The World Bank approved a total of $3.53bn (N5.4tn at the official exchange rate of N1,535/$) in health-related loans to Nigeria over the past nine years, The PUNCH reports.
However, the Medical and Dental Consultants’ Association of Nigeria, the Nigerian Association of Resident Doctors, the National Association of Nigerian Nurses and Midwives, as well as health officials in states, argued that despite the substantial funds committed to healthcare infrastructure in Nigeria and the loans from the World Bank, the results are not visible.
According to the industry operators, the country still has a poor state of health infrastructure that does not reflect the huge amount of loans that have been collected from the global financial firm.
A review of publicly available data on the World Bank’s official project portal revealed that between 2016 and 2025, at least 11 major health sector projects secured funding totalling $3.527bn in loans and an additional $111.29m in grants. This brings the total World Bank financial commitment for health-focused interventions in Nigeria to approximately $3.64bn during the period under review.
The PUNCH also observed that the global lender is expected to approve an additional $250m health-related loan to Nigeria in September, which would raise the total value of loans and grants for the country’s health sector to $3.89bn.
The funding, which cut across multiple health initiatives, was primarily channelled through federal institutions such as the Federal Ministry of Health, the Nigeria Centre for Disease Control, the National Primary Health Care Development Agency, and the Federal Ministry of Finance.
The financial support was aimed at boosting immunisation, maternal and child health, nutrition, pandemic preparedness, and primary healthcare services across several states. Data reviewed by PUNCH show that the bulk of the financing was secured between 2018 and 2024, with a significant surge occurring in the wake of the COVID-19 pandemic.
Operators speak
But operators in the medical space, as well as health officials in states, argued that despite the substantial funds committed to healthcare infrastructure in Nigeria, the results are not visible.
The President of the Nigerian Association of Resident Doctors, Dr Tope Osundara, said the country still has a poor state of health infrastructure that does not reflect the huge amount of loans that have been collected from the World Bank.
Osundara said, “You are also aware that at some point, power supply is a major problem. I am going to cite an example of what happened in UCH in recent times: there was no light. So, really, when you now look at the amount the World Bank is pumping into our healthcare system in Nigeria, you will discover that there is nothing really to show for it except that we now have more creation of health facilities, more creation of federal medical centres.
“Concerning the remuneration for healthcare workers, too, this is also very poor when you compare it to what the standard should be. So, the medical support for healthcare workers is not really there. You can hardly be able to access a loan, in terms of a mortgage, car loan. Some of these amenities that can make life easy and better for healthcare workers are not really there. It is not readily accessible.
“So, when you now begin to look at the amount of money the World Bank has loaned Nigeria, it appears like maybe there is a form of diversion away from what the money is actually meant for. Because if this money is actually there, we should see a whole lot of improvement. You go to the hospital sometimes, there is no drug, and no light.”
The NARD President urged the government to use loans judiciously.
“It should not be diverted. The Ministry of Health should monitor all funds and loans that are given in relation to health care or health needs. So, these funds should be adequately used, and any form of siphoning or diversion of money into something else should be stopped or should be checked.
“The government should now begin to look into how to strengthen the health system, especially with these loans that are coming from the World Bank. We should begin to look into how to strengthen the health system and find a way to respond to health emergencies, and collaborate with relevant stakeholders so that we can strengthen the health care system in Nigeria,” he added.
The Medical and Dental Consultants’ Association of Nigeria said that while there have been some improvements in infrastructure and medical facilities, the development of human resources in the sector remains dismal despite the billions of dollars in health-related loans received from the World Bank.
The President of MDCAN, Prof Muhammad Muhammad, stated that the training and availability of medical personnel in the country are far from where they should be.
When asked if the World Bank loans had significantly boosted medical support in the country, he noted that the impact is below average when compared to the size of the loans received. To ensure better outcomes, he advised the government to involve frontline medical professionals in identifying critical areas of need before deploying the funds.
“Primary end-users should be part of the needs assessment process so that the funds can be channelled into interventions that deliver immediate results. The government must involve primary end-users to conduct a need assessment on areas of need that can be put to use immediately,” he stated.
The Public Relations Officer of the National Association of Nigerian Nurses and Midwives – Federal Health Institutions Sector, Omomo Tibiebi, said the state of health infrastructure in Nigeria faces significant challenges despite receiving substantial World Bank health-related loans.
He stated that with over $3bn in loans, the country’s health system still grapples with inadequate funding, poor health outcomes, infectious diseases, and weak infrastructure.
“Government’s expenditure on healthcare remains low, at 0.62 per cent of GDP and 4.1 per cent of general government spending, translating to approximately $14 per capita. Nigeria has some of the worst health outcomes globally, with a life expectancy of 54 years, maternal mortality exceeding 1,000 per 100,000 live births, and under-five mortality at 114 per 1,000.
“Six of Nigeria’s top ten causes of death are infectious diseases, including malaria, HIV/AIDS, tuberculosis, and diarrheal diseases, and the primary healthcare centres are often under-equipped and under-staffed, with limited access to essential services,” he said.
Tibiebi further said that while the World Bank loans aim to improve Nigeria’s healthcare system, the impact is hindered by slow disbursement of funds, limited progress, among others.
He explained that, “Only 16 per cent of previously approved loans ($775m out of $4.95 billion) had been disbursed as of July 31, 2024, raising concerns about the pace of project implementation. Nigeria’s public health response remains fragile, with significant gaps in disease surveillance, emergency response, and logistics.
“However, some projects show promise, such as the Primary Healthcare Provision Strengthening Programme (HOPE-PHC), which aims to benefit 40 million Nigerians, particularly in underserved areas.”
He urged the government to prioritise timely implementation, invest in training and capacity building for healthcare workers, particularly at the primary healthcare level, strengthen governance structures and promote transparency and accountability in the healthcare sector, and engage with local communities to raise awareness about healthcare services and promote utilisation.
The loans
In 2020 alone, the World Bank approved $500m under the Nigeria COVID-19 Preparedness and Response Project, and another $750m under the Additional Financing for COVID-19 Response through the States Fiscal Transparency, Accountability and Sustainability programme. A further $400m was approved in 2021 as additional financing for the same COVID-19 preparedness initiative.
These three projects alone attracted a combined total of $1.65bn, representing nearly half of the total health-related loan portfolio secured by Nigeria from the Bank in nine years.
Apart from pandemic-specific interventions, other prominent World Bank-funded projects during the period included the Improved Child Survival Programme for Human Capital, approved in February 2020 with a financing value of $650m; the Primary Healthcare Provision Strengthening Programme, approved in September 2024 with a $500m loan and a $70m grant; and the Accelerating Nutrition Results initiative, which received $225m in 2018 and an additional $80m in 2025 for its second phase.
The nutrition projects focused on improving service uptake for pregnant and lactating women, adolescent girls, and children under five years of age in selected states. Grants were also attached to several of the loans, totalling $111.29m across four projects.
The largest single grant amount, $70m, was recorded under the Primary Healthcare Provision Strengthening Programme. The initial COVID-19 project secured a $14.28m grant, while the nutrition programme received $7m. These grants were non-repayable and aimed at supporting technical assistance, targeted service delivery, and soft infrastructure.
Other notable projects included the Additional Financing for the Nigeria State Health Investment Project, approved in 2016 with a commitment of $125m; the BASIC Healthcare Provision Fund Project of 2018 with $20m; and the Nigeria Polio Eradication Support Project Additional Financing of $150m, also approved in 2018.
These were aimed at improving the operationalisation of the Basic Healthcare Provision Fund, routine immunisation efforts, and maternal health delivery mechanisms. The World Bank also extended regional support to Nigeria under the REDISSE Phase II project, which focused on cross-border disease surveillance systems in collaboration with neighbouring countries, including Guinea-Bissau, Liberia and Togo.
This project, approved in March 2017, had a total commitment of $147m and sought to strengthen epidemic preparedness across the West African sub-region. A new project, the Health Security Programme in Western and Central Africa – Nigeria Phase III, is currently listed as “Begin Negotiation” on the World Bank’s portal.
The $250m programme, slated for approval in September 2025, is designed to enhance regional collaboration and strengthen Nigeria’s capacity to prevent, detect and respond to future health emergencies. Most of the loans were classified under the International Development Association, which offers concessional loans to low-income countries with low interest rates and long repayment periods.
Despite their concessional nature, the loans contribute to Nigeria’s rising debt stock, a concern that analysts have raised in light of the country’s growing domestic and external obligations. Available records show that while many of the projects are still active, at least three of them—the BASIC Healthcare Project, the Polio Eradication Financing, and the first round of Additional Financing for the State Health Investment Project—have since closed.
Meanwhile, others, including the COVID-19 response programmes and nutrition interventions, are expected to close between 2024 and 2026. The Health Security Programme in Central and West Africa is scheduled to close in 2030. Federal-level institutions have largely handled project implementation, though execution has involved subnational components and collaboration with state governments.
Agencies like the NCDC, NPHCDA, and state health ministries have been tasked with service delivery, monitoring, and oversight functions. In some cases, like the REDISSE project, implementation was undertaken in conjunction with regional bodies such as the West African Health Organisation, reflecting the transnational nature of epidemic threats.
While the approved sums are substantial, actual disbursements and on-ground impact have varied. However, experts have repeatedly raised concerns over the effectiveness of fund utilisation, pointing to challenges such as delays in procurement, weak coordination at the state level, and limited transparency in some cases.
Meanwhile, data from the Debt Management Office showed that Nigeria’s total debt to the World Bank rose to $18.23bn as of March 31, 2025. This marks a $420m increase in just three months since December 2024, when Nigeria’s total exposure to the World Bank stood at $17.81bn.
The DMO data showed that borrowings from the International Development Association, the concessional financing arm of the World Bank, rose from $16.56bn in December 2024 to $16.99bn in March 2025. At the same time, loans from the International Bank for Reconstruction and Development — the non-concessional lending window of the World Bank — remained unchanged at $1.24bn.
In total, the World Bank Group now accounts for $18.23bn, or about 39.7 per cent of Nigeria’s total external debt stock, which stood at $45.98bn as of March 2025. This reflects a marginal increase in the World Bank’s share of the debt portfolio, up from 38.9 per cent recorded in December 2024 and 36.4 per cent at the end of 2023.
Further analysis indicates that the World Bank now constitutes 81.2 per cent of Nigeria’s total multilateral debt, which reached $22.43bn in Q1 2025. This represents a rise from the 79.8 per cent share recorded at the end of 2024 and underlines the central role the institution continues to play in Nigeria’s financing framework.
As the Federal Government continues to seek external support to revitalise the health sector, attention is increasingly shifting to sustainability, transparency, and value for money, especially as challenges in the health sector persist in the country.
The PUNCH earlier reported that Nigerians spent at least $29.29bn on foreign medical expenses during the eight years of former President Muhammadu Buhari’s administration. This was according to a detailed analysis of data from the Central Bank of Nigeria’s quarterly statistical bulletins.
The sum, recorded under the “Health-Related and Social Services” category, reflects cumulative outflows of foreign exchange from June 2015 to May 2023 — precisely covering the duration of Buhari’s two-term presidency, which spanned from May 29, 2015, to May 28, 2023.
The data, reviewed by our correspondent, shows the depth of Nigeria’s dependence on foreign healthcare services, with the CBN’s record showing a year-on-year movement of funds abroad for medical purposes amid economic downturns or dollar shortages at home.
It also highlights the irony that, despite repeated declarations by the administration to revamp the health sector and reduce capital flight, health-related foreign exchange outflows remained significant and even spiked dramatically during the latter years of Buhari’s presidency.
States react
The Secretary of the Lagos State Council of NANNM, Toba Odumosu, argued that despite the substantial funds committed to healthcare infrastructure in Nigeria, the results are not visible.
He said if the funds were focused on one major healthcare facility in each of the six geopolitical zones, Nigeria could achieve international standards in healthcare delivery. He, however, advised that the government should concentrate borrowed funds on a few flagship federal healthcare projects to create functional, world-class centres.
“If we are borrowing, it would be borrowing to ensure that we have centres of healthcare that can meet international standards, that we won’t have a situation where our presidents have to die in hospitals outside the country, and we can have public hospitals that are accessible to ordinary Nigerians that would be a centre of excellence in terms of healthcare,” he noted.
The Nasarawa State Ministry of Health commended the World Bank for its numerous interventions, which had helped in resolving most of the health issues affecting residents of the state.
The Ministry, however, said sustaining the interventions had been a challenge because the health community and end-users are most time not carried along during the planning process of the interventions.
The Director of Public Health in the state, Dr Peter Attah, disclosed this while speaking with our correspondent in Lafia, the state capital, on the World Bank’s health-related loans to Nigeria within the last nine years.
A senior medical practitioner in Gombe State expressed concern over the modest health infrastructure development in the state, despite Nigeria securing over $3.5bn in health-related loans from the World Bank in the past nine years.
Dr Benjamin Adamu, a Consultant Physician in Gombe, said that while there have been pockets of improvement, the overall state of health infrastructure in the state remains underwhelming.
“When you consider the scale of financing—over $3.5bn from the World Bank for Nigeria’s health sector over nine years—one would expect a more robust and modernised health infrastructure across the country,” Dr Adamu told our correspondent.
“In Gombe State, while we have seen some positive developments, such as renovations in selected primary health care centres and the availability of some medical equipment, the overall infrastructure remains inadequate. Many secondary health facilities still lack basic diagnostic tools, our referral systems are weak, and rural health centres are often poorly staffed and under-equipped,” he said.(Punch)
