This health millennium developmentgoals (MDGs) program for results (PforR) operationcontributes to Ethiopia's fourth health sectordevelopment program (HSDP-IV) objectives by disbursingagainst achievement of a subset of its key results. MDGperformance fund (PF) supports a sub set of key prioritiesfor HSDP-IV. The three areas that the MDG PF supports are:(i) maternal health, (ii) child health, and (iii)strengthening health systems. The presented P4R operationwill provide 100 million dollars International DevelopmentAssociation (IDA) funding for the MDG PF provided agreedresults have been achieved and have been verified. The IDAcredit will be complemented by a United States (U.S.) 20million dollars grant under the health results innovationtrust fund (HRITF). The assessment examined programexpenditure framework to determine whether it iscomprehensive, clearly defined, and determination whether itis part of the borrower's budget and financialmanagement processes. It also focused on key elements ofprogram procurement arrangements. The key risks identifiedby the integrated fiduciary systems assessment arise fromthe performance of the pharmaceutical fund and supply agency(PFSA), which is critical for PforR operation, andresponsible for procuring and distributing most of thehealth products required for producing the results. Theassessment concludes that the examined program financialmanagement and procurement systems are adequate to providereasonable assurance that the financing proceeds will beused for intended purposes, with due attention to principlesof economy, efficiency, effectiveness, transparency, andaccountability and for safeguarding program assets.