Despite receiving health-related loans totaling $3.53 billion (approximately N5.4 trillion at the official rate of N1,535/$) from the World Bank over the last nine years, Nigeria's health sector continues to face deep-rooted challenges.

According to healthcare professionals, including the Medical and Dental Consultants’ Association of Nigeria, the Nigerian Association of Resident Doctors (NARD), and the National Association of Nigerian Nurses and Midwives (NANNM), the impact of these significant funds remains largely invisible on the ground. They argue that the nation’s health infrastructure remains substandard and does not reflect the scale of international financial assistance received.

Public data from the World Bank shows that between 2016 and 2025, at least 11 major health initiatives in Nigeria received funding amounting to $3.53 billion in loans, with an additional $111.29 million in grants—bringing the total to $3.64 billion. Furthermore, an additional $250 million loan is projected for approval in September 2025, raising the cumulative total to nearly $3.89 billion.

These funds have been channeled through various federal agencies such as the Ministry of Health, the Nigeria Centre for Disease Control (NCDC), the National Primary Health Care Development Agency (NPHCDA), and the Ministry of Finance. The projects targeted improvements in immunization, maternal and child health, nutrition, pandemic preparedness, and primary healthcare delivery, particularly following the COVID-19 outbreak.

Concerns from Health Professionals
Despite the significant financial support, healthcare professionals say outcomes have fallen short.

Dr. Tope Osundara, President of NARD, emphasized the stark reality faced in many hospitals. “We still have poor infrastructure, inadequate power supply, and under-resourced facilities. For example, in a recent incident at the University College Hospital (UCH), operations were hindered by power outages,” he said.

He also noted that healthcare workers continue to face poor remuneration and lack access to basic support systems such as mortgage or car loans. “If the World Bank funding is truly being applied as intended, we should see drastic improvements in infrastructure and workforce welfare. Sadly, that’s not the case,” Osundara added.

He called on the government to ensure transparency, proper oversight, and effective utilization of healthcare loans, urging the Ministry of Health to play a stronger role in monitoring fund allocation and usage.

Prof. Muhammad Muhammad, President of the Medical and Dental Consultants’ Association of Nigeria, acknowledged modest improvements in infrastructure but pointed out that human resource development is lagging. He advocated for involving frontline workers in identifying critical areas of need before funds are disbursed.

“Health professionals should participate in the needs assessment process. This ensures that funding is directed toward projects that will deliver immediate, tangible results,” he suggested.

Omomo Tibiebi, Public Relations Officer for NANNM’s Federal Health Institutions Sector, also expressed dissatisfaction with the sector’s progress despite receiving over $3 billion in external support. He highlighted persistent issues like inadequate funding, poor health outcomes, and outdated infrastructure.

“Healthcare expenditure remains low—about 0.62% of GDP and 4.1% of total government spending, or just $14 per capita,” he said. Tibiebi emphasized that Nigeria still records some of the worst global health statistics, including a life expectancy of 54 years and maternal mortality rates exceeding 1,000 per 100,000 live births.

He pointed out that while initiatives like the HOPE-PHC programme aim to improve access for 40 million Nigerians, only 16% of previously approved loans had been disbursed as of July 31, 2024. He called for improved implementation speed, investment in healthcare worker training, and greater transparency in fund management.

Breakdown of World Bank Loans
The World Bank’s health-sector investments in Nigeria have included major initiatives like:

COVID-19 Response Projects: In 2020, $500 million was approved for COVID-19 preparedness, followed by $750 million in additional funding through the States Fiscal Transparency programme. An extra $400 million was approved in 2021, bringing total COVID-related loans to $1.65 billion.

Child and Maternal Health Projects: These included a $650 million child survival initiative (2020), a $500 million loan with a $70 million grant for primary healthcare provision (2024), and $305 million (combined in 2018 and 2025) for nutrition programmes targeting women and children.

Grants: These totaled $111.29 million across four projects, with the largest being the $70 million grant for primary healthcare. Others supported nutrition and COVID-19 projects.

Other Projects: Notable ones include the $125 million State Health Investment Project (2016), $150 million for polio eradication (2018), and the $20 million Basic Healthcare Provision Fund Project (2018).

Regional Initiatives: The REDISSE Phase II project, approved in 2017, committed $147 million toward epidemic surveillance and response in collaboration with West African countries.

An upcoming Health Security Programme in West and Central Africa – Nigeria Phase III, valued at $250 million, is currently in negotiation and expected to strengthen disease preparedness and response capacities.

While the loans are mostly concessional under the International Development Association (IDA), they still contribute to Nigeria’s growing debt profile.

Rising Debt Levels
Data from the Debt Management Office reveals that Nigeria’s total debt to the World Bank stood at $18.23 billion as of March 2025—up from $17.81 billion in December 2024. Of this, $16.99 billion came from IDA, while $1.24 billion came from the International Bank for Reconstruction and Development (IBRD). The World Bank now represents nearly 40% of Nigeria’s external debt.

Within the multilateral category, the Bank accounts for over 81% of Nigeria’s multilateral debt, underscoring its influence on the country’s fiscal landscape.

Continued Medical Tourism
While borrowing for healthcare remains high, Nigeria’s reliance on foreign medical services continues. From June 2015 to May 2023, Nigerians spent an estimated $29.29 billion abroad on medical expenses. This capital flight occurred even as the government repeatedly promised to strengthen the local healthcare system.

Voices from the States
Toba Odumosu, Secretary of the Lagos State Council of NANNM, believes the funds should be consolidated into flagship facilities across Nigeria’s six geopolitical zones. “If we focus resources on building one major hospital per zone to international standards, we can reduce medical tourism and provide accessible world-class care,” he said.

In Nasarawa, state health officials acknowledged the World Bank’s support but raised concerns about sustainability. Dr. Peter Attah, Director of Public Health, noted that many interventions face difficulties because end-users are often excluded during planning stages.

In Gombe State, Dr. Benjamin Adamu, a Consultant Physician, expressed disappointment at the slow progress in infrastructure development despite billions in loans. He noted that while some facilities have seen improvements, many rural health centres still lack staffing, equipment, and basic diagnostic tools.