding clear accountability mechanisms. “What is being done to safeguard government and public resources and ensure operations follow the law and regulations? What plan has been prepared to rectify these audit findings?”

Officials responded by saying the audit discrepancies arise from the purchase and distribution of medicines as part of epidemic response operations.

A representative from EPHI told lawmakers that the payments involved were legitimate and made out to the Ethiopian Pharmaceuticals Supply Agency (EPSA).

“The payments mentioned were made for these medicines,” he said, adding that gaps in documentation have since been corrected.

The Committee also questioned the Ministry over incomplete audits within the electronic health insurance system, ESAN.

When the last fiscal year concluded, barely more than half of the 475 community-based health insurance institutions slated for audit had actually been audited. Similarly, less than 3,000 of the planned 3,625 health posts were audited for claims, while 65 hospitals across the country were also omitted.

“Why was the ESAN claim audit not completed as planned? Where do the audit findings—both claim audits and financial audits—currently stand?” asked one MP.

Committee members also demanded status updates on preparations for launching community-based social health insurance for civil servants and pensioners as required by law.

Before shifting to epidemic preparedness, the MPs highlighted declining performance in core public-health services.

They noted that postnatal family planning and long-acting family planning coverage remained low, and that the Ministry had not identified coverage levels of safe abortion services.

Nutrition-related services also registered underperformance, including growth monitoring and promotion for children under two, and provision of Vitamin A supplements and treatment of intestinal worm infections.

Another major concern was the low rate of medicine availability, which reports place at 81.3 percent, below the national target. MPs raised concern about reports of significant stock accumulation in central and branch warehouses, and demanded an explanation as to why medicines are not being deployed to service delivery points.

MPs also questioned why more than 74 percent of revenue expected from the sale of medicines has gone uncollected despite a new regulation allowing the EPSA to withdraw funds directly from the accounts of health facilities if they fail to service their payables within a six-month window.

Abdulqadir Galgalo (MD), director-general of the state-owned EPSA, told MPs that while the agency had collected five percent of expected revenue over the first quarter, he expects the figure to rise significantly in the coming months as health institutions near the six-month deadline.

The Director-General said that the recently changed procurement laws have “created significant momentum and awakening within our institution and across the sector.”

EPSA reported that 4,978 health facilities have entered contract-based digital supply agreements and 85 percent of these facilities had already collected medicines at least once.

Abdulqadir stated that the remaining 15 percent (746 facilities) had not yet collected supplies and that facilities submitted requests totaling 25.5 billion Birr worth of medicines.

According to the Director-General, EPSA has stocked 58 percent of items committed for first-quarter delivery and expects 75 percent coverage after second-quarter procurement arrives.

“This is a major transformation,” he said, emphasizing that under the proclamation, “facilities determine their own needs and commit their budgets.”

The agency is stocking 68 new medicines, mostly imported and previously outside the national supply list, according to the Director-General.

Abdulqadir told MPs his agency expects domestic pharma manufacturers to supply medicines valued at 10 billion Birr this year, with 2.2 billion Birr worth of products already delivered and 2.9 billion Birr doled out in advance payments in a bid to support local production.

Committee members also grilled health officials about slow responses and rising burdens in regard to epidemics and outbreaks. Malaria, in particular, was a point of concern for MPs.

A World Health Organization (WHO) report from late 2024 indicates that while Ethiopia recorded lowest-ever malaria case count in 2019, progress in fighting the vector-borne disease has largely been undone over the past four years.

“Towards the end of 2021, [Ethiopia] began experiencing a resurgence of the disease. Starting in 2022, malaria epidemics have been reported across most regions, accompanied by a notable upward trend in cases year-over-year,” reads the October 2024 report.

The WHO says malaria cases in Ethiopia more than tripled to 4.1 million between 2021 and 2023, while 7.3 million cases and 1,157 deaths were reported over the first 10 months of 2024.

MPs highlighted the worrying trend and questioned the Ministry’s preparedness and ability to mount an effective response.

In response, Mesay Hailu (PhD), EPHI chief, claimed that malarial transmission in woredas heavily hit by outbreaks has fallen by more than half following intensive response efforts carried out in partnership with local and regional administrations.

Mesay also outlined extensive preparedness measures, including vulnerability and risk assessments conducted in more than 1,300 woredas, and weekly surveillance and reporting for 36 priority diseases, including malaria.

Addressing concern from MPs about polio, rabies, and cholera, Mesay stated that more than 10,000 children residing in border areas were vaccinated as part of a cross-border prevention program.

He reports zero rabies cases over the past four months, and significant progress in taming cholera outbreaks although the waterborne disease persists in high-mobility areas, requiring sanitation and clean-water interventions.

He said modernized surveillance and quicker early detection had “significantly reduced the time required to respond [to outbreaks].”

The Committee questioned the Ministry’s coordination with stakeholders in community-led disease prevention, malaria control in high-risk areas, and outbreak management at large. It also pointed to underperformance in HIV-related services—specifically, PMTCT and antenatal liver-disease screening.

“What strategy has the Ministry developed to improve these activities?” members asked.

Performance regarding non-communicable diseases (NCDs) was also reportedly low.

The Committee demanded updates on the implementation of three proclamations approved by Parliament in recent years, including the Community-Based Health Insurance Proclamation, the Health Service Administration and Control Proclamation, and Ethiopian Pharmaceutical Fund and Supply Proclamation.

“What work has been undertaken to issue regulations and directives and to start implementation?” asked one MP.

EPSA officials responded that 12 directives were under development or implementation.