Massive Funding, Modest Impact
Between 2016 and 2025, Nigeria secured at least $3.53bn (₦5.4tn at the official exchange rate) in health-related loans from the World Bank, alongside $111.29m in grants. These funds supported 11 major projects targeting immunisation, maternal and child health, nutrition, pandemic preparedness, and primary healthcare strengthening.
While additional approval for a $250m Health Security Programme is expected in September 2025, bringing the total to nearly $3.9bn, the question remains: has this money translated into visible change?
Many doctors, nurses, and health officials insist the answer is “not enough.” Their verdict: Nigeria’s health infrastructure still bears the scars of underfunding, poor maintenance, and weak governance.
Frontline Voices of Frustration
Dr. Tope Osundara, President of the Nigerian Association of Resident Doctors, said the reality on the ground does not reflect the billions borrowed.
“In some federal medical centres, power outages cripple operations, drugs are scarce, and basic facilities are inadequate,” he noted, recalling an incident at the University College Hospital, Ibadan, where a blackout halted medical services.
He also criticised the lack of welfare support for healthcare workers, from low remuneration to poor access to loans for housing or transportation. “If these funds were used as intended, we should see significant improvement. Instead, it feels like there is diversion,” Osundara said, urging tighter monitoring by the Ministry of Health.
Human Resource Gap Overshadows Infrastructure Gains
Prof. Muhammad Muhammad, President of the Medical and Dental Consultants’ Association of Nigeria, acknowledged some infrastructure upgrades but stressed that human resources remain neglected.
“Training, recruitment, and retention of medical personnel have not kept pace with the scale of borrowing,” he said. He recommended involving frontline professionals in needs assessments to ensure funds target urgent, high-impact interventions.
Grim Health Statistics Persist
For nurses, the picture is equally concerning. Omomo Tibiebi of the National Association of Nigerian Nurses and Midwives highlighted Nigeria’s low health spending—just 0.62% of GDP and $14 per capita—despite the billions received in loans.
The result: life expectancy remains 54 years, maternal mortality exceeds 1,000 per 100,000 live births, and under-five mortality stands at 114 per 1,000. Six of the country’s top ten causes of death are infectious diseases such as malaria, tuberculosis, and HIV/AIDS.
Tibiebi also flagged a startling statistic: as of July 31, 2024, only 16% of approved World Bank loans had actually been disbursed, hampering progress.
Where the Money Went
Nearly half of Nigeria’s nine-year health-related borrowing came during the COVID-19 crisis. Three key projects—the Nigeria COVID-19 Preparedness and Response Project, additional financing for state-level COVID response, and further pandemic preparedness funding—totalled $1.65bn.
Other high-value programmes included:
- Improved Child Survival Programme for Human Capital – $650m (2020)
- Primary Healthcare Provision Strengthening Programme – $500m loan + $70m grant (2024)
- Accelerating Nutrition Results Initiative – $225m (2018) + $80m (2025)
Grants, though non-repayable, were relatively modest, with the largest at $70m for primary healthcare strengthening.
Rising Debt, Growing Concerns
Nigeria’s debt to the World Bank reached $18.23bn in March 2025, representing nearly 40% of the nation’s total external debt. Most of this is from concessional International Development Association loans, which, while low-interest, still add to the country’s repayment burden.
Calls for Smarter Investment
Across states, reactions vary.
- Lagos: NANNM’s Toba Odumosu suggested concentrating loans on a few flagship hospitals per geopolitical zone to achieve world-class standards.
- Nasarawa: Officials praised the World Bank’s interventions but warned that sustainability suffers when end-users are excluded from planning.
- Gombe: Consultant Physician Dr. Benjamin Adamu described progress as “pockets of improvement,” lamenting poorly equipped secondary and rural facilities.
Medical Tourism: A Costly Irony
Despite the huge inflow of health loans, Nigerians spent an estimated $29.29bn abroad for medical treatment during President Muhammadu Buhari’s eight-year tenure. The outflow of foreign exchange underscores the failure to make local facilities competitive, even as billions were borrowed to improve them.
The Road Ahead
With another $250m loan under negotiation, experts are calling for reforms in how health funds are planned, disbursed, and monitored. Proposals include:
- Prioritising needs-based projects identified by frontline workers
- Ensuring timely disbursement and project completion
- Strengthening primary healthcare centres as the foundation of the system
- Enforcing transparency and accountability to prevent diversion of funds
Nigeria’s healthcare financing from the World Bank is significant by any standard. Whether it will translate into the kind of system that keeps citizens from seeking care abroad remains an open question—one that both patients and practitioners are eager to see answered.