Nigeria’s $3.53bn World Bank Health Loans Show Little Impact, Stakeholders Say

Over the past nine years, Nigeria has secured a staggering $3.53bn (N5.4tn at the official exchange rate of N1,535/$) in health-related loans from the World Bank, alongside $111.29m in grants, according to publicly available project data. However, health professionals and stakeholders say the impact of this massive funding on the nation’s healthcare system remains disappointing.

Between 2016 and 2025, at least 11 major health sector projects received World Bank financing. These projects were aimed at boosting immunization, improving maternal and child health, strengthening nutrition, enhancing pandemic preparedness, and expanding primary healthcare. Institutions such as the Federal Ministry of Health, Nigeria Centre for Disease Control, National Primary Health Care Development Agency, and Federal Ministry of Finance managed the funds.

Despite these investments—and a pending $250m loan expected in September—medical practitioners argue that Nigeria’s health infrastructure, service delivery, and human resource capacity remain alarmingly inadequate.

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Healthcare System Still in Critical Condition

The Nigerian Association of Resident Doctors (NARD) President, Dr. Tope Osundara, expressed concern that the poor state of facilities, unreliable electricity, and inadequate medical supplies suggest possible mismanagement of the loans. He cited incidents such as recent power outages at University College Hospital, Ibadan, noting that despite an increase in the number of federal medical centres, patient care quality has not significantly improved.

He criticised the lack of incentives and support for healthcare workers, pointing out the absence of accessible loans or amenities to improve their welfare. “If the money was properly utilised, hospitals would have drugs, electricity, and functioning equipment,” Osundara said. He called for strict monitoring of health-related loans and measures to prevent diversion of funds.

Similarly, the Medical and Dental Consultants’ Association of Nigeria (MDCAN) President, Prof. Muhammad Muhammad, noted that while some infrastructure has improved, human resource development lags far behind. He emphasised that frontline medical workers must be part of the needs assessment process to ensure funds address the most urgent issues.

Billions Spent, but Poor Outcomes Persist

The National Association of Nigerian Nurses and Midwives’ Federal Health Institutions Sector PRO, Omomo Tibiebi, highlighted that Nigeria’s healthcare expenditure is just 0.62% of GDP—around $14 per capita. This low investment has contributed to some of the worst health statistics in the world, including a life expectancy of only 54 years, maternal mortality above 1,000 deaths per 100,000 live births, and under-five mortality of 114 per 1,000.

Tibiebi said six of Nigeria’s top 10 causes of death are infectious diseases, including malaria, HIV/AIDS, tuberculosis, and diarrheal illnesses. Many primary healthcare centres remain under-equipped and understaffed, limiting access to essential services.

Even more troubling, as of July 31, 2024, only 16% of previously approved loans ($775m out of $4.95bn) had been disbursed, slowing project progress. While some initiatives—like the Primary Healthcare Provision Strengthening Programme (HOPE-PHC)—hold promise for improving access for 40 million Nigerians, overall implementation remains sluggish.

Tibiebi urged the government to speed up project execution, invest in workforce training, strengthen governance, ensure transparency, and engage communities in healthcare planning.

COVID-19 Projects Took Nearly Half of Funds

A significant portion of Nigeria’s health-related borrowing came during the COVID-19 pandemic. In 2020 alone, the World Bank approved $500m under the Nigeria COVID-19 Preparedness and Response Project and $750m under the Additional Financing for COVID-19 Response via the States Fiscal Transparency, Accountability, and Sustainability programme. In 2021, another $400m was approved as additional COVID-19 financing.

These three projects accounted for $1.65bn—almost half of Nigeria’s total World Bank health loan portfolio in the past nine years. Yet, according to medical workers, even these emergency funds have not translated into stronger health system capacity or better preparedness for future crises.

Transparency and Results

The consensus among stakeholders is clear: the problem is not necessarily the lack of funding but the ineffective utilisation of resources. They argue that without proper monitoring, needs-based planning, and strict accountability, even the largest loans will fail to produce meaningful change.

As Nigeria prepares to receive another $250m in September, experts are urging the government to prioritise visible, measurable improvements in healthcare delivery. They want projects that address immediate gaps—such as equipment shortages, power supply, staffing, and drug availability—while also building long-term resilience in the health sector.

For a country battling some of the world’s toughest health challenges, the stakes could not be higher. Whether the billions from the World Bank will finally deliver lasting improvements depends on whether the government can shift from loan acquisition to genuine healthcare transformation.