Cros, Marion JaneGuracha, Tseganeh AmsaluSchramm, NoemiAdugna, Mideksa2025-07-152025-07-152025-07-15https://hdl.handle.net/10986/43459Ethiopia achieves a high overall rate of execution of its health budget. From 2016 to 2021 the health budget execution rate averaged 95 percent of the original budget allocation. The health budget execution rate was higher than the execution rates for overall government spending. The execution rate also increased each year. Nonetheless, the execution rate for regions was lower than for the federal government. The execution of the capital budget was also weaker, particularly at the regional and woreda levels. Data on execution rates for specific government programs are not available and may involve much more volatility than aggregated execution rates. Development partner spending managed outside of the federal Treasury also had much higher volatility in execution. Good practices that underpin Ethiopia's high execution rates include relatively low levels of arrears; reasonable turnaround times for payroll changes and high accuracy of payroll expenditures; timeliness and good communication of budgeting processes; and shortening of timeframes for transfers from federal to decentralized levels. Areas that hold back the quality of budget execution include limited transparency on execution data; capacity constraints at the facility and woreda levels; external resources being managed outside of government systems; limited flexibility of spending for health facilities; and overly simplified procurement processes that prioritise only the lowest price.en-USCC BY-NC 3.0 IGOGOOD HEALTHBUDGET EXECUTION CHALLENGESHEALTH FINANCING PERSPECTIVEPUBLIC FINANCIAL MANAGEMENTWorking PaperWorld Bankhttps://doi.org/10.1596/43459